Ankylosing Spondylitis (AS) could be the Cause of Your Chronic Back Pain

Ankylosing Spondylitis is a relatively difficult disease to diagnose that is often mistaken for back pain caused by mechanical issues such as injury. AS is a chronic, inflammatory, autoimmune disease that attacks the spine resulting in back pain and, in some cases, pain to the shoulder blades, hips, and even feet. Rather than brought on by an injury, heavy lifting, or physical strain, back pain caused by AS is due to inflammation in the spinal joints, referred to as inflammatory back pain (IBP). In contrast, back pain caused by injury or strain is referred to as mechanical low back pain (MLBP). So why are you just recently starting to hear people talk about AS? It was previously thought to be a fairly rare disease, but has garnered more attention in recent years as doctors have discovered a much higher prevalence in the U.S. Current estimates predict that 1 out of every 200 adults in our country may have AS. If that estimate is correct, over 1 million Americans are affected by AS–close to the number of people diagnosed with rheumatoid arthritis!

Here are answers to some of the most commonly asked questions about AS:

Q: What groups are susceptible to AS? A: AS usually affects younger adults, with symptoms starting to arise between ages 20 and 30. While it was prior belief that men were much more likely to have AS than women, new research has suggested that there is no gender bias.

Q: What causes AS? A: It can be genetic, but most people won’t know if that applies in their case since the majority of Americans struggling with back pain resulting from AS don’t realize it’s being caused by a medical issue, and therefore are never diagnosed or aware of the disease.

Q: What are the signs and symptoms of AS, and how do they differ from those for MLBP? While the pain may be similar or identical, studies have demonstrated some common disparities between patients with IBP from those with MLBP. Prolonged morning stiffness lasting over 30 minutes is a distinguishing sign of inflammatory back pain (although not determining). In conjunction with the disparity in morning pain experienced, IBP patients are much more likely to wake up very early in the morning due to pain in comparison to MLBP patients, while both groups studied were equally likely to wake up at other times throughout the night resulting from their pain. IBP also has a slower onset, whereas most MLBP has a very acute onset. Another strong indicator is improvement from rest and exercise. AS patients are more likely to report pain relief from exercise but not rest (which was actually linked with worsening the pain), while MLBP patients report the complete opposite (most experienced improvement from rest but no noticeable trend was found between exercise and pain relief).

Q: Is there a way to medically test for AS? There isn’t a medical test per se, but a rheumatologist will be able to determine AS to a fairly accurate degree by evaluating x-rays, medical history, and blood work to test for HLA-B27. The majority of IBP patients in studies conducted tested positive for HLA-B27 (89.1% of sample), a protein found on the surface of white blood cells that helps the body’s immune system tell the difference between its own cells and foreign, harmful substances. In contrast, very few patients with MLBP are carriers of the HLA-B27 protein.

Q: What is the treatment for AS? Common treatment includes medication, exercise, and in some cases physical therapy. NSAIDs (nonsteroidal anti-inflammatory drugs) are the most common medications used to treat the pain and stiffness for AR. More recently, biologics (aka TNF Blockers) have demonstrated promising results for effectively treating the pain in the joints and spine. Aside from medication and exercise, practicing good posture and applying heat/cold therapy can help to reduce the pain and soreness. If you are under 45 and have begun experiencing chronic back pain that worsens with rest, you may have Ankylosing Spondylitis. Schedule an appointment with a rheumatologist to be evaluated for the other signs and symptoms to determine if your back pain is inflammatory rather than mechanical. Sources: http://onlinelibrary.wiley.com/doi/10.1002/art.21619/full#tbl1 http://www.spondylitis.org/about/as_diag.aspx http://www.nlm.nih.gov/medlineplus/ency/article/003551.htm