On any given day, the waiting room of Texas Back Institute is filled with people who are experiencing back pain. In most cases, these patients are over 50 and have age-related causes for their pain, ranging from arthritis, wear and tear from work or other conditions that affect their spine. By and large, back pain is an older person’s problem. However, a form of chronic back pain that affects younger patients has received more discussion and research among spine specialists. This disease is ankylosing spondylitis.
According to a report in Medical News, “Ankylosing spondylitis (AS) is a painful and progressive form of spinal arthritis and symptoms of inflammatory back pain often first present in people before age 35. It typically begins in the late teens and early twenties and in severe cases may result in fusing spinal vertebrae and may cause structural damage to hips and other joints. Often misdiagnosed as “just back pain” or undifferentiated arthritis, AS is a systemic inflammatory disease that, in addition to its effect on the spine, can affect internal organs, peripheral joints, and vision.”
The Spondylitis Association of America estimates that between 350,000 and one million people in the U.S. suffer from ankylosing spondylitis. However, millions more may have the disease and are unaware of this.
Understanding the causes and treatments for this often-crippling disease requires the training, experience and clinical expertise of a spine expert. Dr. Kevin Ju, who is a spine surgeon at Texas Back Institute, has treated many patients with this disease.
What is Ankylosing Spondylitis and how is it Treated?
“This is a disease that causes pain and stiffness,” Dr. Ju said. “Typically, it is found in the back and neck, but sometimes it can cause difficulties in the hips. It is a form of arthritis that results in inflammation around the bones in the spine and, if this continues, it can cause the bones to fuse together resulting in a stiff spine.
“The treatment for AS depends on how severe the symptoms are. As a starting point, physical therapy is usually prescribed because it is important to improve and maintain one’s posture and increase the strength and conditioning of the body’s core and the muscles around the spine.
“In addition to PT, anti-inflammatory drugs such as Aleve and ibuprofen are often prescribed. Because this is an inflammatory disease, reducing this inflammation can slow down the progress of the disease. There are also more specialized drugs, such as those used for treating rheumatoid arthritis.
“In extreme cases, where AS has been going on for some time, spinal deformity can occur,” he said. “In these cases, the patient can get a kyphosis or ‘humpback,’ making it difficult for them to stand up straight. In these severe cases, surgery is required for its treatment.”
What Causes AS?
“The exact cause of AS is unknown,” Dr. Ju said. “However, we do know that genetics play a key role. People who have a gene called HLA B27 are at a higher risk of developing AS, but most people who have this gene, never develop the condition. It’s believed that having the gene makes a person more susceptible to getting the disease, but some form of triggering environmental factor must be present. This could be in the form of a bacterial infection.
“Just to confuse this issue even more, one can get AS even if he or she doesn’t have the HLA B27 gene. Plus, even though the disease is inherited, even if one parent has the condition, there is only a ten percent chance that their offspring will have the disease. Ankylosing spondylitis is also known to affect certain population groups, such as Caucasians, in higher numbers.”
The Prevalence is High
Many people in the United States are unaware that they have this disease.
“About a quarter to one-half of one percent of the population in the U.S. has AS,” Dr. Ju noted. “However, the prevalence is high enough that all of the physicians at TBI see it in our practices. Fortunately, it is very rare for an individual to have the severe form of the condition where there is a deformity.
“That being noted, even with a quarter or one-half of one percent of the population having the disease that represents millions of patients who may not know they have it. Where spine surgeons see this disease is when a patient who has the disease presents with a spine fracture due to the stiffness and instability caused by AS.”
In the past, young males were more likely to contract AS than females. However, that may be changing.
“It was traditionally thought that males were more likely than females to have AS,” Dr. Ju said. “However, there is research to suggest that this might not be the case.
“The disease is also more likely to affect adolescents and young adults. While most back pain occurs in older patients, typically the incidence of AS happens during the age range of 17 – 45 years.”
Other Organs can be Affected
While the spine and the joints are more likely to be impacted by AS it is also possible for this disease to damage other organs.
“Because this is an inflammatory disease, it is possible for it to cause problems among other parts of the body,” Dr. Ju said. “There have been cases of AS causing infections in the eyes, bowels, heart, kidneys, and lungs. It is a systemic problem in the body and even though it may be seen first in the sacroiliac and spine, it can infect other parts of the body.”
What to Look for
The symptoms of AS can be confusing and, because of this, the diagnosis is somewhat more difficult.
“In our practice, patients with AS typically first present with back pain,” Dr. Ju said. “Since approximately 80 percent of the population has back pain, this covers a wide range of factors.
“In checking for AS, we look for atypical factors. For example, patients with ankylosing spondylitis are younger and exhibit different signs from other back pain conditions. Interestingly, patients with AS tend to feel worse after they have rested their back. So, first thing in the morning, after they have been sleeping all night, they feel greater pain than after they have been awake and moving around. This is atypical from other back pain conditions.
“When is it important to see a spine specialist? Under any circumstances, if back pain is not getting better after a few weeks of rest, it is a good idea to see a specialist to determine the cause.”