Low Back Rheumatism – Ankylosing Spondylitis

Ankylosing spondylitis is a rheumatic disease that mainly involves the spine and can also be called lumbar rheumatism among the people. Although it mostly affects the waist, back and neck, it can also give symptoms in joints such as hips, knees and shoulders. Due to the involvement of the spine, it causes severe, long-term (chronic) low back and back pain and stiffness. It is often confused with herniated disc and strain on the back muscles. Because low back pain is a very common problem, it may not be easy to diagnose ankylosing spondylitis. However, if attention is paid to the unique characteristics of the disease, delay in diagnosis can be avoided.

Lumbar rheumatism / ankylosing spondylitis is a disease that can remain active for a long time, sometimes for a lifetime, once it occurs in a person. If it is not detected and treated early, the inflammatory process in the spine can cause the bones to stick together and the back to solidify like wood; It can lead to severe limitation of movements such as bending over and turning the neck. The shoulders, hips, ribs, heels, small joints of the hands and feet can also be affected by this disease. Sometimes it also affects the eyes, causing an eye inflammation called uveitis. More rarely, it can affect internal organs such as the lungs and heart.

Ankylosing spondylitis can show symptoms in many different parts of the body. However, the most used feature in diagnosis is that it involves the joint between the lumbar (sacrum) bone and the pelvis (iliac) bone, in the lowest part of the spine, below the waist. This place is called the sacroiliac joint, and edema and inflammation called sacroiliitis occur in ankylosing spondylitis. Sacroiliitis can be seen on MRI (sacroiliac joint MRI) film in the early period, and on X-ray film (pelvis AP) in the late period.

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Back Rheumatism Symptoms

The symptoms of ankylosing spondylitis / lumbar rheumatism can vary greatly from person to person. Generally, the first symptoms appear between the ages of 17-45. However, it can also start at younger ages or in the elderly. It is more common in men than women.

The most common early symptoms are pain and stiffness in the lower back and buttocks. These complaints may appear gradually with an insidious onset and persist for several weeks or months. The pain may first be on one side (right or left) or displaced between the waist and buttocks. The person may not be able to describe the exact location of the pain. It is usually felt as a blunt, widely disseminated pain. The second half of the night and the morning are the worst times for complaints. Light exercise and a hot bath can reduce symptoms. Depending on the inflammatory process, there may be mild fever, loss of appetite, and general discomfort. Low back pain seen in low back rheumatism, which increases at rest and decreases with movement, and causes stiffness for more than half an hour in the morning, is defined as “inflammatory low back pain”.

Low back pain in ankylosing spondylitis is typically persistent; It lasts for more than 3 months. Over the months and years, the pain and stiffness spread to other parts of the spine, such as the neck. Pain and discomfort may also occur in the ribs, shoulder blades, hips, thighs, and heels. Depending on the inflammatory process, fatigue and anemia may also occur.

The onset periods of ankylosing spondylitis may not always be as we describe here. Especially in women, it may first show symptoms in the neck.

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More rarely, lumbar rheumatism may show symptoms not in the waist or neck, but in joints such as hip, ankle, elbow, knee, heel, shoulder. Joint involvement may precede spinal involvement, especially in children with the disease that starts at the age of 10. Inflammation may occur where tendons or ligaments attach to bones; this is called enthesitis.

Some patients with ankylosing spondylitis may also have ulcerative colitis or Crohn’s disease (inflammatory bowel disease).

One-third of patients with ankylosing spondylitis may experience at least one eye inflammation called uveitis. In this case, symptoms such as eye pain, watering, redness, blurred vision and sensitivity to bright light occur.

Low Back Rheumatism Diagnosis

For long-lasting low back pain, you can be examined by a physical therapy and rehabilitation doctor. The doctor will first listen to your complaints and ask questions. It asks how long the pain has been, how it started, where it is felt, the factors that increase and decrease it. If he suspects ankylosing spondylitis, he will also inquire about rheumatic disease in your family, joint swelling (arthritis), eye inflammation (uveitis), psoriasis (psoriasis), intestinal disease (ulcerative colitis or Crohn’s), a history of infection (reactive arthritis). Then comes the physical examination. Pain-sensitive areas in the waist, range of motion, leg strength, sensory and reflex examination, and special maneuvers that provoke pain are evaluated by examination. Measurements evaluating the flexibility of the waist and rib cage are valuable in diagnosis.

Inflammatory parameters are checked in blood tests. It is known that the genetic feature called HLA-B27 predisposes to ankylosing spondylitis. Therefore, genetic analysis can be done. With a hip x-ray, it can be seen whether the sacroiliac joints are involved or not. In the early period, there may be no findings in X-ray films, so MRI (sacroiliac joint MRI) may need to be taken.

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Treatment

The first treatment options are exercise and pain relievers in the non-steroidal anti-inflammatory drug group. Although these drugs are generally used as pain relievers, they may have a reducing effect on rheumatic complaints in ankylosing spondylitis. Inflammation in the waist can lead to ossification and loss of flexibility of the spine in the long term. Doing regular posture and stretching exercises can alleviate this process. Exercise is also good for pain. If these methods are not effective and the inflammatory process is severe, newer and more effective treatments called biologic drugs (anti-TNF drugs and other treatments) can be used. These treatments are organized by physical therapy and rehabilitation or rheumatology specialists.

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