As a result of rheumatic inflammation, long-lasting pain and stiffness occur in the waist, back, neck and back of the hips.
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatism that usually occurs at a young age, typically affecting the spine and the sacroiliac joints located between the last part of the spine and pelvis. Sharing his views on the 1st of May World AS Day, which is declared for awareness on the first Saturday of May every year, Prof. Dr. Fatoş Önen conveyed important information.
As a result of rheumatic inflammation, long-lasting pain and stiffness occur in the waist, back, neck and back of the hips. In the later stages, sometimes hunchback and permanent limitation of movement in the spine The disease is 2-3 times more common in men.
AS is in the group of chronic inflammatory rheumatic diseases called spondyloarthritis (SpA). This group also includes non-radiographic axial SpA, reactive arthritis, psoriatic arthritis (psoriatic rheumatism), and arthritis accompanying inflammatory bowel disease. In our country, SpA occurs in one out of every 50-100 people and AS disease occurs in one out of every 200 people in our country.
Pay attention to these symptoms in Ankylosing Spondylitis (AS).
AS disease causes chronic inflammation in the spine and sacroiliac joints, and consequently pain and stiffness. Stating that the first application complaint is mostly inflammatory back pain, 9 Eylül University Faculty of Medicine Rheumatology Department Head, Turkey Rheumatology Association Chairman and Scientific Committee Member Prof. Dr. Fatoş Önen listed the most important features of this type of low back pain as follows:
- Start before the age of forty,
- Insidious start,
- It takes three months or longer,
- Appearing with rest, especially in the second half of the night or in the morning, and decreasing with movement,
- Morning stiffness and stiffness that lasts longer than half an hour and respond very well to non-Cortisone anti-inflammatory drugs.
Prof. Dr. Fatoş Önen: “In AS, patients especially complain of pain in the lower parts of the waist and the back of the hips. Pain can also occur later in the back and neck areas and in the rib cage. In some patients with advanced AS, kyphosis (forward bending in the upper part of the spine) and limitation of movement in the spine may occur due to newly emerging bone formations and fusion between the vertebrae.
In AS, which is a chronic disease, asymmetrically located pain, swelling and sometimes rash (arthritis) may develop in large joints such as ankles and knees. There may also be pain and swelling in the small joints of the hips, hands and feet. Pain and swelling may occur in areas where the muscle tendons and ligaments attach to the bone. Heel pain, which occurs especially in the first wake in the morning, is an important complaint that can develop as a result of swelling.
Except for symptoms in the musculoskeletal system in AS;
- Recurrent anterior uveitis attacks (redness and pain in the eye),
- Various skin findings (psoriasis, red-painful skin hardness),
"Long-lasting bloody diarrhea and abdominal pain may develop due to inflammatory bowel disease (Crohn's disease or ulcerative colitis)," he said.
AS disease is usually diagnosed by rheumatologists.
The diagnosis of AS is usually made by rheumatologists. Rheumatologists are physicians who specialize in diseases of the musculoskeletal system, especially inflammatory rheumatism. Stating that the most important clues in diagnosing AS, as in most diseases, are obtained from the history of the disease, Prof. Dr. Fatoş Önen continued his words as follows: “In the early diagnosis of patients with AS, it is very important to recognize the inflammatory back pain that appears as the first complaint in most patients. The occurrence of pain at night or in the mornings, decreasing with movement and having long-term morning stiffness allows it to be distinguished from other mechanical types of back pain. Pain and morning stiffness in the back, neck, back of the hips and chest, pain and swelling in the knees, ankles or other joints, heel pain and swelling are other diagnostic features. Eye and skin findings, prolonged diarrhea, family history of SpA-related disease increase the probability of AS diagnosis. Limitation of spine movements, swelling in the joints and heels, and sensitivity by pressing on it during the examination are other important clues for diagnosis. Although there is no diagnostic laboratory test, detection of high CRP and sedimentation in the blood and HLA-B27 tissue type supports the diagnosis. In patients with inflammatory type back pain, a direct pelvic radiograph (film) should be taken first for the diagnosis of AS. Detection of changes in the sacroiliac joint and surrounding bone tissue, which we call sacroiliitis, in this graph makes the diagnosis of AS clear. If the pelvis radiography is normal, it can be diagnosed with advanced imaging methods.
As a result; The rheumatologist reaches the diagnosis of AS by evaluating and synthesizing the information obtained from the history of the disease and physical examination together with the laboratory results and radiological examinations.
Ankylosing Spondylitis is mistaken for a herniated disc
Prof. Dr. Fatoş Önen: “Low back pain is one of the most common reasons for consulting a doctor; It is mostly caused by mechanical reasons that can improve within 2-3 days. However, unnecessary lumbar MRIs cause patients to be mistakenly diagnosed as "lumbar hernia". Because even in a significant part of lumbar MRIs taken in people without herniated disc, appearances compatible with herniated disc can be detected ”.
If there is no alarm symptom such as fever, weight loss, history of trauma, serious neurological problems, there is no need to do any examinations in acute back pain; Stating that a few days of pain relief or muscle relaxant treatment will improve, Prof. Dr. Fatoş Önen warned that patients with back pain that lasts more than three months and becomes evident especially at night or in the morning and accompanied by morning stiffness should definitely consult a rheumatologist.
Ankylosing spondylitis is a lifelong illness
The cause of AS is not fully known. However, it is believed that genetics play an important role in the emergence of the disease. Dr. Fatoş Önen: "In people who are genetically susceptible to AS, the disease can occur as a result of the triggering effect of an environmental factor (for example, a gastrointestinal infection) as a result of excessive work of the immune system and the body reacting against its own structures.
Prof. Dr. Fatoş Önen: “AS is not a temporary disease like infections; It lasts for a lifetime, but the chance of a painless and quality life emerges as a result of early diagnosis of AS, appropriate medication and starting exercise, and smoking cessation if used. The results of some studies suggest that if treatment is initiated early and continued as recommended, deformities in the spine that may develop in some patients can be prevented or alleviated.
Warning that some patients with AS may bend forward in the spine (kyphosis) or pain and permanent limitation of movement, especially in the hip joint, Prof. Dr. Fatoş Önen continued his words as follows: “Chronic pain, limitation of movement and spinal deformity can cause significant labor loss, economic losses and psychological problems. In case of severe impairment of functions due to severe spinal curvature, spine surgery may be considered. However, since it is an extremely risky operation, this treatment method is used only in specialized centers and rarely. "Functional limitation in the hip joint can be corrected with prosthetic operations."
Very good results are obtained in most AS patients with treatments.
Prof. Dr. Fatoş Önen: “AS is a life-long disease, periodic flare-ups in signs and symptoms of the disease occur. Complete recovery of the disease is not expected. The basis of treatment in AS; education of the patient and his family, smoking cessation if used, and exercise. Nonsteroidal anti-inflammatory drugs are the first choice; With this treatment, a good response is obtained in 60-70% of the patients. Nonsteroidal anti-inflammatory drugs are not simple pain relievers. It improves rheumatic inflammation in AS. However, to be effective, they should be used in appropriate doses and during the period of complaints. These drugs can be discontinued in good periods of the disease, and restarted when symptoms and signs recur. Because of individual response differences, patients who do not respond to a non-steroidal anti-inflammatory drug should be tried another non-steroidal anti-inflammatory drug.
Synthetic disease-regulating antirheumatic drugs are used in patients with joint swelling and pain (arthritis). In cases where these treatments are not effective, treatment is started with biological drugs. Very good results are obtained in most patients with AS when these treatments are initiated. However, since adverse effects such as susceptibility to infections occur more frequently than drugs used in the first step and they are expensive treatments, it is important that biological drugs be used carefully only in the required patients and under follow-up. "
Emphasizing that exercise is one of the most important parts of the treatment, Prof. Dr. Fatoş Önen stated that when exercise is done regularly, it slows down the development of movement limitation, helps to maintain posture, and that non-cortisone anti-inflammatory drugs reduce pain and limitation of movement; He stated that it made daily exercises more comfortable.
Rheumatism patients in pandemic should continue their treatment
Prof. Dr. Fatoş Önen: “Most rheumatic diseases do not cause suppression in the immune system. When diabetes, lung diseases, kidney diseases accompany these diseases, or when drugs that suppress the immune system are used, the susceptibility to infections increases. It should be kept in mind that with the discontinuation of these therapies, sometimes life-threatening disease symptoms may be activated and the risk of getting infections more frequently during active disease may occur. For these reasons, it is recommended to continue the treatments used by rheumatism patients during the pandemic process ”.
While the widespread use of the internet today facilitates communication, it has also led to the emergence of information pollution. Dr. Önen: “Therefore, it is extremely important to access correct and reliable information. Our patients can access information resources on rheumatic diseases from the pages in the “For Patients” section of the official website of the Turkish Rheumatology Association (www.romatoloji.org). "Romatizma TV (romatizmatv.org)", which can be linked from this site, contains informative videos with answers to almost every question about various rheumatic diseases. Romatizma TV has now started a series of podcasts consisting of the opinions and recommendations of experts in the field of diagnosis, treatment and follow-up of rheumatic diseases. It is possible to find answers to different and up-to-date questions about rheumatic diseases in the podcast series.