Most patients diagnosed with ankylosing spondylitis are between the ages of 20 and 40. It is a chronic condition caused by inflammation of the spine and sacroiliac joints that is treated by rheumatologists.
In Spain there are some 400,000 affected by ankylosing spondylitis, the name by which a disease characterized by chronic inflammation of the spine and sacroiliac joints is known. Sometimes, it also affects the peripheral joints causing arthritis.
The inflammation causes a dull and continuous pain, especially, in the lower part of the spine. It is very common to suffer from it in the middle of the night and wake up in the morning with a stiff spine It will take more than 30 minutes.
“To check this, information is collected about symptoms, personal history of joint inflammation, presence of skin lesions or intestinal changes, including family history of the disease,” explained Dr. Alejandro Escudero, head of the Rheumatology Service at the University Hospital. Reina Sofia (Córdoba)
Afterwards, A complete examination of the musculoskeletal system is performed, evaluating spinal mobility and possible joint anomalies. Later comes the turn of laboratory tests to detect inflammatory markers in the blood and imaging tests to look for deep inflammation of the sacroiliac joints. Finally, a genetic test is requested (HLA-B27) positive in more than 90% of cases, which helps to confirm the diagnosis.
DIFFICULT TO DIAGNOSE
Despite this, diagnosing ankylosing spondylitis remains a challenge for rheumatologists, who They usually notice it in patients between 20 and 40 years of age. “In the case of a person under 45 years of age, with persistent lower back pain (more than three months), difficulties in resting at night and limited movement between at least 30 minutes and an hour when rising, this disease must be considered. ,” explained Escudero.
Usually, this disease appears in an age group where a career is encouraged and a family is formed, therefore many patients have difficulties starting their days and taking care of their children, which can make symptoms difficult even with daily activities such as walking, working or exercising. In addition, chronic pain and fatigue can affect mood and social relationships.
For all of the above, ankylosing spondylitis significantly reduces the quality of life of patients. And the diagnosis is a relief for those who have endured years of pain they thought was normal.
In addition, Early diagnosis of the disease allows it to be treated and avoid sequelae., which in many cases is already there when said diagnosis occurs. The damage does not heal, even after starting the treatment.
However, delaying treatment can have more complex consequences. For example, the presence of uveitis with the risk of severe ocular involvement, as well as severe diseases of the skin, nails or intestines. In all cases, an attempt is made to relieve symptoms, prevent joint damage and improve the patient’s mobility and quality of life..
As a chronic condition, treatment is very long-term and aimed at preventing severe outbreaks and long-term remission. The most common treatments include non-steroidal anti-inflammatory drugs., which reduces pain and inflammation. If this is not effective, biological therapy is used.
The most relevant advances in recent years come from a better knowledge of ankylosing spondylitis and the pathogenic mechanisms involved, which allow progress. new therapeutic molecules such as biological drugs, able to block signaling molecules between cells. These treatments are more effective in preventing symptoms and disease progression.
Recently, new drugs capable of blocking the mechanism of action of signaling molecules have also been included. Worldwide, they have achieved excellent clinical response rates.
There are still some pending tasks to reduce the impact of ankylosing spondylitis on the quality of life of those affected. Examining the educational and awareness raising actions of population would be a good start. In this sense, experts consider it very important to know the disease and request a medical evaluation if there is long-term low back pain without a reasonable cause.
Likewise, it is key to visit a rheumatologist to receive an early diagnosis to avoid permanent consequences and to inform the affected person of the pathology, its symptoms, its treatments and the best way to manage it. However, there is a remarkable delay in diagnosis because the main symptom of the disease, low back pain, is a frequent symptom and, therefore, normalized in the Spanish.
It is also important to get adequate treatment early, to control symptoms and prevent joint damage. Similarly, experts believe that Access to physical therapy should be facilitated to improve mobility and reduce pain. Another challenge is to open the door to occupational therapy to adapt to the physical limitations of the disease, as well as improve psychological support which reduces the emotional impact of the diagnosis and promotes social support for the patient, from their family to patient associations.