This condition is frequently diagnosed in young men and can even start as young as 20 years old.
Dr. Amarilis Pérez de Jesús, rheumatologist. Photo: Journal of Medicine and Public Health.
The Back pain may go unnoticed by many patients, however, this is a characteristic symptom of ankylosing spondylitisan autoimmune condition, which affects the spine and joints large size of the human body.
To learn more about this disease, Dr. Amarilis Pérez de Jesús, rheumatologist and member of the board of directors of the Foundation for Rheumatic Diseases (FER), explained to the Revista Medicina y Salud Pública the main characteristics and symptom of patients, in addition to the diagnostic process and treatment alternatives to prevent the progression of the ankylosing spondylitis.
This is a less common condition than arthritis psoriatic, but it falls within the group of conditions known as spondyloarthropathies. “It occurs more commonly in young men, who can begin to develop the disease at the age of 20 years. A distinctive feature is the patient who complains of Back painin the sacroiliac area, we identified that, but what the patient says is that he has pain in the lower back”, he explained.
Furthermore, he emphasized that the Back pain is worse in the morning and improves during the day, contrary to Back pain mechanical that worsens as the patient is having physical activity.
In a young man who wakes up with Back pain in the morning, “that stiffness can last 30 minutes,” he added. “We can only have spinal involvement or arthritis peripheral, that is, they have inflammation in the areas of jointssuch as hands, feet, etc.”, he specified.
On the other hand, he mentioned that the ankylosing spondylitis It is also diagnosed in women, although it does not occur frequently. “I want to clarify that it is a condition that is also seen in women and perhaps it is not as common because it was not being diagnosed as much in women, since many times it has been managed similar to conditions such as fibromyalgia, since the picture can be confused by the area of pain or enthesitis”, explained the specialist.
“If we see them in females, it is not as common, but today we are identifying it more compared to years ago,” he added.
To arrive at the diagnosis of ankylosing spondylitisspecialists take into account the physical examination of the patient, their symptomhistory, and screening tests.
“We have an associated gene, HLAP27, therefore, it is a condition that has a genetic contribution. I saw a patient last week that he started reading about his Back painis 37 years old, is a young patient, and he asked his primary care doctor to do the HLAP27 test, and it came out positive, he told me that he had ankylosing spondylitisHowever, we made the diagnosis through history, physical examination and other findings” narrated Dr. Amarilis.
Although the cause of this condition is unknown, the specialist affirms that it is important to take into account the patient’s history and previous evaluations. “As part of the patient evaluation, we can find pain in the sacroiliac area, we can have enthesitis, which is pain at the union of the ligaments with the bone, as we see in the arthritis psoriasis,” he added.
Regarding this, he explained that in diagnostic tests they carry out the HLAP27 test, which is a histocompatibility antigen and in most cases of ankylosing spondylitis the result will be positive, as in the patient you treated.
They also test inflammationX-rays, particularly of the sacroiliac area, and in many cases, if they are negative, they resort to magnetic resonance imaging, which already identifies patients who are in an early stage, where radiologically no changes are observed, but the patient does present symptom.
“Once we establish the diagnosis, we proceed to treat the patient. It is important to note that if a patient does not receive treatment for ankylosing spondylitis your spine can be fused and you lose functional capacity affecting your daily life. Our goal as rheumatologists is to manage that patient to prevent it from reaching those damages because once we have the damage it is permanent”, stressed the rheumatologist.
For this, early treatment is essential, as in any rheumatological condition. Currently, there are different alternatives of treatments as:
“Today we have a range of treatments which are much more sophisticated where we are going to try to block or reduce the presence of those substances that are pro-inflammatory. We have interleukin inhibitors that, depending on the stage, we start treatment and patients usually respond well and their quality of life can be normal within their condition,” Dr. Pérez stressed.
Finally, he highlighted the importance of physical therapy in patients, to help the joints have a good movement and fulfill the function in the organism, avoiding its deterioration.
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