What exactly is the cause of your persistent back pain? (Axial Spondyloarthritis) Let's learn about it!

Do you sometimes have aches and pains in your back or hips that don't go away for months? Do you feel stiff and stiff especially when you wake up in the morning? Do you also suffer from back pain that sometimes gets better with exercise, but gets worse when you sleep or rest at night? While you may think that these things are just a backache, a sprain, or a strain, it could be something deeper. Today we are going to talk about axial spondyloarthritis , or (axSpA) for short, a condition that is a bit complicated, but can be controlled if managed properly.

What exactly is axial spondyloarthritis?

Simply put, axial spondyloarthritis (axSpA) is a type of arthritis. But it's not like the joint pain we usually hear about as we age. It specifically affects our "axial skeleton." That is, the bones in the middle of our body - the main parts like the chest, spine, and hips - are most affected. This condition (axSpA) is caused by a change in the way our immune system works. To be precise, the immune system, which is supposed to protect our body, mistakenly starts attacking our own joints and soft tissues. We call this "inflammation." This inflammation is what causes joint swelling, pain, and over time, joint damage. (axSpA) is a condition that belongs to a larger group of diseases called spondyloarthritis . A unique feature of this group of spondyloarthritis diseases is that they can affect not only the joints, but also other systems of the body. For example, if you have (axSpA), in addition to back pain, you may also experience symptoms such as inflammation of the eyes (uveitis) and diarrhea . Although these may not seem related to back pain at first glance, these things can occur with (axSpA).

Who is more likely to develop this condition (axSpA)?

Actually, anyone can develop axSpA. But it is a relatively rare condition. It is estimated that only about 1% of the world's population has this disease. This condition is especially common among people under the age of 40. Symptoms often begin to appear in your teens or early 20s . Both men and women can develop this disease equally.

How does axial spondyloarthritis (axSpA) affect my body?

If axSpA is not treated properly, over time the bones in the spine can begin to fuse together . This fusion of bones is medically known as ankylosis.This causes the spine to lose its flexibility, making it difficult to keep the spine straight. Also, this condition can lead to a bone thinning disease called osteoporosis in the spine. This can weaken the bones in the spine, increasing the risk of spinal fractures . Just think, even a small fall can break a bone in the spine.

What are the causes of axSpA?

Although the exact cause of axSpA is not yet known, it is believed to run in families . Genetic testing of many people with axSpA has found that they have a gene called HLA-B27 . However, this does not mean that everyone who has the HLA-B27 gene will develop axSpA. Also, people who do not have this gene, and those who have no family history of the disease, can develop axSpA. So, this is a bit complicated.

What are the symptoms of (Axial Spondyloarthritis)?

The main and most common symptom of axSpA is back pain . But it's not just back pain. There are several specific characteristics of this pain:

• Chronic: This means that the pain may last for more than three months.
• Not caused by an injury or mechanical problem: For example, it is not a pain caused by something like a slipped disk or a muscle spasm.

If you have axSpA, your back pain may also look like this:

• When you exercise and move your body, it decreases a little.
• The pain increases at night when you sleep or rest.
• When I wake up in the morning, my back aches with stiffness .
• The pain spreads to the hip area or buttocks.

The inflammation caused by axSpA is not limited to the spine. It can also affect other systems in the body. For example:

• Digestive problems: Like having a stomach ache.
• Fatigue .
• Enthesitis: Swelling, calcium deposits, and bone spurs at the points where tendons and ligaments attach to bones.
• Dactylitis: Complete swelling of the fingers or toes (like sausage toes).
• Psoriasis is a skin disease.
• Inflammation of the eyes, especially uveitis .

Imagine, a young man named Saman had been suffering from back pain since he was about 22 years old. When he woke up in the morning, he couldn't bend his back. He thought he had sprained his ankle while playing cricket. But months passed and the pain didn't go away. Later, he saw a doctor and learned about this (axSpA). He also said that in addition to his back pain, his eyes sometimes became red and painful.

How is Axial Spondyloarthritis diagnosed?

When you see a doctor about your back pain, he or she will first check your vital signs and perform a physical exam . These two things can give you an idea of ​​your general health. In addition, the doctor may also do tests like:

• Blood tests : Blood tests are done to check for the presence of the HLA-B27 gene and to check the level of C-reactive protein, which indicates whether there is inflammation in the body.
• Imaging tests: These tests help to see the condition of the bones in your axial skeleton, such as your spine and hips.
• X-ray: An X-ray of the spine can help diagnose axSpA or other bone problems.
• MRI: These can take very clear, detailed pictures. MRIs can detect things like inflammation in the spine before they can be seen on an X-ray.

Sometimes, you may have symptoms of axSpA (such as back pain), but no obvious inflammation can be seen on imaging tests (X-rays or MRIs). However, doctors may call you "non-radiographic axSpA ." "Non-radiographic" means it is not visible on imaging tests. Some people with this "non-radiographic axSpA" may have their condition worsen over time and become visible later on an X-ray or MRI. But in most cases, the condition may not be as severe as it appears on imaging tests.

How is Axial Spondyloarthritis treated?

Unfortunately, there is no cure for axSpA. However, with the right treatment, symptoms can be controlled and quality of life can be improved . Treatments you may receive may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDS):These are over-the-counter (OTC) medications that you can buy at a pharmacy without a prescription. They relieve pain and reduce inflammation. The most commonly used medications are aspirin, ibuprofen, and naproxen sodium .
• Physical therapy: Your doctor may refer you to a physical therapist, who will teach you specific exercises tailored to your needs. Physical therapy can help reduce pain and increase flexibility and strength.
• Steroid injections: Corticosteroids are a powerful class of drugs that fight pain and inflammation. If you have severe pain or swelling in a specific area of ​​your body, a steroid injection into that area may provide relief.
• Disease-modifying anti-rheumatic drugs (DMARDs): If other treatments don't help you enough, a class of drugs called disease-modifying anti-rheumatic drugs (DMARDs) may be used. These reduce pain and joint swelling. They also help prevent future joint damage.
• Biologics: These are a special type of medication that also belongs to the DMARDs category. They directly target your immune system and help control inflammation. While these biologics can be very effective, they can also cause some side effects, such as an increased risk of infections. Therefore, they should be used only under medical advice.

Can this condition (Axial Spondyloarthritis) be prevented?

To be honest, there is no known way to prevent axSpA. Also, it is not caused by back injuries.

How do I know if I'm at risk for developing this?

If your parents or siblings have axSpA, you are at slightly higher risk of developing the condition. However, it is not certain that you will develop axSpA just because someone in your family has it or has the HLA-B27 gene.

What will the future hold for those with Axial Spondyloarthritis?

As mentioned earlier, axSpA cannot be cured completely. If you have axSpA, your symptoms may come and go at times. Or they may be constant. However, if managed properly, people with the condition can live long, happy lives. The most important thing is to work with your doctor to manage your symptoms and stay as healthy as possible.

How do I take care of myself?

There are several things you can do to maintain your health and manage your symptoms of axSpA:

• See your doctor on your scheduled appointments. If your treatment plan includes physical therapy, be sure to attend that as well.
• Use the medication exactly as prescribed by the doctor.
• Don't smoke. If you smoke, get help to quit. Smoking can increase inflammation and worsen axSpA, which can damage bone health.
• Do light exercise, such as walking, regularly. Exercise helps keep your bones and joints healthy. It can also help control the progression of axSpA and increase flexibility in your spine.
• Eat a healthy diet rich in fruits and vegetables. These help fight inflammation.

When should I see a doctor?

If you experience any of these symptoms, see your doctor immediately:

• If the treatment you are taking causes unwanted side effects .
• If your symptoms seem to be getting worse .
• If you feel like the current treatments are not helping .

What is the difference between (Axial Spondyloarthritis) and (Ankylosing Spondylitis)?

Ankylosing spondylitis is actually a type of axial spondyloarthritis (axSpA) . Ankylosing spondylitis mainly affects the sacroiliac joints , which are the joints where your lower spine connects to your hips. However, axSpA can also affect the chest or other parts of your spine. There are several other conditions that fall into the spondyloarthritis category:

• Peripheral spondyloarthritis: This usually affects the joints in your hands and feet.
• Psoriatic arthritis: An arthritis condition associated with the skin disease psoriasis.
• Reactive arthritis: A somewhat rare type of arthritis caused by a bacterial infection.
• Inflammatory bowel disease (IBD)-related arthritis: Commonly seen in people with diseases such as Crohn's disease or ulcerative colitis.

Take-Home Message

Living with ankylosing spondylitis (axSpA) can be challenging. But remember, many people with this condition manage it well and live long, healthy lives. You can help manage your condition by seeing your doctor regularly and taking care of your overall health. It’s also helpful to join support groups for people with ankylosing spondylitis (axSpA) and spondyloarthritis. These groups can help you talk to people who understand your feelings and know the challenges you’re facing.

So, if you have symptoms like persistent back pain and morning stiffness, it's best to see a doctor and find out exactly what the problem is without just ignoring it. If you recognize it early and start treatment, you too can live a normal life.

Axial spondyloarthritis, back pain, joint inflammation, HLA-B27, arthritis, spondyloarthritis, ankylosing spondylitis