Back pain is one of the commonest symptom for which patient is seen in the outpatient department. But remember majority of back pains are mechanical, which do not require intervention. They require rest and exercises. How ever there are some serious causes of back pain.
Spondyloarthritis (SpA) is a family of inflammatory diseases. Commonest is ankylosing spondylitis. Others are reactive arthritis, psoriatic arthritis and enteropathic arthritis, which is associated with the inflammatory bowel disease.
Cause is mainly genetic, with environmental triggers. The major gene is called HLA-B27. Other genes are not available for routine testing. Environmental factors includeinfections, trauma, smoking among others. In majority there is no single factor which is responsible for the disease. Any dietary cause has not been found so far. The role of intestinal bacteria is evolving rapidly.
SpA has two main symptoms. The first and predominant symptom is low back pain. This is inflammatory in nature; the important features are pain in the back which is worse at night with significant morning stiffness. This pain is better with activity. If not controlled, spinal inflammation progress, resulting in fusion of the vertebrae and limiting the spine’s mobility. This is the late stage called as bamboo spine.
Less commonly, the symptoms can be pain, swelling and stiffness in the joints of arms and legs, this is known as peripheral spondyloarthritis. As compared to rheumatoid arthritis, in this disease the inflammation can be, intermittent and recurrent. Other problems that can occur along with spondyloarthritis, include-pain and redness of the eye (uveitis), inflammation of the aortic heart valve, intestinal inflammation (colitis) and the skin disease (psoriasis).
Is based on history and physical examination, Imaging (X ray, CT and MRI) and blood tests are done to confirm the diagnosis.
X-rays of the sacroiliac joints, show changes called sacroilitis. Magnetic resonance image (MRI) can show these changes before an X-ray. HLA-B27 gene can also help confirm a suspected diagnosis of SpA.
Various nonsteroidal anti-inflammatory drugs (NSAIDs), are the major stay in treatment of SpA.
Disease-modifying anti rheumatic drugs (DMARDs) are most effective for peripheral arthritis but not spinal diseases. Biologic drug like tumor necrosis alpha (TNF-alpha) blockers are effective for arthritis of the both the spine and peripheral arthritis. However, they are expensive and not needed in all patients. When other organs are effected like eye or skin other specialists are also involved in treatment also. Surgery like joint replacement, can relieve pain and restore the joint’s function, in certain cases. Self care for patients with SpA- include regular exercise and to smoking.
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