How to differentiate back pain from a rare rheumatic disease

Feeling back pain, for many people, is a daily discomfort. However, this ailment can hide a rare rheumatic disease. Last Saturday, May 6, World Axial Spondyloarthritis Day (AxSpA) was celebrated, a day promoted to raise awareness about this pathology and the physical, mental and emotional impact it has on people’s lives.

How is it possible to differentiate both ailments? A first step is to evaluate whether this kind of discomfort persists for more than 3 months in people under 45 years of age.

This is an indication that this rheumatic disease could transit, which is also chronic.

The most common symptoms of axial spondyloarthritis are pain and stiffness in the lower back or hip.

Over time, these signs can appear in other areas of the spine.

In this context, early detection is essential to achieve adequate treatment and avoid irreversible damage, since axial spondyloarthritis is a type of arthritis that causes inflammation between the vertebrae. The latter are formed by discs that make up the spine, and the joints between the spine and the pelvis.

AxSpA is inflammatory in origin and usually causes recurring pain in the lower back (low back pain).

Far from the most common beliefs, in the case of this pathology the pain often worsens during periods of rest or inactivity, such as in the middle of the night or after sitting for a long time.

Meanwhile, lumbar stiffness is usually morning and improves during the day.

Other symptoms may include pain, stiffness, and swelling in other joints; shortness of breath from pain caused by swollen joints connecting the affected ribs; vision changes and eye pain; inflammation in the eye, called uveitis; exhausted; loss of appetite and weight; rashes; abdominal pain and liquid stools.

The most common is that this disease occurs in young people and one of the consequences, without proper treatment, can be disability.

By diagnosing it early, the compromise of other systems, such as cardiovascular diseases, can be avoided.

The average time for the diagnosis of axial spondyloarthritis is 7 years from the appearance of the first symptoms. During this period, irreversible damage may occur if treatment is not indicated in the proper time.

Likewise, in the case of women, this process can take up to 10 years, among other things, because there is a false belief that the pathology mainly affects men.

What are the risk factors for developing axial spondyloarthritis?
-Family and genetic history, with the presence of HLA B27 (NdeR: leukocyte antigen) in some patients.

-Age. Most people develop symptoms of the pathology before the age of 45.
-Sex. Men are more likely to have axial spondyloarthritis than women.
-Other conditions. People who have Crohn’s disease, ulcerative colitis, psoriasis, or uveitis may be more prone to developing the disease.

According to various estimates, 64% of people with AxSpA suffer from depression and 75% have difficulty finding a job or are more likely to stop working.

Under these precepts, the objective of treatment in patients is to maximize quality of life by controlling symptoms and signs of the disease, preserving structural damage and long-term functionality.

Currently, there are various therapeutic options available.

The treatment of axial spondyloarthritis is staggered according to the intensity of the symptoms and the patient’s response.

Initial treatment is with non-steroidal anti-inflammatory drugs. If there is no response, disease-modifying anti-rheumatic drugs, physiotherapy, biological therapies and also oral therapies (jak inhibitors), recently approved in our country, can be used.