2024-04-13 13:00:12
Kim Yong-gil, Professor of Rheumatology, Asan Medical Center, Seoul
About 97% of back pain is due to muscle or joint damage. It may be caused by a herniated disc (vertebral disc), spinal stenosis, or spinal fracture. This type of pain is called ‘mechanical pain.’
Pain can occur even without these causes. Pain caused by chronic inflammation. It is ankylosing spondylitis. Kim Yong-gil, a professor of rheumatology at Asan Medical Center in Seoul, said, “If you miss the right time to treat ankylosing spondylitis, you may end up unable to straighten your back for the rest of your life.”
●What kind of disease is it?
Ankylosing spondylitis occurs when inflammation in the spine becomes chronic. Pain usually occurs in the lower back, hips, arm and leg joints, chest, heels, or soles. It can also invade other organs. When it progresses to the eyes, inflammation occurs in the area called the uvea. Uveitis is prone to recurrence and may worsen into glaucoma.
The cause of the disease has not yet been clearly identified. However, it is known to be closely related to a specific gene (HLA-B27). Therefore, if you have a family member with ankylosing spondylitis, your risk of developing it increases. In addition, there is a hypothesis that environmental factors, physical stimulation, etc. may be the cause, but this has not been clearly established.
Ankylosing spondylitis is a type of autoimmune disease and a systemic inflammatory disease. For this reason, it is difficult to cure completely and cannot be treated with surgery. Without knowing the cause of the disease, prevention is impossible. Ultimately, early detection and treatment is the best solution. If you start treatment early, inflammation can be properly controlled. In this case, you can maintain your quality of life without taking medication for the rest of your life.
If this disease is not treated, the spine becomes stiff like bamboo. This is also called ‘Bamboo Spine’. In this condition, you cannot bend forward. So it becomes impossible to exercise properly. There is always a risk of recurrence. Therefore, if you neglect it even if you feel better, there is a high possibility that it will relapse. Lifelong care is required.
The number of domestic patients is slightly over 100,000. It mainly occurs between the ages of 20 and 40. There are more male patients than female patients. The number of cases decreases after the age of 50.
●It hurts more when I rest
![Back pain that goes away when you exercise… Could be ankylosing spondylitis[베스트 닥터의 베스트 건강법]](https://dimg.donga.com/wps/NEWS/IMAGE/2024/04/12/124454292.7.jpg "Back pain that goes away when you exercise… Could be ankylosing spondylitis[베스트 닥터의 베스트 건강법]")
Since early detection and early treatment are important, it is good to know how to self-diagnose. First of all, like spinal disc or spinal stenosis, ankylosing spondylitis causes pain around the back, waist, and pelvis. This means that it cannot be distinguished based on pain alone. However, since the pain patterns are different, be aware of the differences.
Back pain from ankylosing spondylitis has the characteristic of gradually progressing. It usually lasts for more than 3 months. Pain appears and disappears repeatedly. Also, the intensity of the pain gets worse and then gets better. If the pain persists, you should go to the hospital, but the fact that it disappears soon is a factor that prevents early detection. Many people think it is temporary pain and ignore it. For this reason, it is often difficult to accurately determine the time of initial onset. Professor Kim said, “In fact, most patients come to the hospital after suffering for 3 to 4 years.”
The pain cycle varies from patient to patient. Professor Kim said, “There are patients who are in pain for a month and then feel fine for three or four months, and there are also patients where once they become ill, the pain persists for a long time and then disappears.”
The pattern of pain is completely different from that of a spinal disc. Pain in spinal discs decreases when you rest. However, in the case of ankylosing spondylitis, the pain decreases when you exercise, but the pain actually gets worse when you rest. In the case of a herniated disc, neurological symptoms such as numbness in the legs appear, but in ankylosing spondylitis, there are no such symptoms at all. Also, in the case of a spinal disc, the symptoms only appear on one side, but in ankylosing spondylitis, pain may appear alternately on the left and right sides.
If you suspect ankylosing spondylitis, you should go to the hospital right away. At the hospital, the flexibility of the spine is first tested. Next, a blood test is performed to check whether there are genetic factors or whether inflammation levels are high.
Next, an X-ray is used to check how stiff the spine is, and if a detailed examination is necessary, a magnetic resonance imaging (MRI) test is performed.
●If left untreated, bones harden.
Professor Kim said, “There is currently no way to completely cure the disease. “The goal of treatment is to slow or stop the progression,” he said. If you are diagnosed with this disease, the first step is rehabilitation treatment along with exercise. If the effect is minimal, use anti-inflammatory painkillers. If inflammation is not controlled even after 3 months, biological agents are used to suppress the progression of inflammation. If this is also ineffective, another biological agent or targeted therapy is used.
As already mentioned, early detection and response are important. Mr. A’s treatment case is a representative example. Two years ago in February, Mr. A, a 21-year-old active-duty soldier at the time, woke up every morning because of back pain. I took anti-inflammatory painkillers from the medical center and the pain went away, but after a few days it started hurting again. Military medical staff conducted tests on suspicion of ankylosing spondylitis, and it was confirmed that it was in the early stages.
The medical staff administered anti-inflammatory painkillers. The treatment results were not bad, but additional treatment was needed to control inflammation. Mr. A visited Professor Kim. Professor Kim administered additional injections of biological agents. After that, Mr. A was discharged early and devoted himself to treatment. The disease did not worsen. These days, my condition has improved to the point where I no longer need anti-inflammatory painkillers. The only treatment is getting injections at the hospital every three months.
The case of Mr. B, a 42-year-old man, became more serious due to neglect of treatment. Mr. B was diagnosed with ankylosing spondylitis in 2018. For his first year, he went to the hospital and received good treatment. However, since 2019 he has not been to the hospital. About three years later, in July of last year, Mr. B visited Professor Kim again. His physical condition was serious. He took an X-ray and found that all but a few of his vertebrae were attached. Mr. B became unable to bend his body forward. If he doesn’t get treatment now, even his neck vertebrae will become attached. Professor Kim said, “We are trying to save at least the parts that are not hardened. “If all the bones are attached, a fracture may occur with just a small impact, and in that case, the upper body will bend forward.”
●Stretching to prevent disease worsening
There are exercise methods to prevent the progression of ankylosing spondylitis. Let’s follow the five movements suggested by Professor Kim Won of the Department of Rehabilitation Medicine at Asan Medical Center in Seoul. Even if you are not a patient, you can achieve the effect of strengthening your spine by performing this stretch. The exercise principle is as follows. First, you have to do it every day. Follow all five movements for 20 to 30 minutes. Second, perform each movement slowly over 10 to 20 seconds and repeat 3 to 5 times. However, the sixth ‘back muscle strengthening’ exercise is repeated 10 times more slowly. In addition, do aerobic exercise and refrain from extreme exercise.
Stretching to prevent the progression of ankylosing spondylitis
Reporter Kim Sang-hoon [email protected]
2024-04-13 13:00:12