2023-09-27 00:21:52
Immune-mediated diseases
Updated Wednesday, September 27, 2023 – 00:21
Most patients diagnosed with ankylosing spondylitis are between 20 and 40 years old. It is a chronic condition due to inflammation of the spine and sacroiliac joints that is treated by rheumatologists.
In Spain there are some 400,000 affected by ankylosing spondylitis, the name by which a disease characterized by chronic inflammation of the spine and sacroiliac joints is known. Sometimes, it also affects the peripheral joints, causing arthritis.
The inflammation causes a dull and continuous pain, especially, in the lower area of the spine. It is very common to suffer from it in the middle of the night and wake up in the morning with a stiffness in the spine that lasts for more than 30 minutes.
To diagnose it, information is collected about the symptoms, personal history of joint inflammation, presence of skin lesions or intestinal alterations, including family history of the disease, explains Dr. Alejandro Escudero, head of the Rheumatology Service at the Reina Sofia University Hospital. (Crdoba).
Afterwards, a complete examination of the musculoskeletal system is performed, evaluating the mobility of the spine and possible joint anomalies. Later comes the turn of laboratory tests to detect inflammatory markers in the blood and imaging tests to look for deep inflammation in the sacroiliac joints. Lastly, a genetic test is requested (HLA-B27) which is positive in more than 90% of cases, which helps confirm the diagnosis.
DIFFICULT TO DIAGNOSE
Despite this, diagnosing ankylosing spondylitis remains a challenge for rheumatologists, who They usually detect it in patients between 20 and 40 years of age. When faced with a person under 45 years of age, with continuous low back pain (for more than three months), difficulties resting at night and limited mobility between at least 30 minutes and an hour when getting up, this disease should be considered, explains Escudero.
Often, this ailment appears in an age group in which a career is given a boost and a family is formed, so many patients have difficulties starting their days and caring for their children, which can make symptoms even difficult for daily activities such as walking, working or exercising. Additionally, chronic pain and fatigue impact mood and social relationships.
For all of the above, ankylosing spondylitis greatly reduces the quality of life of patients. And having a diagnosis is a relief for those who have been suffering for years from pain that they believe is normal.
In addition, Early diagnosis of the disease allows it to be treated and avoid joint sequelae., which in many cases are already there when said diagnosis occurs. The damage is irreparable, even after starting treatment.
However, delaying treatment can have even more complex consequences. For example, the presence of uvetis with risk of severe ocular involvement, as well as serious skin, nail or intestinal alterations. In all cases, an attempt is made to relieve symptoms, prevent joint damage and improve the patient’s mobility and quality of life..
MOST COMMON TREATMENTS
As a chronic condition, treatment is very prolonged and aims to control acute outbreaks and long-term remission. The most common treatments include nonsteroidal anti-inflammatory drugs, which reduce pain and inflammation. If they are not effective, biological therapy is used.
The most relevant advances in recent years have come from a better knowledge of ankylosing spondylitis and the pathogenic mechanisms involved, which has allowed the development of new therapeutic molecules such as biological drugs, capable of blocking signaling molecules between cells. These treatments are more effective in controlling symptoms and disease progression.
More recently, new drugs capable of blocking the mechanism of action of signaling molecules have also been incorporated. Globally, they have achieved better clinical response rates.
CHALLENGES AHEAD
There are still some pending tasks to minimize the impact of ankylosing spondylitis on the quality of life of those affected. Delve into the educational and awareness actions of the population would be a good start. In this sense, experts consider that it is very important to know the disease and request a medical evaluation when there is prolonged low back pain without a justified cause.
Likewise, it is key to visit a rheumatologist to receive an early diagnosis to avoid permanent consequences and to inform the affected person of the pathology, its symptoms, its treatments and the best way to manage it. However, there is a notable delay in diagnosis because the key symptom of the disease, low back pain, is a frequent sign and, therefore, normalized by Spaniards.
It is also essential to institute appropriate treatment early, to control symptoms and prevent joint damage. Likewise, experts believe that Access to physical therapy should be facilitated to improve mobility and reduce pain. Another challenge is opening the door to occupational therapy to adapt to the physical limitations of the disease, as well as promote psychological support that minimizes the emotional impact of the diagnosis and promotes social support for the patient, from their family to patient associations.
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