Ankylosing Spondylitis and AxSpA
There is a condition related to Rheumatoid Arthritis that causes lower back pain and stiffness. It often goes undiagnosed because symptoms are subtle.
We used to think that Ankylosing Spondylitis (AS) and AxSpA affected men much more than women, and that all patients would have the “question mark posture” when it came to diagnose them. We know now that both men and women are affected, but symptoms may be different between them. We also know that the question mark posture is a sign of the late stages of the disease. In order to make a difference to quality of life, AS needs diagnosing much earlier.
What is AS?
AS is Ankylosing Spondylitis, which falls under the broader term AxSpA. This is short for Axial Spondyloarthritis, which directly translates to “arthritis of spinal joints”.
AS in inflammatory condition that mostly affects the joints of the pelvis and lower back. During inflammatory episodes, the joint is damaged, which is painful. As the flare subsides, the body tries to heal itself, but mistakenly forms bone over the whole joint. Over time, this causes fusion and stiffness that does not remit.
There are strong medications available to help slow the progression of the disease. Only a rheumatologist can diagnose AS, but your osteopath is in the perfect position to spot the signs and get you there.
Symptoms of AxSpA
One of the most important signs your osteopath will be looking for is inflammation. Some achiness or stiffness first thing in the morning is normal. If they last beyond 20 minutes, we start thinking about inflammatory conditions. Back pain and stiffness following an inflammatory pattern is the main indicator, but there are other factors too.
Symptoms typically develop in adolescence, or before the age of 40. Sometimes this coincides with an injury, which may be mistakenly used as an explanation for chronic back pain. The inflammatory nature means that periods of rest aggravate the symptoms of pain and stiffness. Movement helps, but excessive exercise also makes things worse.
Alongside spinal symptoms, there may be signs of enthesitis. This is inflammation where tendon and bone meet. The Achilles tendon is often the first enthesis affected, which might be mistaken for a generic calf injury. Like the spine, this would be worse after rest or prolonged exercise.
Because AS is related to rheumatoid arthritis, a personal or family history of RA or other related conditions is relevant. Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) is part of the same family. At your appointment we may use a questionnaire to help identify the likelihood of AxSpA. If results suggest further intervention is appropriate, we can support your journey to the GP and rheumatologist with a referral letter.
“Question Mark” Posture
Like Rheumatoid Arthritis can cause deformities of the fingers, AS deforms the spine. On an X-Ray, the spine may look like bamboo when viewed from the front or back. This is because of the overgrowth of bone around the joints. As the bone builds up, the spine is fixed in a straight line, rather than the usual curve. The neck compensates for the altered angle, forming the hook of the question mark.
We want your case to be investigated properly long before you reach this point. By the time the question mark posture is established, the disease has often “burnt itself out”. Pain subsides, but the stiffness is permanent. Early diagnosis can mean early medication, and prevention of late stage AS.