As far as the limelight goes, some autoimmune diseases get all the twinkle. Lupus is among these media darlings, as are multiple sclerosis, celiac disease and type 1 diabetes.
There is, however, an autoimmune disorder you’ve probably never heard of. Even its name is textbookish: ankylosing spondylitis. But this odd-sounding disease is more common than you might suppose, often because it’s mistaken for more common ailments.
Is that back pain an old football injury? Or ankylosing spondylitis. Is that neck stiffness just from working out? Or ankylosing spondylitis.
That’s the job of a rheumatologist, such as Tanner Clinic’s Dr. Greg Austad, who makes the distinction and then provides expert treatment.
Ankylosing spondylitis is an arthritic process that begins when a young person develops an autoimmune response to some kind of foreign antigen such as a virus. They’ll first notice a stiff and tender lower back — actually centered in the sacroiliac joints, which connect our spine to our pelvis. Next is more stiffness and sometimes very significant pain, says Dr. Austad.
Before long, ankylosing spondylitis actually fuses this lower-spine joint, he said, and then “starts working its way up the spine to a point where the whole spine has become fused, like a bamboo pole.” Ankylosing spondylitis cements the vertebrae so patients are left with “fused spines” — their neck is fused and their back is fused. And thus unable to stand up straight.
Disease presents as stiff back
Ankylosing spondylitis must be treated early on, since once the discs are fused, the results are permanent with no surgical cure. The difficulty, said Dr. Austad, is that this disease tends to affect young people and, in these early stages, it often appears as a back that’s stiff after a raucous game of football or after finishing a strenous run. Often, it’s confused with a spinal injury.
“It has to be caught and treated early — and aggressively — because it will cause irreversible damage later on,” Dr. Austad said.
A stiff back isn’t the only symptom; others include:
- Red, painful eyes (iritis)
- Hunched shoulders
- Rashes on the palms or bottom of the feet
- Red, hot and swollen joints
“And those manifestations are what usually brings them into see me,” said the rheumatologist. “I’ll say, ‘OK, let’s get some x-rays of your back.’ ”
The disorder is diagnosed through x-ray, a physical exam and patient history.
Dr. Austad sees patients at all stages of the disease. There are the early-comers: “They’ll come in very early with hot, red swollen knees. I’ll ask them if they have back pain, and they’ll say, ‘Well, you know, I’ve had back pain for a few years.’”
And then there are the longtime sufferers: “I’ve also seen people who’ve had ankylosing spondylitis for years and it was never diagnosed — they thought it was chronic back pain.”
Symptoms of fused spine irreversible
When Dr. Austad looks at this patient’s entire clinical picture, he’ll likely find someone who has a history of iritis, inflammatory arthritis, and “Oh, by the way, my back doesn’t move very well.”
Once the damage is done, it can’t be reversed. But there are some great medications to stop ankylosing spondylitis from progressing. Dr. Austad said it’s been found that scheduled nonsteroidal anti inflammatories, such as Aleve (naproxen), “not only decrease the joint pain, but also decrease the erosive damage that gets done.”
Keeping pace with technology
Newer treatments on the market also slow down pain and damage without the potential kidney and liver damage caused by long-term use of these over-the-counter pills. Also new are TNF inhibitors (as in tumor necrosis factor), which block the TNF proteins that cause the inflammation.
“That’s one thing I like about rheumatology — you can give people their lives back,” Dr. Austad said.
He adds, “Unless you’ve had a disease like an inflammatory arthritis, you just can’t understand how painful and debilitating it is. I have people come in in tears, unable to move, thinking their life is over.”