Spinal inflammatory disease 

What are inflammatory diseases of the spine?

Inflammatory arthritis describes a group of diseases caused by an overactive immune system.

The causes of inflammatory arthritis are largely unknown.

For people who suffer from inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your tissues instead of foreign substances, and causes continued inflammation.

Inflammatory arthritis is known as an "autoimmune disease"

The most common inflammatory arthritis related to back pain is ankylosing spondylosis which primarily affects

• Spine

• Sternum

• Large joints in the body.

The most common cause of ankylosing spondylosis is genetic. Over 90% of those with ankylosing spondylitis have a particular genetic marker that can be found on their white blood cells, called HLA-B27

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Symptoms of inflammatory arthritis 

Common symptoms include

• Joint pain

  • Pain is usually relieved by physical activity and improves by the end of the day

• Morning stiffness

• Loss of range of motion of joint

Symptoms specific to ankylosing spondylosis

• Back pain

• Uveitis (inflammation of the eye)

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When should I seek medical help?

There are circumstances when back pain might be caused or accompanied by serious issues. If such symptoms are present it is best to seek immediate medical attention to avoid further complications.

Although these are rare to encounter, it is always good to make sure you have no worrying symptoms.

If you experience any symptoms above including

• Unexplained back pain which improves with exercise

• Morning stiffness

• Loss of range of motion of joint

• Strong family history of ankylosing spondylosis

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Diagnosis 

Early diagnosis is very important with ankylosing spondylitis.

To diagnose any inflammatory disease in your lower back your doctor will perform a physical examination and special tests, taking your case history and past medical history. They will also palpate (gently examine by touch) the area to establish the source. They will take blood from you for further testing including inflammatory markers and the HLA-B27 gene. 

Further imaging including an X-ray will be done. If necessary for more detailed evaluation, CT exams or MRI scanning would be required

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Treatment 

The treatment of inflammatory arthritis includes

Physiotherapy and exercise

• Engage in physical therapy and home exercise

  • Strive for proper maintenance of posture to help maintain maximum possible flexibility.

Medication is important to relieving pain, restoring mobility, and stopping or slowing disease progression.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, stiffness, and pain

• Anti-TNF agents (biologics) can provide marked functional improvement, and these are used in many patients with more serious diseases.

• Local steroid injections can help with pain and stiffness.

Surgery

• Only considered when AS has progressed to a point at which the patient’s mobility is severely impaired due to chronic, debilitating pain or a painful deformity