Who has never had back pain raise your hand. There are few who can do it, unfortunately. Even among young people. Suffice it to consider that the World Health Organization calculates that back pain is the leading cause of disability and absence from work in young adults. It affects 1 out of 22 Italians and more than 80% of people will suffer from it at least once in their lifetime.
So if many, if not all, know what back pain is, perhaps few know the difference between mechanical pain, a muscle tear or injury, and inflammatory pain. The latter affects about 1 in 5 people – especially young people between the ages of 20 and 30 – and could be the indicator of a rheumatic disease, such as ankylosing spondylitis.
Doctors also don’t know it, who often refer patients who complain of chronic back pain to orthopedic tests and therapies, without thinking that it could be a rheumatological pathology. Result: in some cases it can take up to ten years to arrive at a correct diagnosis.
Rheumatological diseases: patients waiting for a diagnosis even for seven years
by Irma D’Aria
Breaking down this time is the goal of the “Don’t turn your back” campaign created by Abbvie in collaboration with patient associations from all over Europe: a site (www.nonvoltarglilaschiena.it) full of information and an online test validated by experts to understand the nature of back pain and invite those who suffer from it to go to the doctor.
The differences between back pain
“Back pain isn’t a diagnosis, it’s a symptom that needs to be diagnosed and treated promptly,” she says Francis CicciaProfessor of Rheumatology at the University of Campania Luigi Vanvitelli. “To understand what back pain is suffering from, it is important to pay attention to some characteristics. Mechanical back pain often develops after an effort and the patient recognizes exactly the moment in which it arose, improves with rest and does not respond well to anti-inflammatory drugs. In contrast, inflammatory back pain comes on slowly and the patient cannot pinpoint when it started, does not improve with rest, is associated with morning stiffness lasting more than 30 minutes, and is often accompanied by similar to that of the sciatic nerve which however stops at the level of the knee”. If you suffer from this type of pain for more than three months, the advice is to get tested and seek medical advice.
The impact on quality of life
In fact, many young people let too much time pass before they get to talk to the right specialist, the rheumatologist. “A dangerous delay because, over time, the conditions that cause inflammatory back pain can limit movement and, in severe cases, cause the bones of the spine to fuse together, developing into a form of spondyloarthritis such as ankylosing spondylitis,” Ciccia goes on. “A disease that strikes at a young age, after the age of 20, and causes a progressive stiffening of the spine that can cause severe pain, reduced mobility and long-term structural damage”.
Rheumatic diseases: early diagnosis to find ‘invisible’ patients
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Pains that deeply undermine the quality of life of those who suffer from it, as in the case of Giacomo Leopardi who, as an Italian study hypothesized on the basis of the symptoms he himself described in his correspondence, could be suffering from juvenile ankylosing spondylitis, probably the real cause that influenced his character traits up to “cosmic pessimism”. Or more simply, as he describes Silvia Tonolopresident of the National Association of Rheumatic Patients Anmar, suffering from ankylosing spondylitis: “a disease that prevented me from holding my child as much as I would have liked. And that I lived for years without being understood, because a diagnosis had not been made. That’s why awareness campaigns such as “Don’t turn your back” are essential to inform people about the symptoms and pain attributable to chronic inflammatory back pain.
Ankylosing spondylitis
Among the different forms of arthritis are spondyloarthritis, including ankylosing spondylitis. It is a pathology that mainly involves the joints of the spine, the joints of the pelvic bones, and the adjacent soft tissues: tendons, ligaments and entheses, i.e. the points where muscles and tendons attach to the bones. However, it can also involve other organs, such as the eye, the heart, the lungs.
With the evolution of the disease, generally slow, the stiffness of the spine worsens, which is accompanied by a progressive loss of the lumbar lordosis and the appearance of a dorsal kyphosis, determining, in the more evolved forms, the characteristic gait of the “bent man” .
If ankylosing spondylitis is not treated, spinal deformities can occur: over 30% of patients have kyphosis. “Today, however, thanks to therapies, if ankylosing spondylitis is diagnosed promptly, the symptoms can be controlled and the progression can be avoided”, explains Ciccia. The pillars of pharmacological treatment involve the use of non-steroidal anti-inflammatory drugs and in patients who do not respond to this treatment, the use of biological drugs or small molecules, such as the new JAK inhibitors that are taken orally.
Ankylosing spondylitis: a new drug for those who do not respond to therapies
by Dario Rubino
