Ankylosing spondylitis: inflammatory back pain upon waking

Waking up with a stiff lower back and pain could be a sign of ankylosing spondylitis. As one moves more, the pain will decrease and the stiffness will decrease. It is an autoimmune disease in which the vertebrae become inflamed, swell and cause pain with immobility. What causes chronic inflammatory rheumatism of the back and how is this disease – also called Ankylosing Spondylitis (AS) – treated?

Bekhterev’s disease

  • Symptoms of ankylosing spondylitis
  • Suspected causative agent
  • Relationship with juvenile rheumatism
  • Degree of occurrence
  • Treatment of ankylosing spondylitis

Symptoms of ankylosing spondylitis

Often the first symptoms of Ankylosing Spondylitis are lower back pain, stiffness and immobility. This mainly occurs in the morning or immediately after waking up. If the person moves for an hour, the pain and stiffness gradually decrease. In addition, it may be accompanied by specific complaints:

  • pain in the lower back and occurs mainly in the morning;
  • asymmetrical joint pain;
  • buttock pain, heel pain;
  • eye inflammation (common in women);
  • swollen toes (sausage toe due to dactylitis) or fingers;
  • inflammation of the urinary tract;
  • acute diarrhea and followed within a month by painful joints.

The previous complaints may be accompanied by other immune-related conditions such as psoriasis, balanitis, Crohn’s disease or ulcerative colitis. As the disease progresses, in addition to the lumbar vertebrae, the mid-back and cervical vertebrae as well as the hips and shoulders will also be affected. In advanced stages of the disease, vertebrae will fuse together, causing complete immobility.

Suspected causative agent

So far it is not known exactly what causes it. Because it concerns a chronic inflammation and stiffening, the cause probably lies in your own immune system. Certain proteins and associated cells are often considered foreign and the immune system takes action against them. The functioning of your own body is hindered, which can cause far-reaching inflammation. In addition, a degree of heredity applies. Furthermore, it also appears to be related to inflammation of the urinary tract and intestines.

Relationship with juvenile rheumatism

In the case of JIA or juvenile rheumatism, the child may be affected by rheumatism at an early age. This variant is also caused by your own defenses. It often manifests itself in various inflamed joints. It can also be accompanied by inflammation of the spine, thereby additionally causing Ankylosing Spondylitis. Juvenile arthritis can occur in three different degrees, affecting a few or many large and small joints. Organs can also become inflamed, including the spine.

Degree of occurrence

The condition often develops between the ages of fifteen and forty. It occurs in both men (2:3 patients) and women (1:3). In the case of juvenile rheumatism, it mainly concerns late oligo-articular rheumatism, occurring in adolescent boys. Approximately one percent of the population develops this disease, and it can occur in varying degrees. Because the disease involves a progressive deterioration, people will experience more and more painful complaints. This also means that the disease is not noticeable at first.

Treatment of ankylosing spondylitis

Because the disease is increasingly worsening, it is necessary to take medication in a timely manner. Regular painkillers only help with the pain, but the inflammation must be counteracted. Medication such as Prednisone and methotrexate are often prescribed for this purpose. These medications suppress the immune system and combat inflammation. Sometimes biologicals also need to be prescribed. These are biological medicines and therefore expensive. For example, in the case of Enbrel, the goal is to suppress the TNF-α factor. This is a specific protein that causes inflammation. Traditional rheumatoid medications cannot counteract these inflammations. Often a combination of medications will be used. In addition to medication, sufficient exercise and exercise are also necessary. Please let your physiotherapist inform you about this. Please note that surgery is possible. Because spinal surgery entails many risks, it is only used as a last resort.

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