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Spondylosis Signs Symptoms Diagnosis And Treatment

Spondylosis Signs Symptoms Diagnosis And Treatment

Posted By HealthcareOnTime Team Posted on 2022-02-09

Among top day-to-day health concerns, back pain is one of the most known and commonly experienced condition. Long hours of sitting in the office, frequent leaning down to pick up things, lifting heavy bags or other items, and many such hip twisting-turning activities and others tend to make you experience back pain every now and then Moreover, this back pain which at times can be mild while at other times excruciating can make you seek refuge in some or other form of pacifiers like medicines, hot bag, ointments, etc. Even studies suggest that mostly every adult is bound to seek medical attention for back pain at some point in their life! As we mentioned, there could be numerous reasons behind the back pain you may experience with majority of them being contributed by some or the other way of mechanical stress or even sudden trauma to your back. But beware, not always it could be some mechanical stress that affects and gives you back pain. Because there lies one serious condition in which the back pain may also signal... Ankylosing spondylitis.

Spondylosis Signs Symptoms Diagnosis And Treatment

What is spondylitis?
Ankylosing spondylitis (AS) is a chronic inflammatory disease that is found to affect the sacroiliac joints and the spine. It is thus not any normal back pain one may experience due to physical trauma to the spine. Rather, it is a kind of rheumatoid Arthritis, which causes either growth or even fusing of the vertebrae, resulting into a rigid spine. The fusing of the spine thus manifests itself in the form of severe pain and stiffness right in the neck to the lower back of the affected individual. Such mild to prominent changes in the spine may give rise to 'stooped-over' posture making even simple movements like sitting or walking painful for the individual.

The exact cause of spondylitis is unknown however, geneties and heredity is found to play a significant role in this condition. The alleles of Major histocompatibility complex (MHC), particularly of HLA-B27 is known to account for the major portion of being a causative factor towards spondylitis. Other MHC alleles that may also contribute towards spondylitis include HLA-B60, HLA-DR1. HLA-B27 is also found to be an important marker which can vary based on the race and ethnicity of an individuals or groups.

Who is affected by Ankylosing Spondylitis?
Being a disorder primarily affecting the axial skeleton, spondylitis is found to be prevalent in about 0.19 to 29 in a given population with a higher score on the male population than in females. The estimated male female ratio is as high as 5:1 with a mean age for its onset being between 15 to 35 years.'

Signs & Symptoms of Spondylitis
The course of spondylitis development differs greatly from individual to individual. While in some the onset of symptoms would start as early as at the age of 17, in others, the symptoms may appear in adulthood. Moreover, the symptoms are generally found to appear within the age span of 17 to 45 years and in certain cases, even before 17 years. Intermittent flare-ups of pain and stiffness in the spine are the common symptoms of spondylitis; however, the disease in later stages can also affect other joints along with eyes and intestines. Advanced stages of spondylitis can also enuse bone growth in the spine that ultimately fuse together reducing the mobility of an individual.

The initial symptoms of spondylitis include pain and stiffness in the lower back and buttocks which eventually increases over the course of weeks to months. Usually a diffused or dull pain and discomfort is felt either on one side of the back or alternate sides worsening in the mornings and during nights. The pain may subside with a warm shower or light exercise, but only temporarily The individual may also suffer from general discomfort, mild rise in temperature and loss of appetite. Though these initial symptoms of back pain may be similar in nature to one which are caused due to long hours of sitting, lifting of heavy things, etc., it should be understood that spondylitis is not caused due to any mechanical straining, but purely due to inflammation of the spine. Also, yet another aspect to be noted is that the presentation of symptoms at its onset are different in males and females.

As the condition advances vigorously, the pain becomes chronic and is felt on both sides of the spine, This will continue for a minimum of 3 months until the stiffness and pain gradually spread throughout the spine reaching the neck area. The pain will eventually be felt in the ribs, shoulder blades gradually moving down the hips, thighs and even heels. The chronie pain and stiffness in the back eventually poses danger of spinal fusion thus rendering difficulty in mobility in an individual

Other spondylitis symptoms that the individual might experience would include fatigue which is mostly caused due to body's energy spent in dealing with the increased inflammation. This could be coupled with anemia of mild to moderate nature, overall contributing to tiredness. One may even experience fever and loss of appetite and in some cases, may also develop lung and heart problems. Yet another group of individuals will experience the symptoms differently with the onset of pain in peripheral joints like that of hip, ankle, elbow, heel or shoulder than in the lower back. The peripheral joint pain is more common in juveniles suffering from spondylitis and is generally confused with other types of arthritis.

spondylitis though affects the spine and other joints, is also found to be associated with other conditions such as ulcerative colitis (Crohn's Disease). Again, it is reported that almost one third of people suffering from spondylitis are also found to experience inflammation of the eyes (iritis). This typical inflammation of the eyes is characterised by painful, red and watery eyes. The individual also becomes sensitive to bright light and may experience blurring of vision.

An individual suffering from spondylitis may also experience its effects on some of the ligaments and tendons that are attached to the bones. Inflammation of these tendons (tendonitis) may give rise to pain and stiffness in the areas surrounding and beneath the heel.

Diagnosis of Spondylitis
The diagnosis of spondylitis is usually found to get delayed till the later stages. This is mostly due to symptoms experienced which are not specific to the condition in its initial stages. Diagnosis in its initial days is however, based on various factors as mentioned below.

Physical Examination: As the clinical signs are minimal in the initial stages, physical examination, specifically of the musculoskeletal system is essential. This would also include sacroiliac joint, spine and neck examination.

Other physical examination strategies would include measurement of chest expansion during breathing. This is essentially done as in the later stages of the condition, the spine becomes stiff affecting its mobility in all the planes including restriction of chest expansion.

Examination of motion of the hip, shoulder joints, presence of signs of enthesitis (inflammation of the entheses - a site where the tendons/ligament enter the bone) are also carried out to achieve an early diagnosis of spondylitis. Though important findings may be observed in enthesitis, they are majorly overlooked in juvenile AS patients.

In the advanced stages, diagnosis of spondylitis would show presence of spinal osteoporosis which is majorly caused due to lack in mobility of the spine. However, it is also important to note that spinal osteoporosis can also show relation with mineralisation defect. Such individual with a l'igid spine accompanied with osteoporosis is highly susceptible to severe fractures by any mild trauma.

Imaging: A yet another reliable way to diagnose spondylitis is through imaging. On accurate physical examination, the next step would include to understand the radiographic features of the spin and other joints which may be affected due to spondylitis. Evidence of any inflammation of the sacroiliac joint (sacroiliitis) detected through X-ray analysis forms a major indicator to understand the presence of spondylitis in the individual. spondylitis in its intial stages might not necessarily be easy to interpret using normal X-ray radiographs. In such cases, the patient may be required to undergo a magnetic resonance imaging (MRI), which will conveniently aid in understanding the presence of the condition.

Also, implementation of dynamic MRI or short tau inversion recovery (STIR) to understand inflammatory response associated with sacroiliitis is suggested.

Computed Tomography (CT) analysis is again another technique that is implemented to detect changes in bones which are secondary to sacroiliitis. Also, the cross-sectional image produced in a CT is more accurate in providing complete image of the anatomy of the sacroiliac joints. However, there are also chances of the PET-CT Scan report being a false positive for diagnosis of sacroiliitis as the results obtained in the images may also be due to normal age-related erosion and space narrowing

Biochemical analysis: HLA-B27 testing can be used for biochemical analysis for spondylitis and very well proves to lessen the uncertainty linked in determining presence of spondylitis in the individual. HLA-B27 testing forms as a presumptive test along with other methods like physical examination, or familial history which suggests presence of the condition. HLAB27 cannot be regarded purely as a routine, diagnostic or even confirmatory test for spondylitis if the patient shows symptoms of arthritis or back pain.

Studies suggest that up to 70% of patients with active spondylitis also show elevated levels in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) despite lack of any correlation with the condition. However, these acute phase factors have found to be of limited usefulness to screen and understand the presence of this condition.

Treatment strategies for Spondylitis
Due to delayed diagnosis of the condition, spondylitis tends to remain under-treated. Though there is no complete cure to the condition, treatments available for the same can be only implemented to reduce the discomfort one may experience. Thus, the treatments implemented majorly involve reducing the pain and stiffness that occurs in the spine, prevent any type of deformity or troubled posture and assist in performing everyday activities with least difficulty.

Medications: Use of medicines and other pain relieving drugs is the only way to lower the painful episodes of spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen are commonly suggested and used for treating spondylitis. Again antirheumatic drugs can be used in combination with NSAIDs if they prove to be less effective towards reducing inflammation, pain and stiffness. Many types of steroid injections are also used to relieve pain from joints or tendons.

Occupational and physical therapies for spondylitis This would include implementation of a well-scrutinised exercise schedule suggested by a physician or physiotherapist to help reduce stiffness and strength ening the muscles. Following a proper exercise regime will ensure in minimising and preventing chances of succumbing to any form of disability

Surgery: Majorly implemented in advanced stages which have affected the joints or other parts. Surgical intervention is mostly needed in joint replacements and is majorly carried out due to the extreme effects on the joints of hips or knees. "

Ankylosing spondylitis affects majorly in the adolescent stage challenging an individual's future endevours in life. But with timely diagnosis and proper treatment plans in place, one can surely live a better life with less pain and challenges to face in their day-to-day activities.


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