Severe back pain

Bechterew’s disease: warning signs are often overlooked

Deep pain in the lumbar spine as a warning signal.

(Bild: ArTo/stock.adobe.com)

It often begins before the age of 40, usually in the 20s or 30s: severe pain occurs in the lower lumbar spine. It usually torments sufferers in the early hours of the morning, forcing them out of bed. Sleep is no longer an option, as the problems only improve after getting up and moving around.

"These complaints are often not easy to distinguish from 'normal' back pain caused by muscle weakness and tension, and can of course also occur," explains Vienna-based Priv.-Doz. Dr. Johannes Grisar, specialist in internal medicine and rheumatology. "This is why ankylosing spondylitis is still diagnosed late in many cases. On average, it takes up to seven years before a person knows what they are actually suffering from."

High number of unreported cases
The number of unrecognized patients is likely to be correspondingly high. This inflammatory rheumatic spinal disease is an autoimmune disorder that often begins with inflammation in the sacroiliac joints. In this country, around one in 200 Austrians is affected. The condition cannot be prevented, nor do we know what actually triggers it.

There are other indications that put doctors and patients on the right track: Certain genetic markers in the blood are elevated in up to 90 percent of those affected, but not necessarily. And accompanying symptoms are also special, according to Doz. Grisar: "Almost half suffer from uveitis, i.e. inflammation of the iris in the eye. Many suffer from psoriasis, and inflammatory bowel diseases such as Crohn's disease or ulcerative colitis rarely occur at the same time. Other joints can also be affected and become swollen or painful." If there is also a family history of inflammatory (rheumatic) autoimmune diseases, these symptoms should also ring alarm bells.

Nobody needs to despair today! There are now very good therapies available, but these should be started early.

Priv.-Doz. Dr. Johannes Grisar, Rheumatologe, Wien

Bild: Crown Copyright

Don't despair, there is help!
"But nobody has to despair today! There are now very good therapies with several treatment options, but these should be used early to avoid late effects such as hardening and stiffening of the bones," says the rheumatism specialist encouragingly. "Painkillers (non-steroidal anti-inflammatory drugs) work well for some patients. However, if these do not lead to sufficient pain relief, so-called biologics are used. These include TNF blockers and interleukin 17 inhibitors, which are injected under the skin. JAK inhibitors from the small molecule group, which are taken in tablet form, have also been available for around five years."

These options can be considered equally helpful; the doctor and patient decide together which form of therapy is most suitable.

Regular exercise is important
Regular exercise is also important for ankylosing spondylitis sufferers. "In fact, people who exercise often feel much better physically than 'couch potatoes'. Regular physiotherapy is also a necessary supplement to drug treatment," explains Doz. Grisar.