Today, I'm diving into the realms of back pain and sciatica, shining a light on ankylosing spondylitis (AS) and the vital elements surrounding its diagnosis and management. Stick around till the end, and I’ll also share a crucial tip to prevent back and neck pain during Zoom and Microsoft Teams calls.
Ankylosing spondylitis, or AS, often slips under the radar, masquerading as just another case of back pain. A young physiotherapist once referred to AS as a "trap" — a diagnostic pitfall that leads to a long-standing misdiagnosis. Many patients endure years of uncertainty, resulting in severe complications like spinal deformities.
Your key elements form the history are:
1. Age and Duration: If the patient is under 45 years old and has experienced back pain for over three months.
2. Morning Pain: Back pain that worsens in the morning or disturbs sleep, improving with exercise or movement.
3. Morning Stiffness: Lasting for more than 30 minutes.
4. Diagnostic Momentum: Revisiting the diagnosis rather than adhering to labeled mechanical back pain, especially in men and those with a family history.
The way to catch AS is to get back to basics. Use the good old SOCRATES acronym. I mentioned diagnostic momentum which means if someone has been labelled as having mechanical back pain, there is a risk that we will just run with that diagnosis without retaking a proper history, and maybe just give them some more naproxen. Remember, men are twice more likely to get AS, it does run in families and there can be extra-articular features such as uveitis. If left untreated –there are long-term complications involving spinal fractures, osteoporosis and deformities.
In terms of investigations and tests – I would be guided by your local rheumatology dept. Often we can speed up the difficult diagnostic process by facilitating a pelvic x-ray looking at the SI (sacroiliac) joints – inflammation of these joints is a one of the diagnostic criteria.
Regarding referrals – if you have someone under the age of 45 years with back pain for more than 3 months and 4 or more of the following features – refer. And this is from CKS.
Low back pain starting before the age of 35 years.
Symptoms which wake them during the second half of the night.
Improvement when moving.
Improvement within 48 hours of taking a nonsteroidal anti-inflammatory drug (NSAID).
Spondyloarthritis in a first-degree relative.
Current or past arthritis.
Current or past enthesitis.
Current or past psoriasis.
Now, if you want to look smart, you should always mention HLA-B27. Chances are people will stare at you in awe of your knowledge and won’t follow up with any extra questions, because most of us have heard of this but not really done any extra reading on it. It’s basically a gene known as the Human Leukocyte Antigen B27 gene and it’s thought that 90% of people with AS have this gene. Interestingly- 8% of the human population have this gene as well, although that does not correlate with the prevalence of AS (0.05% - 0.23% according to NICE 2016). Other diseases associated with HLA B27 are Psoriasis, Inflammatory Bowel Disease and Reactive Arthritis.
And now, the bonus tip to spare your back and neck during online meetings:
Preventing Zoom-induced Pain: Raise your screen! Invest in a separate keyboard, prop your laptop up on a riser or box, and adjust the camera to eye level. It’s a simple switch that can alleviate the strain on your back and neck, especially during extended virtual meetings.
Hope this information proves helpful! If you need recommendations or want more content like this, drop a comment below or subscribe for future updates. Feel free to email me directly for any queries.
Wishing you a pain-free, healthy day ahead!
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All readers should be aware that medical sciences are constantly changing and evolving and whilst the author has checked all dosages and guidance are based upon current indications, there may be specific practices and procedures that differ between localities, countries and nations. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practicing.