Kangjun Yoon, CEO of Gangnam Peter Hospital
# Hwang Sang-yeop, a man in his 30s, has felt severe pain in his lower back when he wakes up in the morning for several years. I didn’t think it was a big deal because the symptoms went away when I moved, but the pain slowly got worse to the point where I woke up early in the morning. Mr. Hwang, who was initially diagnosed with lumbar disc herniation and received physical therapy, did so and eventually went to another hospital because the pain extended to his ankles, where he was diagnosed with “spondylitis ankylosing”. Mr. Hwang was confused by the unfamiliar name of the disease, thinking it was a geriatric disease, but the doctor explained that it was a “rheumatic disease,” which has a high risk of developing in men in their 20s and 40s.
Spinal diseases will be more likely to occur in men in 2040… It’s a slow process, but if left untreated it can stiffen the back.
It is a type of autoimmune disease that causes symptoms throughout the body, such as peripheral arthritis, psoriasis, and ocular uveitis.
After the initial diagnosis it is possible to lead a normal life if exercise and drug treatment are combined. Arbitrary interruption of treatment is prohibited.
“Ankylosing spondylitis,” unlike other spinal diseases common in older adults, is a “young” spinal disease that affects socially active men in their 20s and 40s. According to data from the Health Insurance Review and Assessment Service (HIRA), there were 52,616 patients in 2022, and this number is increasing every year. Taiwan’s top singer Jay Chou is known to suffer from ankylosing spondylitis, and King Sejong the Great is also believed to have suffered from ankylosing spondylitis since he was 30 years old.
Ankylosing spondylitis is a type of spondyloarthritis characterized by inflammation of the spine and its attachment area (where tendons, ligaments, etc. attach to bones). Gangnam Peter Hospital’s neurosurgery specialist director, Kang-Jun Yoon, explains: “Ankylosing spondylitis progresses slowly, but if it continues to get worse, it develops into a ‘bamboo spine’ symptom where the lower back stiffens like bamboo.” In this case, it is not only difficult to bend and straighten the back, but the risk of vertebral fractures occurring even with a small impact quickly increases.
The problem is that, since the disease itself is not well known, the risk of not diagnosing it early is high because it is confused with other symptoms such as disc and muscle pain. The first Saturday in May each year is World Ankylosing Spondylitis Day. To celebrate the upcoming World Ankylosing Spondylitis Day, we’ve taken a detailed look at ankylosing spondylitis, from the characteristics and symptoms of the disease to the treatments.
Having a specific gene increases the chance of developing the disease… Peripheral arthritis, psoriasis and eye pain may also occur
Although the exact cause of ankylosing spondylitis has not yet been revealed, the medical community believes that it is a type of autoimmune disease caused by genetic factors. This is because it is known that the probability of developing the disease is relatively higher if you have the HLA-B27 gene, one of the white blood cell antigens. CEO Kang-Jun Yoon explained: “Not everyone who has the HLA-B27 gene suffers from ankylosing spondylitis, but 90% of patients with ankylosing spondylitis have the gene,” adding: “In other words, it can be considered a of diseases that runs in families.
Ankylosing spondylitis is closer to a systemic disease than a musculoskeletal disease. The symptoms are not limited to the spine but appear in the joints and various organs. One of the representative symptoms is stiff back pain, but its appearance is different from other spinal diseases. Ankylosing spondylitis worsens during rest or sleep, while the pain improves with activity or exercise. It is also common to suffer from peripheral arthritis of the knees, ankles and toes, achilles tendonitis, shoulder tendonitis and psoriasis. Additionally, symptoms such as inflammatory enteritis, uveitis of the eyes, and reduced kidney function may occur. In fact, there are records that King Sejong the Great also suffered from back and knee pain, and eye pain that was presumed to be uveitis.
If the symptoms are left untreated, as mentioned before, the risk of the entire bone becoming attached and hardening increases. A series of processes occur in which the inflammatory tissue within the spine is replaced by bone and at the same time, osteophytes of the bone ligaments grow through endocartilaginous ossification and the vertebrae transform into a united bamboo spine Together. When spinal deformation like this occurs, the risk of fractures from even a small impact increases, while also increasing the risk of complications such as cardiovascular disease, gastrointestinal disease, and kidney disease.
What is noteworthy is that, as mentioned above, the incidence of ankylosing spondylitis is high in men under the age of 40. People often experience the first symptoms between their teens and 20s. In fact, according to HIRA data, in 2022 there were 38,216 male patients, 2.6 times more than female patients, and among these the percentage of patients aged between 20 and 39 was approximately 38.8%. Since it is a disease that affects the most active age group and since it begins with mild symptoms, the risk of inadvertently ignoring it is high. In fact, the Korean Society of Rheumatology announced the results of a survey in 2019 that showed it takes nearly three years to receive a correct diagnosis of ankylosing spondylitis.
Although it is an incurable disease with no cure, daily living is possible with regular exercise and drug treatment.
Ankylosing spondylitis is an incurable disease without a cure, but if it is diagnosed early and you continue to receive appropriate treatment, you can lead a peaceful daily life. CEO Kang-Jun Yoon said: “If your back pain persists for more than 3 months, feels stiff when waking up in the morning, or is accompanied by various symptoms other than back pain, it is best to immediately consult a specialist and receive a diagnosis”. The earlier the diagnosis, the better the treatment.” “The prognosis is good, so the quality of life can be improved,” he explains.
Ankylosing spondylitis is first diagnosed through physical examination, imaging tests, and blood tests. The physical examination is conducted with the ‘Schober test’, ‘thoracic distensibility test’, and measurement of the distance from the larynx to the wall (occiput-wall), but in the case of patients, their overall movements tend to be inflexible . In addition, observation of the spine via X-ray and MRI (magnetic resonance imaging) and blood tests are also performed to check genes, inflammation levels and rheumatoid factor.
Once ankylosing spondylitis is diagnosed, treatment is directed at reducing and managing pain and stiffness. First, to reduce pain and increase mobility, anti-inflammatory painkillers are taken for a long time, and physical therapy is also performed. It is important to keep your joints flexible and stable by consistently performing stretching, aerobic exercises, strength training and spinal exercises. If this method does not work, biologic agents such as TNF blockers (tumor necrosis factor inhibitors) and IL-17 blockers (interleukin inhibitors) are used to prevent spinal deformation.
What is most important is consistent treatment and follow-up management. Gangnam Peter Hospital neurosurgery specialist director Kang-Jun Yoon said: “Since ankylosing spondylitis is a persistent disease, if it is neglected or arbitrarily stopped treatment, there is a risk of accelerated spinal stiffness He added: “If you have any suspected symptoms, visit a hospital and consult a specialist. “I advise you to consult yourself,” he explained.
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