What if your back is stiff when you wake up in the morning? Ankylosing spondylitis should be suspected…

It is different from normal back pain. After waking up in the morning, the stiffness of the lower back continues for more than 30 minutes, and the pain disappears only when you move. It is most common in young men between their late teens and early 20s. Starting from the hips and climbing to the waist, chest and neck, the spine hardens into whole bones like bamboo. It is called rigidity because the broken spine is deformed hard. Learn about ‘ankylosing spondylitis’, a disease that quietly destroys life.

Ankylosing spondylitis is common in young menㅣSource: Getty Image Bank

What is ankylosing spondylitis, which increased by 27.7% in 5 years?
Ankylosing spondylitis is not a problem of simple back pain that gets better with rest, like a herniated disc. ‘Rigidity’ means that joint changes occur after a long period of inflammation, resulting in slow movement of the joints. Spondylitis is inflammation of the spine. In other words, ‘ankylosing spondylitis’ is a chronic inflammatory disease where inflammation appears in the spine and it becomes stiff. As well as the spine, it can also occur in the hip, knee and shoulder. Unlike other spinal diseases that occur in the middle-aged and elderly, the awareness of symptoms is very low, and it is often neglected.
However, according to data from the Health Insurance Review and Assessment Service, the number of patients is constantly increasing every year. The number of patients which was 40,064 in 2016 increased consistently every year recording 51,106 in 2021. This is an increase of 27.7% over 5 years. In addition, as of 2020, male patients (34,891) were found to be 2 to 2.5 times more than female patients (13,370).
Park Jin-soo, professor of rheumatology at Ilsan Hospital of the National Health Insurance Service, said, “Men have more severe symptoms than women, and the onset time is about 2 to 3 years earlier, but the reason is unknown. It is thought to be linked to sex hormones as well as genetic factors.” he explained.
The cause of ankylosing spondylitis has not yet been clearly identified, but it appears to be linked to genetic factors. In actual patients, the genetic factor ‘HLA-B27’, which is not easily seen in others, appears. However, even if you have it, ankylosing spondylitis does not necessarily occur, and only 1-2% of benign cases develop. In addition to genetic factors, various causes such as environmental factors or increased immune responses affect ankylosing spondylitis.

Young uninvited guests ‘ankylosing spondylitis’, it’s not just back pain
Ankylosing spondylitis is difficult to prevent, but early diagnosis and treatment can prevent spinal deformity and ankylosis. The symptoms vary from person to person, but the most common is back pain. In the early stages of symptoms, pain starts slowly in the lower back or hip and is accompanied by stiff ‘morning stiffness’ on waking in the morning. It can be mistaken for simple muscle pain, disc, menstrual cramps, etc., so there are cases where the disease develops or when the timing of the treatment is missed. Back pain is characterized by an improvement in movement and stiffness again when the patient is at rest.
Ankylosing spondylitis is a chronic inflammatory disease that can affect any part of the body. In other words, it’s not just back pain. According to the Korean Society of Rheumatology, in addition to the spine, joints in one leg may be swollen or painful, and pain may occur in the heel and ribs. Depending on the patient, leg symptoms may appear before spine symptoms, so attention is needed.
In some cases, chest pain comes first without spinal symptoms. Ankylosing spondylitis can cause inflammation in the area where the ligament attaches to the bone Inflammation of the rib cartilage can cause chest pain. Furthermore, if the lungs cannot expand due to stiff ribs, shortness of breath or coughing can occur.
Ankylosing spondylitis is not a simple spinal disease, but an autoimmune disease where the body’s immune cells attack the spinal joints beyond the immune system, so symptoms can appear in areas other than the joints.
The most common disease is uveitis. Symptoms may include red, painful or watery eyes, double vision or blurred vision due to bright lights. In addition, when inflammation occurs in the mucous membrane, symptoms such as abdominal pain, diarrhea, indigestion, and bloody stool may appear, and psoriasis may occur.

Regular stretching and quitting smoking are helpful.
Spinal joints once deformed by ankylosing spondylitis do not recover to their original condition. Therefore, it is important to seek treatment as soon as possible when ankylosing spondylitis is suspected. If treatment is started early, it is possible to live a normal everyday life by slowing down the progression of the disease as well as preventing the symptoms from worsening further.
Ankylosing spondylitis is mainly treated with non-steroidal anti-inflammatory drugs to reduce inflammation and eliminate pain. Recently, considering the effect of preventing spinal deformity, it is treated with a biological injection called ‘tumor necrosis factor (TNF)-alpha inhibitor’. Because it treats inflammation by blocking the action of TNF-alpha, which is the cause of the disease , it cures pain quickly.
In order to increase the effect of the treatment, it is good to combine medication and exercise. Exercises recommended by the Korean Society of Rheumatology include stretching, swimming and cycling. Stretching is good for stretching the neck, shoulders, torso, waist, and hip joints back as much as possible. Regular stretching can help relieve pain.
“Ankylosing spondylitis is a disease that needs constant management, and it is important to stretch often to maintain joint flexibility and maintain proper posture,” says Haidak Rheumatology Consulting Doctor Song Sang-ho (Welton Hospital) “Swimming It’s also an aerobic exercise that doesn’t put too much stress on the joints, but care is needed if there’s a neck deformity.”
Lifestyle is also important. Avoid lying or sitting in too soft a place for a long time, and smokers should stop smoking immediately. Smoking is very dangerous, especially if spinal stiffness has already developed. This is because cigarettes not only have a bad effect on the lungs, but can also further reduce lung capacity due to rigidity.

Support = Director Song Sang-ho, counseling physician at Haidak (Rheumatology Specialist at Welton Hospital)

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