According to the Arthritis Society of Canada, 6.5 million Canadians report experiencing chronic mechanical back pain at one time or another.
But sometimes, your back pain can signal something more — like Ankylosing Spondylitis (AS).
AS is a type of inflammatory arthritis that affects roughly 300,000 Canadians. If left untreated, it can cause immense pain and lasting damage to the spine.
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“This is a slowly progressive disease… that starts off with pain and slowing down and stiffness,” said Dr. Nigil Haroon, co-director of the Spondylitis Program at the University Health Network in Toronto.
Without treatment, the spine can fuse together and decrease mobility.
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However, getting an accurate diagnosis can be difficult because back pain is so common.
Singer Dan Reynolds, the frontman for Imagine Dragons, recently revealed he was diagnosed with AS after years of pain.
“Not only did I not know what AS was, but for a lot of doctors, it’s not the first thing they think of,” Reynolds told People.
According to Haroon, the average delay in diagnosis is eight to 10 years.
Because of this, the number of people with a confirmed diagnosis is likely lower than the actual number of Canadians living with AS.
One reason AS takes so long to diagnose is because back pain can be a symptom of several other issues. There is also no definitive test that you can do for AS.
There is a gene associated with AS — the HLA-B27 gene — but not everyone who has AS has the gene. Alternatively, if you do have this gene, that does not necessarily mean you will develop AS.
Haroon says much is still unknown about AS and its causes. However, a family history increases your risk of developing AS significantly.
“Among the rheumatic diseases, this is probably one of the most common ones that you will see running in families right now,” said Haroon.
Smoking can also increase your risk of developing AS, and it can make treatment less effective.
If you’re concerned your back pain may actually be AS, there are some other signs and symptoms to look out for.
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The signs and symptoms of Ankylosing Spondylitis
The No. 1 symptom of AS is persistent back pain that lasts longer than three months.
Other symptoms can include joint pain, psoriasis, eye inflammation and inflammatory bowel disease (IBD).
According to Haroon, age is also a factor.
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“The nature of back pain in AS is slightly different from what you would see in somebody who is elderly,” said Haroon. AS is more common in people under the age of 45.
Dr. Robert Inman, a rheumatologist who sits on the Canadian Spondylitis Association Medical Advisory Board, agrees.
“Peak onset age is in between your 20s and 30s, and it affects both men and women,” he said.
There are many different treatment options
The treatment options have significantly improved in the last 10 years, said Haroon.
Both Haroon and Inman agree that there are different forms of treatment that are better suited for different stages of the illness.
Initially, Inman prescribes exercise and physiotherapy as a way to manage pain and keep the spine moving.
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“At stage two, I will prescribe non-steroidal anti-inflammatory drugs,” said Inman.
“If those two approaches don’t get us where we want to go — which is an adequate control of the symptoms — we move onto what are called the biologics.”
Biologics are pharmaceutical drugs. If diagnosed with AS, you may be prescribed any one of the following: adalimumab, certolizumab pegol, etanercept, golimumab, infliximab or secukinumab.
“We would estimate, in general, a 75 per cent response rate to the first biologic,” said Inman. “If the patient hasn’t responded to one, we will commonly go onto a second and even, on occasion, a third to achieve symptomatic improvement.”
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In treating AS, medical professionals have both short-term and long-term goals.
“The short-term goals are to improve symptoms — which are primarily pain, stiffness and fatigue — and improve quality of life and overall functioning,” said Inman.
Inman says there is evidence to support that biologics can do both.
Early treatment is key
“The best results are achieved when we diagnose early and we treat early,” said Inman.
While this is to improve quality of life, it’s also to avoid a fusing of the spine — which can happen if the symptoms are left untreated.
“When you have pain… you have a tendency to slouch,” Haroon said. “If the spine fuses in that posture… then you lose your horizon because you have a big stoop forward.”
Only around 10 per cent of people have this kind of severe fusion.
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If you’re diagnosed with AS, taking care of your body is crucial.
“Do your exercises, take your medications… quit smoking,” said Haroon. “All of these are good, healthy habits which will help to manage pain.”