Pay Attention to Lower Back Pain in Young People!

Lower back pain is a very common problem worldwide and is becoming more frequent over time. Chronic lower back pain due to various causes may develop in at least 10% of the adult population. Since most of it has no clinical significance and resolves in a short time, lower back pain is often not taken seriously. However, some of these pains are caused by mechanical reasons such as herniated disc and compression fractures of the lumbar vertebrae, while others are caused by inflammatory rheumatic disease, especially Ankylosing Spondylitis (AS) and related diseases, which start in late youth and middle age. In addition, although rare, some types of cancer may present for the first time with lower back pain. Some infections, such as Brucella, may also present with lower back pain. For these reasons, lower back pain should be taken seriously and it is necessary to investigate whether there is an underlying disease.

Here we will discuss Ankylosing Spondylitis (AS) and related diseases, which are a common cause of chronic lower back pain in young people. AS has been recognized in recent years as a common disease in society. It is reported that AS and related diseases occur in approximately 0.1-1% of adults. That is, for example, if we assume there are 100,000 adults in a medium-sized province, we can estimate that there are at least 100 to 1,000 patients with AS and related diseases.

What is the cause of the disease?

The cause is not yet known. However, if one of the parents has this disease, the likelihood of it appearing in children increases. This suggests a genetic component. Indeed, a gene called HLAB27 is found in these patients at least 10 times more frequently than in healthy people. In addition to the presence of this gene, some microbes that cause intestinal and urinary tract diseases lead to the development of AS and related diseases. Also, psoriasis and inflammatory bowel diseases (such as Crohn's disease and ulcerative colitis) can cause these diseases to occur.

How does the disease begin?

Its main feature is lower back pain that develops insidiously between the ages of 20 and 40. This pain increases after long periods of inactivity. For example, the patient feels worse in the morning, and the lower back pain becomes more intense in the morning, starting from midnight. When the patient moves, goes to work, or bathes in hot water, they feel better in terms of lower back pain. Over time, the pain also settles in the back and neck, restricts movements of the lower back, back and neck, and may cause a hunched back. These diseases do not only affect the lower back. They can also affect many joints, especially joints such as the ankle and knee. Involvement of the hip joint can be severe enough to require a hip replacement.

In some cases, the disease begins for the first time with an eye disease called uveitis. Therefore, it is essential that everyone with anterior uveitis in particular be investigated for AS and related diseases. In people with psoriasis and inflammatory bowel disease, if back pain occurs, these diseases should be considered carefully. Less commonly, it can lead to problems with the heart, lungs and kidneys. It can cause decreased bone density in the spine and compression fractures. Timely consultation with a rheumatology specialist allows the disease to be diagnosed earlier. Many cases undergo years of treatment, and even surgeries, under the diagnosis of herniated disc.

Is there a difference between women and men?

Some studies report that this group of diseases is seen slightly more frequently in women. However, the disease generally progresses more mildly in women. In men, it may progress more severely and go on to a severe hunched back over time. Severe disease presentations are rarer in women. However, the presence of this disease in women does not mean it should go untreated. Untreated patients may experience many problems, especially deformities of the spine and other joints, as well as kidney and heart problems.

What is the treatment like?

These diseases are inflammatory conditions that progress in genetically predisposed individuals and are triggered by some external factors, such as infection. Our primary goal is to suppress inflammation. For this, in addition to medication, patients should do exercises that strengthen the back muscles. Swimming and volleyball are very suitable for this purpose. Patients are advised to avoid sleeping on their side, to sleep on their back or stomach and lie straight, and to quit smoking. In conclusion, young people with lower back pain that is more pronounced in the morning should not neglect it and must consult a physician. Early diagnosis and treatment will minimize joint and spinal damage associated with this disease and the disabilities that may develop.