Watch Out for Back Pain in Young People!

Back pain is a very common problem worldwide and becomes more frequent over time. Chronic back pain due to various causes can develop in at least 10% of the adult population. Since most cases resolve within a short time, back pain is often not taken seriously.

Causes of Back Pain

Some back pain is caused by mechanical reasons such as a herniated disc or a compression fracture of the lumbar vertebrae,

Some is caused by an inflammatory rheumatic disease that begins particularly in young to middle age, Ankylosing Spondylitis (AS) and related diseases.

In addition, although rare, some types of cancer may also present for the first time with back pain.

Likewise, some infections such as Brucella can also present with back pain.

For this reason, 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 frequent cause of chronic back pain arising in young people. AS has been recognized in recent years as a disease that is common in society. It is reported that AS and related diseases occur in about 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 Ankylosing Spondylitis?

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, in these patients a gene called HLAB27 is detected at least 10 times more often than in healthy people. Furthermore, 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. Likewise, psoriasis and inflammatory bowel diseases (such as Crohn's disease and ulcerative colitis) can also cause these diseases to emerge.

How does Ankylosing Spondylitis begin?

Its main feature is back pain that develops insidiously between the ages of 20 and 40. This pain increases after prolonged periods of inactivity. For example, the patient feels worse in the morning; the pain in the lower back starts after midnight and becomes more intense in the morning.

When the patient moves, goes to work, or bathes in hot water, they feel better in terms of back pain. Over time, the pain also settles in the back and neck, restricts movements of the lower back, back and neck, and can cause a hunched back. These diseases do not only affect the lower back. They can 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. For this reason, it is essential that everyone with anterior uveitis in particular be investigated for AS and related diseases.

If people with psoriasis and inflammatory bowel disease also have back pain, care should be taken regarding these diseases. Although rare, it can lead to heart, lung and kidney problems. It can cause decreased bone density and compression fractures in the vertebrae.

Timely consultation with a rheumatology specialist allows the disease to be recognized earlier. Many cases have been treated for years, and even undergone surgery, under a diagnosis of herniated disc.

Is there a difference between men and women?

Some studies report that this group of diseases is seen somewhat more often in women. However, the disease generally runs a milder course in women. In men it may run a more severe course, progressing over time to severe hunching. More severe disease presentations develop less frequently in women. However, this disease does not mean it should go untreated in women. In untreated patients it can cause many problems, especially deformities of the spine and other joints, and kidney and heart problems.

How is the treatment of Ankylosing Spondylitis?

These diseases are inflammatory conditions that, in genetically predisposed individuals, are triggered by external factors such as infection. Our primary goal is to suppress inflammation. For this, in addition to medication, patients should do exercises that strengthen back muscles. Swimming and volleyball are very suitable for this. Patients are advised not to sleep on their side, to sleep on their back or lying prone and stretched out, and to quit smoking. In conclusion, young people with 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 deformities associated with this disease and the disabilities that may develop as a result.