Monday, August 20, 2012

Do I have inflammation?

If you watch too much TV you could end up thinking that all pain was due to 'inflammation'.  Interestingly while there are certainly times when the physical tearing of connective tissues occurs most spinal pain is not generated by the significant swelling of the joints.  Even arthritis is mostly non inflammatory.

And thank goodness for that because some people do have conditions which produce significant inflammation, joint irritation and destruction.

Rheumatology is a lifetime of study but there are useful tips which may help guide the individual towards recognising the more complex (and likely) inflammatory conditions which tend to involve amongst other structures, the spine (spondyloarthropathies)

These are typical presentations.  If there are any suspicions it is recommended that you seek advice.  The diagnosis of these conditions often only becomes apparent over time and may involve various blood tests.  Other clues are unusual joint problems in the family. In clinical practise these patients will not respond in the expected manner.  For example response to treatment will vary and lifestyle factors become far more important.

1. Males look out for Seronegative spondyloarthropathies such as Ankylosing Spondylitis

They are inflammatory arthritides affecting the axial skeleton.
Usually present in patients under 40 years of age
Commonly include thoracic pain (commonly with an advancing stoop) , sacroiliitis (low back/pelvis) and enthesopathy - inflammation of tendon insertions in the legs and problems with other connective tissues (the eyes, gut, etc)
Are often more problematic at night with morning stiffness taking > 30 minutes to dissipate.
2. Females are more likely to be affected by Rheumatoid Arthritis which typically begins to affect the hands and is not so evident in the spine.

Our main contribution in these cases is to help improve overall mobility and quality of life.  In some cases education and reassurance are the most significant things we can offer.


EDIT:  Try these links for more recent dietary approaches to AS.