Spondyloarthritis: simple rules for diagnosing

More than 7 in 10 people will experience back pain in their lifetime, most often episodes but sometimes chronically and in some cases with increasing disability.
In the majority of cases, the cause is linked to a deterioration of an intervertebral disc: when an appropriate intervention is quickly implemented, the person with low back pain can quickly regain normal functioning of his back.
But in about 5 to 10% of cases, especially in young men, the cause may be linked to a chronic inflammatory disease: it is then a “spondyloarthritis”. Its diagnosis is difficult and most often late, but a recent study shows that an earlier diagnosis would be possible based on a very small number of signs.

Improve diagnosis

When a low back pain recurs too frequently or lasts more than 3 months, in particular in a person under 45 years old, whether it is a man or a woman, it is advisable to ask yourself the question of spondyloarthritis and ask the only really interesting question: “What time does your back hurt the most during the day: in the morning or in the evening?” “.
If the answer to this question is: “in the morning”, if this pain can be responsible for waking up in the second part of the night or in the early morning (“wake-up-morning” pain), if it is accompanied in the morning stiff back that lasts at least half an hour (“morning rust”) and then subsides during the day.
If this pain is relieved at least 50% in less than 24 to 48 hours by a simple non-steroidal anti-inflammatory drug … the question of the existence of inflammatory low back pain no longer arises and the attending physician will have to ask an MRI of sacroiliacs and a search for HLA B27. These examinations will support the diagnosis in one out of 2 cases and the patient will have to be sent to consult a specialist in rheumatology to confirm this delicate diagnosis and specify the type of spondyloarthritis in question.

A diagnostic period of 7 years

Spondyloarthritis was formerly a disease responsible for ossification of the spine, and therefore “ankylosing”, but with the improvement of hygienic conditions and anti-inflammatory treatments, most of the current patients do not have radiographic lesions. specific during the first years of the disease.
Worse, since these are mostly young, active men, a trivial disc problem can be seen on the x-ray, further complicating the diagnosis.
Finally, in the absence of a simple biological marker (HLA B27 does not exist in all patients and it is found in 7 to 8% of cases in the general population), doctors tend to accept the explanations given by patients. sick: “I just moved. I made a wrong move. I have to change my mattress ”.

A potentially disabling disease

Spondyloarthritis is a group of autoimmune diseases that have in common the inflammation of the insertions of tendons and ligaments on the bone (“entheses”). This “enthesitis” causes inflammatory low back pain which is expressed especially in the morning.
With this low back pain, it is possible to suffer from pain in the buttocks, heels, but also from various tendonitis and extra-articular problems: inflammation and redness of the eye (“uveitis”), skin psoriasis or inflammatory disease of the eye. intestine or colon.
It is also associated with a family history of low back pain and a very high sensitivity of pain to non-steroidal anti-inflammatory drugs.

As spondyloarthritis evolves in flare-ups, it affects the spine and certain joints of the body which gradually deteriorate, as well as other organs (eye, intestines, heart, etc.). The personal and social cost of a late diagnosis of the disease is therefore significant because spondyloarthritis significantly affects the patient’s quality of life and late management often results in an inability to maintain normal professional activity.

National Spondyloarthritis Day, organized by the association ACS, will be held on March 12, 2016 at the Forum de Grenelle, 5 rue de la Croix Nivert, 75015 Paris.

Back pain: Simple rules for diagnosing spondyloarthritis https://t.co/MbpyeEWNRW #health pic.twitter.com/GBmVPQGPAd

– Pourquoidocteur (@Pourquoidocteur) January 30, 2016