Striking prevalence of Axial Spondyloarthritis in primary care patients with chronic low back pain; a cross-sectional study

Among the most common causes of chronic pain is low back pain.  Recent study data indicates a "strikingly high" correlation between  chronic low back pain and Ankylosing Spondylitis.  In my case, I had unusual wear on the low back due to a severe knee injury which caused a limp for a number of years - a limp where the low back and hip took on the load bearing for the injured knee, as well as a shearing motion in doing so.  This strain could have been a contributor to chronic low back pain.  Then there was the osteoarthritis which was more advanced in me than typical in young people as a result of the injury and surgeries such as bone-grafting and other highly invasive interventions.  Then there were episodes of lumbar disc herniation requiring surgery.  All of these alone or as a group, as well as a chronic pain syndrome wherein the overstimulation of certain neural pathways causes perceived pain in the low back, could be responsible for chronic low back pain in my case (and at least some of these perhaps in your case).  Since it on average requires 7-10 years to diagnose  AS, and since AS is most successfully treated early in its' development, there is a new push to give primary care physicians better information so that that long period where AS is seldom diagnosed can be brought down to a shorter interval - and hopefully therefore, allow more effective treatment.

Not only does AS turn out to be present in over twenty percent of patients experiencing chronic low back pain, but that number may be significantly under-reported.  This abstract, and the full article are worth reading if you, or someone you care about is experiencing chronic low back pain.

Remember this:  Just because there is something that MIGHT be causing chronic low back pain (injury, prior surgery, wear and tear arthritis, etc.), don't rely on the fact that your chronic pain COULD be due to one of these other causes, get to an experienced rheumatologist who will carefully look at your status and make a diagnosis of AS if appropriate.   In my own case, the first rheumatologist I saw, about four years into the progression of symptoms, noted that I had injury and osteoarthritis and made the assumption that these were the cause.  My own outcome from treatment of AS would likely have been far more successful at early days in the development of the disease, than it has been since I saw an excellent rheumatologist about eight years into the situation.  If you are referred to a rheumatologist, or have endocrine issues accompanying your chronic lower back pain, see the rheumatologist and by all means get a second opinion.  Four or five years lost in fighting AS is a damn shame.

Press - News - 457 - Striking prevalence of Axial Spondyloarthritis in primary care patients with chronic low back pain; a cross-sectional study

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Understanding Arthritis: What is inflammation?

When the Immune System Turns Against You 

Arthritis isn’t just “wear and tear”.  It is inflammation, and understanding the causes of inflammation can help immeasurably in combating the debilitating and potentially life-altering effects of arthritis.  The following article, from WebMD is a very straightforward discussion of the inflammatory process. 

Understanding Arthritis: What is inflammation?

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Remicade, Lidocaine and Cortisone

I went in today for my Remicade infusion.  After two loading doses I had definitely felt some real improvement in my smaller joints.  I’d had pain and stiffness in my hands, which had made typing and even writing much with pen or pencil difficult.  My left thumb and my right middle finger would sometimes lock in position and I literally had to snap them loose with the other hand.  And it didn’t feel good!  My feet as well as the heels of the foot were always stiff and sore, especially with any standing at all.  The thickening of both shoulders had stretched the muscles and connective tissue and those hurt often.  There were other aches and pains as well.  Remicade thus far has improved the way those smaller joints feel by a noticeable amount.  I am hoping that I see even more benefit now that it is at full strength in my blood.  Since advanced osteoarthritis – something I have a strong family history of, but that likely was set in motion decades earlier than typically by the bone-grafting and revascularizations surgeries I had on my left knee as an early teen – is another contributor to my creakiness, and my knees have both been very sore, I got injections today of lidocaine (numbed the joint for an hour or two) and cortisone (intended to reduce inflammation).  Hopefully the cortisone will reduce the inflammation.  I’ll also have the synthetic joint fluid injections done next week or so.  Those of you who’ve had needles inserted into swollen and sore joints will know that it isn’t that much fun.  Today the lidocaine kicked in quickly and within seconds the knees weren’t hurting at all.  I’d love to be able to use lidocaine every day!  I’ll have to hope that the cortisone does it’s bit and the synthetic joint fluid works well also. 

It is always complicated to resolve interrelated conditions - when you have more than one or two issues contributing to one another, and I’m working on a half-dozen conditions that feed one another.  I’ve been pretty limited and I am still not able to be very active.  But for the first time in years I have seen this degenerative group of conditions stopped, and actual progress has begun.  So I have my fingers crossed.  I’d seen a rheumatologist a couple years ago, but that doc noted advanced osteoarthritis and sent me on my way with instructions to see an orthopedic surgeon and get the knees replaced.  I was referred to Dr. Stephen Overman at Seattle Arthritis Clinic and from the moment I had my intake appointment I knew that if I could be helped, I would be.  He’s written a great book for people combating diseases which are not obvious, called You Don't Look Sick!, written with a patient named Joy H. Selak (http://www.joywrites.com/). 

As a person who has always been active, busy, engaged and had a good time too, the degenerative process that I had been experiencing over recent years was more like a death in the family than an illness.  I found myself unable to do so many things I’d always done, and my sense of humor went to live with somebody else!  Though I have a long way to go, Dr. Overman, the book he has written with Ms. Selak, Remicade, and the many tools and techniques I’ve been made aware of at the Seattle Arthritis Clinic have given me the first progress I’ve seen in years, and hope that I’ll gain back a meaningful semblance of the things I have seen slip away in recent years. 

Technorati Tags: Arthritis Research,Chronic Illness,Chronic Pain,Ankylosing Spondylitis,Remicade,Arthritis Treatment,Dr. Stephen Overman,Osteoarthritis

Mapping Knee Pain Helpful in Diagnosing and Treating Osteoarthritis

From National Institute of Arthritis and Musculoskeletal and Skin Diseases Spotlight on Research, September 2009

Although it is well understood that osteoarthritis causes progressive damage and pain to the knee joint, currently doctors do not have good data concerning which types of damage or location leads to various experiences of pain by patients.  According to C. Kent Kwoh, MD, "Right now we don't have a good idea of what causes knee pain, and different people have various types of knee pain. The Knee Pain Map gives us a better way of describing different groups of people in terms of their knee pain and then getting a better understanding of what's causing it and ultimately how to cure it or help people manage it better."

Dr. Kwoh recently conducted a study to evaluate the impact a standardized process using a diagram of the knee allowing the interviewer to map the locations a patient indicates to be the focus of pain.  The study included nearly 800 patients, and allowed interviewers to determine if pain in the knee was localized to any of seven areas in the knee, or regionalized to any of four larger (hand sized) areas of the knee, or if the patient was either unable to locate the pain in an area the size of their hand, or if the patient was unable to locate the knee pain it is termed to be diffuse.

The researchers found that participants with knee pain could identify pain locations and patterns and that trained examiners could reliably record the location of knee pain using the Knee Pain Map. "To our knowledge, this is the first study that allowed patients to either point to an area or cover a region that hurt, giving the patient the responsibility of identifying their pain as being in a specific location versus a more general region," Dr. Kwoh and his colleagues wrote in the journal Arthritis & Rheumatism.

“It is likely that there are several different causes and sources of pain, says Dr. Kwoh. While there are no nerve endings in the cartilage itself, the surrounding structures - including bone, joint lining, ligaments, etc. - do have nerve endings that may be sources of painful sensation, he says. Mapping the location of pain may eventually help doctors better understand the causes or sources of pain and how to treat them.

The next step will be to compare findings from patients' reports on the Knee Pain Map with x-ray and MRI findings collected as part of the Osteoarthritis Initiative (OAI), a public-private partnership between the NIH and private industry that seeks to improve diagnosis and monitoring of the progression of OA and foster development of new treatments. Nearly 5,000 people who have OA or are at risk of OA are participating in the OAI at four centers in the United States. In addition to x-ray and MRI scans, participants provide biological specimens (blood, urine, and DNA) and clinical data such as dietary intake, medication use and pain, function, and general health assessments.”

Mapping Knee Pain Is a Reliable Way to Identify Pain Location and Pattern

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