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Inflammation of tendons could be a warning sign for the diagnosis of ankylosing spondylitis

Enthesitis, an inflammatory process in the union of bone and tendon, precedes the development of spondyloarthritis.

Dominican Republic, May 2019. Pain in the soles of the feet and heels, lower back pain, particularly in the lower back, which is relieved by physical activity, and morning stiffness in the back are some of the symptoms that patients With ankylosing spondylitis they experience and often confuse with other diseases.

This is confirmed by the Medical Manager of Novartis for Central America and the Caribbean, Dr. Yendry Rojas. “Ignorance of the disease means that many people do not have an appropriate diagnosis; they visit the wrong specialist or self-medicate in an attempt to reduce pain, without getting proper attention to their condition. Some patients take several years to achieve a correct diagnosis; meanwhile, his illness continues to progress. There is no cure yet, but if the disease is treated in time, the patient will have a better chance of controlling their condition properly and will have a better quality of life, ”said the doctor.

Ankylosing spondylitis is a chronic disease that causes pain and inflammation in the joints located between the vertebrae and the sacroiliac joints (the region where the spine meets the pelvis). Occasionally, arms and legs may also be affected. About 70% of patients with severe ankylosing spondylitis may experience vertebral fusion, which significantly reduces their mobility and quality of life.

What do we know about ankylosing spondylitis?

Myth: Ankylosing spondylitis is a very rare disease.
Fact: Ankylosing spondylitis is much more common than diseases such as leukemia, muscular dystrophy or cystic fibrosis. It is estimated that currently, in Latin America, 12.2 out of 10,000 people suffer from the disease.

Myth: Ankylosing spondylitis is a progressive disease that always ends in the fusion of the spine.
Fact: Progress, as well as the symptoms and severity of the disease,  vary from patient to patient. In either case, early detection can make a difference.

Myth: Ankylosing spondylitis only occurs in older people.
Fact: The first symptoms of the disease usually manifest between the ages of 17 and 35; Only 5% of patients have symptoms after age 45.

Myth: Ankylosing spondylitis does not affect women.
Fact: Ankylosing spondylitis is three times more common in men. Women can also suffer from it, although it evolves more slowly in them.

Myth: Nothing can be done to help the patient.
Fact: Although it is a disease that has no cure, an early diagnosis can prevent erroneous treatments and decrease the progression of the disease. A rheumatologist is the one who must diagnose the disease through the assessment of symptoms, blood tests, and x-rays. Initiating proper medical treatment can minimize symptoms and reduce the risk of disability and deformity. There are novel biological treatments that can help the patient.

“Patients who present some of the symptoms described should visit a rheumatologist and together they can evaluate the innovative treatments available that offer sustainable, fast and safe solutions for them,” said Irene Arguedas, Director of Corporate Affairs at Novartis for Central America and the Caribbean.

What causes the disease?

The causes of the disease are not yet clear. However, it is related to the hyperactivity of the immune system and directly, with the cytokine IL-17A. This cytokine is an amplifier of enthesitis, which is the inflammation of the area where the bone and tendon join.

For the patient, this results in strong pain in the soles of the feet or heel, or in other places where it is possible to feel the tendon attached to the bone, such as the knees and elbows, among others. In some cases, the pain is not so obvious, and it may only be possible to perceive it with routine palpation performed by the doctor as part of the clinical evaluation or through ultrasound images. Also, patients may report back stiffness, pain, movement restriction, and fatigue.

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