Causes
Inflammation of the back, i.e. the vertebral joints, vertebral bodies or vertebral ligaments, can be caused by various rheumatic diseases, which are collectively known as spondylarthritides. The group of spondylarthritides includes five clinical pictures: Spondylarthritides are genetic diseases whose mechanism of development has not yet been fully clarified.Probably a mutation of a specific gene, the HLA-B27 gene, is the cause, as this gene has been detected in the majority of patients. Inflammations of the back or vertebral bodies due to infections are called spondylitis.
In most cases, infections of the vertebral bodies result from a colonization with bacteria, which reach the vertebral bodies via the bloodstream. However, an infection of the vertebral bodies is also possible through fungi, viruses or parasites. Inflammation of the back due to an infection of the vertebral bodies with bacteria or other germs is very rare.
- Bechterew’s disease
- Reactive joint inflammation (for example Reiter’s syndrome)
- Enteropathic spondylarthritis (an inflammation of the joints associated with chronic inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis)
- Psoriatic spondylarthritis (an inflammation of the joints associated with psoriasis)
- The undifferentiated joint inflammations that frequently occur in children and adolescents
The diagnosis is made from the symptoms described above. First of all, a detailed medical history is taken in the form of an anamnesis. In addition, there is a physical examination, in which the condition of all joints, especially the spinal column, is assessed, including mobility, pressure pain, swelling or possible bad posture.
If there are symptoms in other organs, these are also extensively examined and any abnormalities are documented. A further important examination in the diagnosis of inflammatory spinal disease is the blood test. Here, the determination of the inflammation parameters in the form of the blood sedimentation rate (BSR) and the C-reactive protein (CRP) is important and indicative.
The determination of the HLA-B27 gene can also be helpful, since the presence of the gene is often associated with rheumatic disease. However, a non-existent HLA-B27 gene is by no means an exclusion criterion for the presence of a rheumatic disease. Only about 60-85% of all patients with an inflammatory spinal disease are HLA-B27 positive.
Likewise, a positive HLA-B27 test does not always have to be associated with a rheumatic disease. However, the blood test alone is not sufficient to make a diagnosis, which is why an X-ray or magnetic resonance imaging (MRI) of the spine is required as a further diagnostic tool. In the early phase of the disease, the spine usually appears normal and inconspicuous on X-ray, as this examination cannot reveal any acute inflammation in the joint.
Only after years, when changes in the joints have occurred in the course of the inflammation, can the consequences, such as ossification, be found in the X-ray image. The situation is different with magnetic resonance imaging (MRT). With this examination method, active inflammatory processes can be visualized even before any changes have occurred in the joints.
For this reason, magnetic resonance imaging is an important examination, especially in the early stages. In addition, unlike X-rays, it is free of any radiation. From the combination of all these examinations, the diagnosis of spinal column inflammation is made at the end.
