Forms
Axial spondylarthritis (inflammation of the spinal column) is divided into two forms, depending on the presence of signs of inflammation or structural changes in the spinal column. Non-radiographic axial spondyloarthritis: No changes are visible on X-rays, but signs of inflammation can be detected on MRI. This is usually the case in the early stages of the disease Radiological axial spondyloarthritis: structural changes or ossification of the joints are already visible in the X-ray image as a result of the chronic inflammation.
- Non-Radiological Axial Spondyloarthritis: No changes are visible in the X-ray image, but signs of inflammation can be detected in the MRI. This is usually the case in early stages of the disease
- Radiological axial spondyloarthritis: Structural changes or ossification of the joints are already visible in the X-ray image as a result of the chronic inflammation.
Therapy
Therapy focuses primarily on pain relief and suppression of inflammation, as well as maintaining spinal mobility and reducing stiffness. Medications of first choice are non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac, as these have both analgesic and anti-inflammatory effects.In case of existing complaints, these drugs can be consistently taken in maximum daily doses, taking into account the side effects caused by them, especially complications in the gastrointestinal tract. If a patient fails to respond to a non-steroidal antirheumatic drug, another one from the same class of drugs can simply be administered, as some patients respond better to one, others better to the other.
If at least two non-steroidal antirheumatic drugs fail, a therapy with so-called tumor necrosis factor-alpha blockers, or TNF-alpha blockers for short, can be considered. TNF-alpha-blockers are drugs that intervene in the regulation of inflammatory messengers and thus reduce inflammatory activity. Besides drug therapy, exercise plays an important role.
Regular exercise can relieve pain and slow down or even stop the progressive stiffening. Physiotherapy is the therapy of choice here, whereby additional joint-gentle sports such as swimming or cycling should be integrated into everyday life. Massages or ultrasound therapy can also help to relieve the pain.
Surgical interventions, for example a joint replacement, are usually only necessary in advanced stages, when ossification or wear and tear of various joints has already occurred. If the back is inflamed due to an infection of a vertebral body with bacteria or other germs, treatment with antibiotics is usually carried out to prevent the bacteria from spreading further. If this treatment does not lead to success, an additional surgical procedure must be performed on the affected vertebral body.
In addition, patients are advised not to smoke, as smokers have been shown to have an increased disease activity and a faster progression of the disease. In the case of inflammation of the back with rheumatic cause, various drugs are used. NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, diclofenac or naproxen can be taken as needed, i.e. always when back pain occurs, or continuously.
They have analgesic and anti-inflammatory effects and can thus improve the mobility of the spine. Inflammations of the back caused by an underlying rheumatic disease can progress in relapses. If there is an acute relapse, the additional administration of cortisone is advisable, since this has a strong anti-inflammatory effect and can strengthen the effect of the NSAIDs.
If NSAIDs and cortisone are taken together, an additional gastric acid inhibitor such as omeprazole or pantoprazole should be taken as stomach protection. In severe cases of early and severely impaired mobility, the so-called biologicals can be used as a reserve remedy. These intervene directly in the immune system and block messenger substances which are necessary for the development of an inflammatory reaction.
A very important messenger of an inflammatory reaction is the tumor necrosis factor-alpha (TNF-alpha). This can be inhibited by a group of drugs, the TNF-alpha blockers, and thus slow down the inflammatory reaction. An important representative of this group is called Eternacept.
In the case of inflammation of the back caused by an infection of a vertebral body with germs, various antibiotics, antifungals or antiparasitics are used, depending on the pathogen. Cortisone plays a major role in the treatment of an inflammation in the back caused by a rheumatic disease. In particular with acute thrusts of back pain or rigidity Cortison is used.
Cortisone inhibits the release of messenger substances required for an inflammatory reaction and thus has an anti-inflammatory and pain-relieving effect, improving the mobility of the spine. If cortisone is taken in high doses over a long period of time, it can cause bone loss (osteoporosis) and disturbances in sugar metabolism (diabetic metabolic state) as important side effects. In addition to medications such as NSAIDs, cortisone or the Biologicals, homeopathic remedies can also be used for back pain in the context of inflammation of the back.
Homeopathic remedies that can provide pain relief in the case of inflammation of the back include Strychnos nux vomica (common nux vomica), Arnica montana (real arnica) or Cimicifuga (grape silver candle). However, if the inflammation of the back is caused by an infection with bacteria or other germs, antibiotic, antifungal or antiparasitic therapy should never be avoided. Inflammations of the back can be treated with both heat and cold.When acute back pain occurs in the context of an inflammation of the back, most people affected feel cold, for example by using cooling gels, cooling compresses or cooling packs to relieve pain.
The cold causes the blood vessels to contract and inflammatory reactions are slowed down, thereby achieving the pain-relieving effect. If the back pain persists over a longer period of time and is already chronic, warmth is usually perceived as pleasant. Persistent back pain usually leads to poor posture and muscle tension. These can be loosened by warmth and the resulting increased blood circulation in the affected muscles and thus an analgesic effect can be achieved.
