Our back is a complex construction of ligaments, muscles, bones and many small joints. One of the most common complaints, from which almost 80% of all Germans suffer once in their lives, is back pain. There are many causes for this, but most of them are temporary problems which in some cases resolve themselves and in others can be remedied with a little therapy.
Back pain that lasts longer than three months is called chronic back pain. In about 5% of the affected people, the cause of chronic back pain is an inflammation of the spine. In medical terminology, this inflammation is called axial spondyloarthritis and belongs to a series of rheumatic diseases.
Typically, the inflammation begins in the sacroiliac-iliac joint and spreads over the course of a few years to the entire spine, although there are always variations in the spread and manifestation of the disease. In addition to the spine, other joints and organs can also be affected by the disease. In the most severe form of the inflammatory spinal disease, the so-called ankylosing spondylitis, the severe chronic inflammation leads to ossification of the vertebral joints with an accompanying stiffening of the affected spinal segment.
Symptoms
The decisive symptom is back pain, but there are some features that are characteristic of inflammatory back pain: In addition, it is typical that patients wake up in the second half of the night because of the back pain and that this pain only gets better after movement. In complete contrast to this, back pain of other causes, for example pain caused by a herniated disc, which worsens under movement and improves at rest. In addition to back pain, other symptoms can occur during the course of the disease, such as joint swelling, which often manifests itself asymmetrically in the legs and feet, heel pain caused by inflammation of the tendon attachment (enthesis) or inflammation of a finger or toe (dactylitis).
Symptoms can also occur in other organs such as: Especially in the early phase of the disease it is difficult to distinguish chronic inflammatory back pain from non-inflammatory back pain. Crucial for the diagnosis is the combination of several symptoms and the specific pain characteristics, as well as a close monitoring of the pain.
- Back pain that begins insidiously at a young age, typically before the age of 45, often between the ages of 20 and 30
- Time of pain: especially at night and in the early morning, in addition there may be morning stiffness that lasts longer than 30 minutes
- After getting up, as well as during movement, the pain improves
- Pain does not improve at rest
- The back pain has existed for more than three months
- The pain can occur alternately in the gluteal region
- Psoriasis on the skin
- Inflammation of the iritis of the eyes (Iritis)
- Chronic inflammatory bowel disease (Crohn’s disease Ulcerosa)
- In very rare and very severe cases, complications of the heart, lungs or kidneys can also occur.
Inflammations of the back, both rheumatic and infectious, can be accompanied by fever, i.e. a body temperature of 38 degrees Celsius or more.
If fever occurs, care should be taken to ensure an adequate fluid intake and cooling measures (e.g. cooling calf compresses) should be used. If the fever is high, antipyretics such as paracetamol can be used to reduce the fever. In the case of an inflammation in the back, pain may also occur in the shoulder blade or between the shoulder blades, depending on the location of the inflammation. Persistent back pain as a result of an inflammation of the back can lead to poor posture and muscle tension, which can also cause pain in the shoulder blade. Pain in the shoulder blade improves under drug therapy with NSAIDs, cortisone and biologicals as well as under physiotherapeutic treatment.
