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Inflammatory arthritis and back pain: when the cause of your back pain is a little different

The term arthritis can be confusing. It's a vague term, often used for multiple conditions that are very different. The most common type of arthritis is osteoarthritis; however, this article is about inflammatory arthritis, which is a specific type of disease process that affects multiple joints throughout the body. It's a different condition for a variety of reasons, which we will explain below.

Inflammatory arthritis is also known as spondyloarthritis, or seronegative arthritis. It's confusing, because there are multiple names for the same disease. And it gets more confusing, because there are specific subtypes.

Spondyloarthropathies are a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases that primarily include ankylosing spondylitis, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases.

Spondyloarthritis arthritis is common in younger patients. The primary pathologic sites are the entheses (the sites of bony insertion of ligaments and tendons); the axial skeleton, including the sacroiliac joints; the limb joints; and some nonarticular structures such as the gut, skin, eye and aortic valve.

The reason inflammatory arthritis affects so many joints and tissues in the body is due to some specific sequences of events in the body. In particular, inflammatory arthritis is an autoimmune disorder. Here, the body's immune system begins to generate specific disease processes in the blood which attack multiple joints in the body. Instead of fighting foreign pathogens, the body begins to attack itself. Because it is systemic, one of the diagnostic factors for this condition is exactly that: multisite joint pain in both sides of the body and affecting the organs. This should make sense because your blood is circulating throughout your body.

Inflammatory arthritis can be frustrating fo patients, who often present to chiropractors, physios, general practitioners. One of the real challenges is the diagnosis of the condition. Typically, it can take 8 years to diagnose this condition. However, once a diagnosis is made, it is a good idea to see a specialist in the area. These specialists are Rheumatologists.

Some common features of the condition include pain that is better with exercise but worse with rest. Pain that affects multiple joints, the stomach, and the eye is also a hallmark feature. One subtype, psoriatic arthritis, is common in people with psoriasis. Some people have changes to the nails or fingers, too.

For Ankylosing Spondylitis, there are a some who will be positive with a specific blood marker known as HLA-B27. It was once thought that this condition was more common in men, who also have HLA-B27. However, the evidence has changed and it is now believed that the condition is just as common in women. Furthermore, it is very common to carry the HLA-B27 gene marker, but not have Ankylosing Spondylitis. One of the tests that is usually performed for this condition is an X-ray of the spine, which can sometime show signs of the disease's progression.

Managing the inflammation involves a global, team based approach. You may require medication from your specialist. These are a good idea and in some cases, they can really slow down some of the disease progression. Exercise, meditation and diet are also beneficial, as is managing stress. Lastly, many people with these conditions also are prone to depression. Therefore, you may require some help from psychologists.

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Khan, Muhammad Asim. "Update on spondyloarthropathies." Annals of internal medicine 136.12 (2002): 896-907.

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