Arthritis of Spine Targets Young Men

October 2, 2008

back pain It’s a disease that affects between 150,000 and 300,000 Canadians, strikes males three times as often as females and is literally a pain in the backside.

Ankylosing spondylitis (AS) is a mouthful to say, so some people call it "poker back." Having it can wreak havoc with your golf game, and make just getting around the house difficult.

New advances in diagnosis and treatment may help catch AS early and greatly ease the negative effects of this disease.

AS is a type of arthritis that usually affects the spine. According to a recent paper by Dr. Saeed A. Shaikh of McMaster University, "ankylosing spondylitis most commonly has its onset while a patient is in their 20s, although late teenage years are also relatively common for initial symptoms."

He adds that the disease "has a predilection to affect young males." It also has a strong genetic component, with a gene called HLA-B27 showing up in 93 per cent of the patients with AS, but is seen in only six per cent of the general population.

According to Shaikh, it can still be very difficult to diagnose, and "on average, there is a seven-to-10-year delay in the diagnosis of this disease from the onset of symptoms."

It doesn’t help that, he says, "the majority of back pain sufferers do not seek care from healthcare providers. Young men tend to be the segment of the population that are the least likely to do so."

So, you young guys, being tough and sucking it up when confronted with an aching back may work against you.

Magnetic Resonance Imaging (MRI) technology can reveal the earliest signs of this disease, especially inflammation in the sacroiliac joints, long before anything would show up on a conventional X-ray. (The sacroiliac joints connect the sacrum — the wedge-shaped bone at the bottom of the spine — to the pelvic bones.)

If left unchecked, AS can cause chronic back pain, stiffness, especially in the morning, as well as fatigue and pain in the joints. There can also be consequences elsewhere in the body, including eye infections, psoriasis and inflammatory bowel disease. In advanced cases, bony spurs can grow out from the edges of the vertebrae, fusing together parts of the spine and making movement even more difficult.

The Arthritis Society of Canada has plenty of good, objective information on this disease on its website, It says treatment usually starts with a non-steroidal anti-flammatory drug, like the ones you probably have in your medicine cabinet. Corticosteroids are sometimes given by injection into the affected join to provide short-term relief. For severe cases, there are disease modifying anti-rheumatic drugs such as methotrexate and sulfasalazine. Of course any medication can have side-effects so the benefits need to be weighed against the risks.

A new class of AS treatments involves biological response modifiers, sometimes just called biologics. These drugs work by plugging up the pathway that leads to inflammation. According to the Arthritis Society, they "recently have been shown to have the potential to slow or even halt the progression of AS in some people."

You can tell there’s big money in biologics, since the company behind one of them, Remicade® (infiximab), has sponsored a very high-quality website called On it, an unidentified, but very trustworthy looking guy in a white coat reviews the treatment options. While the information is medically vetted and factual, with links to other sources, it’s still useful to remember that the pharmaceutical company Schering-Plough Canada Inc. pays the bill for this website.

Most of the biologics are given by intravenous injection, at intervals of several weeks or months. Because of their cost, which the Arthritis Society estimates at $15,000 to $25,000 per year, most provincial health plans restrict them to patients whose disease cannot be controlled by conventional treatments. And because they depress the immune system, there are certainly people who should not be taking them at all.

Of course, there are some excellent non-pharmaceutical approaches to ease this disease. They range from stretching exercises to physical therapy to trying to maintain good posture. A physiotherapist can be very helpful in showing you how.

Moderate physical activity is desirable, but the Arthritis Society cautions against contact sports such as rugby or hockey, or falling down sports like skiing, because a person with AS may be at greater risk of spinal fracture.

Most experts agree that people with AS will always be aware of their disease, but advances in diagnosis and treatment can keep it under control. Famous people with AS reportedly include baseball player Rico Brogna and Mötley Crue guitarist Mick Mars.

Then again, former world chess champion Vladimir Borisovich Kramnik may be a more relevant example for most of us. The discomfort of sitting at a chessboard actually forced him out of the game.

But with medication for his AS, he was back for the 37th Chess Olympiad in June 2006. For now at least he seems to have his disease in check.

Tom Keenan, I.S.P., is an award-winning science writer, professional speaker and professor at the University of Calgary.