[Health Tip] Sudden Hip Pain?... Suspect Gangjigseong Cheokchuyeom (Ankylosing Spondylitis)

Professor Sanghoon Lee, Department of Rheumatology, Kangdong Kyung Hee University Hospital

Professor Sanghoon Lee, Department of Rheumatology, Kangdong Kyung Hee University Hospital
[Image source=Kangdong Kyung Hee University Hospital]

Ankylosing spondylitis is a chronic disease characterized by recurrent inflammation of the spinal joints. As inflammation recurs, changes occur in the joints, causing the back to become hunched and the neck stiff. Early detection and treatment lead to a good prognosis, but missing the treatment window can make daily life difficult. The problem is that ankylosing spondylitis does not cause severe pain initially and can be easily relieved with painkillers. Together with Professor Lee Sang-hoon of the Rheumatology Department at Gangdong Kyung Hee University Hospital, we explore the subjective symptoms and treatments for early diagnosis of ankylosing spondylitis.

◆A disease causing a hunched back due to repeated joint inflammation and deformation= Ankylosing spondylitis is a chronic disease that causes inflammation in the joints. The inflammation in the joints comes and goes repeatedly, leading to joint deformation. The joints become stiff, movement slows down, and eventually, the entire spine stiffens, causing the back to hunch. Besides the spine, inflammation can occur in various parts of the body, and if it affects the intestines, eyes, or skin, it can manifest as inflammatory bowel disease, uveitis, psoriasis, and other conditions.

◆Ankylosing spondylitis patients increased by 20% in five years= The number of ankylosing spondylitis patients is steadily increasing. According to the Health Insurance Review and Assessment Service, the number of patients visiting hospitals for ankylosing spondylitis rose from 43,686 in 2018 to 52,616 in 2022, an increase of over 20% in five years. As of 2022, men were 2.5 times more likely to be affected than women, with men in their 30s and 40s being the most common. The cause remains unclear but is believed to be related to the 'HLA-B27' gene. Infections, trauma, and stress also influence the condition.

◆Starts in the hip joints, causing pain in the pelvic bones= Early detection and treatment of ankylosing spondylitis lead to a good prognosis. However, because the pain is not distinctive, appears intermittently, and can be controlled with painkillers alone, many miss the treatment window. It usually begins with inflammation in the hip joints, initially causing alternating pain in both pelvic bones. As the disease progresses to involve the thoracic vertebrae, even mild coughing causes chest pain, and pressing with the hand also triggers pain. Stiffness and pain are worse in the morning but ease during daytime activity. Pain intensifies overnight, often waking patients from sleep. If these symptoms persist for more than three months, it is essential not to delay and to visit a hospital for diagnosis.

◆Diagnosis through pain patterns, range of motion, and imaging tests= When ankylosing spondylitis patients visit a hospital, doctors first review the pain history and objectively measure the joint's range of motion. Basic X-ray examinations are performed, but abnormalities are difficult to detect in the early stages with simple X-rays alone. Recently, CT or MRI scans allow for more precise and faster diagnosis. Finally, blood tests confirm HLA-B27 positivity for definitive diagnosis.

◆Early ankylosing spondylitis can be controlled with medication and exercise therapy= If detected early, ankylosing spondylitis can be managed with a combination of medication and exercise therapy to prevent progression of spinal stiffness. Daily life is hardly affected. Medication varies according to the patient's condition and includes nonsteroidal anti-inflammatory drugs, antirheumatic drugs, as well as TNF inhibitors, IL-17 inhibitors, and JAK inhibitors. Exercise therapy involves rehabilitation to improve joint flexibility and muscle strength. When medication and exercise therapy are combined, only about 10% of patients progress to ankylosis. However, if diagnosis is delayed and the thoracic vertebrae are involved with some degree of spinal stiffness, treatment outcomes cannot be optimistic. Once joints have stiffened, recovery is impossible. Therefore, it is crucial to recognize symptoms early and start treatment promptly.

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