Inflammation of the back
Our back is made up of a complex construct Ribbons, Muscles, bone and many small joints. One of the most common ailments that almost 80% of all Germans suffer from at one point in their life is Back pain. There are many causes for this, but most of them are temporary problems that in some cases resolve themselves and in others can be remedied with a little therapy.
In the case of back pain that lasts longer than three months, one speaks of chronic back pain. In around 5% of people affected, the cause of chronic back pain is one Inflammation of the spine.
In medical terminology, this is called inflammation axial spondyloarthritis and belongs to a number of Rheumatic diseases. Typically, the inflammation begins in the sacrum-iliac joint, and over the course of a few years spreads to the entire spine, with variations in the spread and manifestation of the disease. In addition to the spine can also other joints and organs be affected by the disease. In the most severe form of inflammatory spinal disease, the so-called ankylosing spondylitis, it comes as a result of the severe chronic inflammation resulting in ossification of the vertebral joints with an accompanying Stiffening of the affected part of the spine.
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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The crucial symptom is that Back pain, however, there are some features that are characteristic of the inflammatory back pain are:
- Back pain that begin gradually at a young age, typical before the age of 45, often already between the 20 and 30 years of age
- Timing of pain: in particular at night and on early morning, can be added Morning stiffnessthat lasts longer than 30 minutes
- After getting up and at Movement will relieve the pain
- The pain does not improve in rest
- The back pain is already there longer than three months
- The pain can alternately in the buttocks area occur
In addition, it is typical that those affected wake up in the second half of the night due to back pain and this pain only improves after exercise.
In complete contrast to this are back pain from other causes, for example pain caused by one disc prolapse which worsen with movement and improve at rest.
In addition to back pain, other symptoms can occur in the course of the disease, such as Joint swellingwhich are common asymmetrical on the legs and feet express, Heel pain- caused by a Inflammation of the tendon insertion (Enthesis) or Inflammation of a finger or toe (Dactylitis).
Symptoms can also occur in other organs such as:
- Psoriasis on the skin (psoriasis)
- a Iris inflammation of the eyes (Iritis)
- inflammatory bowel disease (Crohn's disease / Ulcerative colitis)
- In very rare and very severe cases it can also too Heart, lung, or kidney complications come.
In the early stages of the disease, in particular, it is difficult to distinguish chronic inflammatory back pain from non-inflammatory back pain. The decisive factor for the diagnosis is Combination of several symptoms and the specific pain characteristics, as well as one close monitoring of the pain.
Inflammation of the back, both rheumatic and infectious, can result from fever, so one Body temperature of 38 degrees Celsius and more, be accompanied.
If a fever occurs, one should adequate hydration respected and cooling measures (e.g. cooling calf compresses) can be used. If the fever is severe, the fever can be reduced with medication Antipyretics, for example Paracetamol respectively.
If there is inflammation in the back, depending on the location of the inflammation also pain in the shoulder blade or between the shoulder blades occur.
Persistent back pain as part of an inflammation of the back can lead to Fepostures and muscle tension which can also cause pain in the shoulder blade. Pain in the shoulder blade improves with drug therapy with NSAIDs, cortisone and biologicals as well as with physiotherapy treatment.
Inflammation of the back, so the Vertebral joints, Vertebral bodies or Vertebral ligaments can through different rheumatic diseases be conditional, which are summarized as Spondylarthritis are designated.
Fall into the group of spondylarthritis five clinical pictures:
- the Bechterew's disease
- reactive joint inflammation (for example that Reiter syndrome)
- enteropathic spondylarthritis (an inflammation of the joints associated with inflammatory bowel diseases such as Crohn's disease or ulcerative colitis)
- psoriatic spondylarthritis (an inflammation of the joints associated with psoriasis)
- the undifferentiated joint inflammation that often occurs in children and adolescents
Spondylarthritis is a genetic disease whose mechanism of origin has not yet been fully understood. There is probably one Mutation of a particular gene, of HLA-B27 gene as this could be proven in the majority of those affected.
Inflammation of the back or the vertebral body caused by infections are called Spondylitis designated. Mostly arise Infections of the vertebral bodies by colonization with bacteriawhich reach the vertebral bodies via the bloodstream. An infection of the vertebral bodies is also through Mushrooms, Viruses or Parasites possible. An inflammation of the back due to an infection of the vertebral bodies with bacteria or other germs is very rare.
Diagnosis of inflammation in the back
The diagnosis is made from the symptoms described above. First of all, a detailed survey of the medical history made in the form of a anamnese. There is also one physical examination, which especially the Condition of all joints, especially the spine, with Mobility, tenderness, swelling or possible bad posture is judged. If symptoms are present in other organs, these are also extensively examined and abnormalities are documented.
Another important examination in making a diagnosis of inflammatory spinal disease is the Blood test. The determination of the inflammation parameters in the form of the is important and indicative Sedimentation rate (BSG) and the C-reactive protein (CRP).
The determination of the HLA-B27 gene be helpful because the presence of the gene in many cases is associated with a rheumatic disease goes hand in hand. However, a non-existent HLA-B27 gene is by no means an exclusion criterion for the presence of a rheumatic disease, only approx. 60-85% of all patients with an inflammatory spinal disease are HLA-B27 positive. A positive HLA-B27 test does not always have to be associated with a rheumatic disease.
The blood test alone is not enough to make a diagnosis, which is why another diagnosis is one X-ray examination or one Magnetic resonance examination (MRI) the spine is needed. In the early phase of the disease, the spine usually still appears normal and inconspicuous in the X-ray, since this examination does not reveal any acute inflammation in the joint. Only after years, when changes have occurred in the joints in the course of the inflammation, can the consequences, such as ossification, be found in the X-ray image. It is different with the magnetic resonance examination (MRT). With this examination method can active inflammatory processes before any changes have occurred in the joints. For this reason, the magnetic resonance examination, especially in the early phase, is an important examination. In addition, unlike X-rays, it is free of any radiation.
From the combination of all these examinations, the diagnosis of the inflammation of the spine is finally made.
In the axial spondylarthritis (Inflammation of the spine) a distinction is made between two forms depending on the presence of signs of inflammation or structural changes in the spine.
Non-radiographic axial spondyloarthritis: No changes can be seen in the X-ray image, but signs of inflammation can be detected in the MRI. This is usually the case in the early stages of the disease
Radiographic axial spondyloarthritis: The x-ray shows structural changes or ossification of the skin as a result of the chronic inflammation Joints visible.
When it comes to therapy, the Relieving pain and the Suppression of inflammation in the foreground, as well as the Maintaining the mobility of the spine and the Reduction in stiffening.
First choice drugs are non-steroidal anti-inflammatory drugs (NSAIDs) how Ibuprofen or Diclofenacas these both pain reliever, as well as anti-inflammatory Act. In the case of existing complaints, these medications can be taken consistently in maximum daily doses, especially with regard to the side effects caused by them Complications in Gastrointestinal tract.
If a non-steroidal anti-inflammatory drug fails to respond, another drug from the same drug class can simply be administered, as some sick people respond better to one, others better to the other. If at least two non-steroidal anti-inflammatory drugs fail, therapy with so-called Tumor necrosis factor alpha blockers, short TNF-alpha blockers, be considered. The TNF-alpha blocker is a drug that intervenes in the regulation of the inflammatory messenger substances and thus lowers the inflammatory activity.
In addition to drug therapy, plays Move an important role. Regular exercise can relieve pain and slow or stop the progressive stiffening. physiotherapy is the therapy of choice, with additional joint-friendly sports such as Swimming or cycling should be integrated. Also Massages or ultrasound therapies can help relieve the pain.
Operative interventionsJoint replacements, for example, are usually only required at an advanced stage, when ossification has already occurred or various joints have worn out.
In the event of an inflammation of the back due to an infection of a vertebral body with bacteria or other germs, treatment is usually carried out with Antibioticsto prevent the bacteria from spreading further. If this treatment does not lead to success, an additional surgical procedure must be carried out on the affected vertebral body.
It is also recommended to sick people not to smoke, as increased disease activity and faster disease progression has been demonstrated in smokers.
Find in case of inflammation of the back with a rheumatic cause various drugs Application.
NSAIDs (nonsteroidal anti-inflammatory drugs), how Ibuprofen, Diclofenac or Naproxen can be taken as needed, i.e. always when back pain occurs, or continuously. they seem pain reliever and anti-inflammatory and can thereby improve the mobility of the spine.
Back inflammation caused by an underlying rheumatic disease relapsing run away.
If there is an acute episode, it is additional administration of cortisone makes sense as this one strong anti-inflammatory effect and can increase the effects of NSAIDs. If NSAIDs and cortisone are taken together, a Gastric acid inhibitors, how Omeprazole or Pantoprazole be taken as stomach protection.
At difficult courses with early and severe impairment of mobility, the so-called biologicals be applied. This intervene directly in the immune system and block messenger substanceswhich are necessary for the development of an inflammatory reaction. Tumor necrosis factor alpha (TNF-alpha) is a very important messenger substance in an inflammatory reaction. This can be through a group of drugs that TNF-alpha blockers are inhibited and so the inflammatory reaction is slowed down. An important representative of this group is called Eternacept.
In the case of back inflammation caused by a infection of a vertebral body with germs, different occur depending on the pathogen Antibiotics, Antifungal drugs (Anti-fungal agents) or Antiparasitic drugs for use.
Cortisone plays in the treatment of inflammation in the back from a rheumatic disease a major role. Especially with acute attacks from back pain or Stiffness cortisone is used.
Cortisone inhibits the release of messenger substancesthat are necessary for an inflammatory response and acts like this anti-inflammatory and pain reliever, thereby improving the mobility of the spine.
If cortisone is taken in high doses over a longer period of time, it can be an important side effect Bone loss (osteoporosis) and to Disturbances in sugar metabolism (diabetic metabolism) come.
In addition to drugs such as NSAIDs, cortisone or the biologicals can also homeopathic remedies are used for back pain in the context of an inflammation of the back.
Homeopathic remedies, which can bring about pain relief in inflammation of the back, are for example Strychnos nux vomica (common nugget), Arnica montana (real arnica) or Cimicifuga (Black cohosh).
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.
Back inflammation can be with both warmth, as well as with cold receive supportive therapy. At acute back pain Most of those affected experience an inflammation of the back cold, for example with cooling gels, cooling compresses or cooling packs as pain relievers. The cold causes the blood vessels to contract and inflammatory reactions are slowed down, thereby achieving the pain-relieving effect.
Pass the back pain over an extended timespan and are already chronified, however, will mostly Warmth 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 flow in the affected muscles and thus a pain-relieving effect can be achieved.
Many different factors influence the course of the disease. The decisive factors here are Time of illness (Age) that Duration of illness and the Disease expression (if changes can already be seen in the X-ray or not, other organs are also affected) and how fast this progresses.
About a third of all sufferers show a severe form. The risk of death increases in the severely affected, especially from cardiovascular, kidney and respiratory diseases.
Unfavorable prognostic signs are:
- Hip joint involvement
- high levels of inflammation
- early onset of illness before the age of 16
- Movement restrictions of the Lumbar spine
- Involvement of fingers, toes and other joints
- poor / no response to non-steroidal anti-inflammatory drugs
- severe peripheral complications.
This is important for the prognosis close monitoring the attending physician in order to adapt the therapy to the course of the disease.
Unfortunately, an inflammation of the back cannot be prevented. The risk of developing spondylarthritis is genetically predetermined and cannot really be influenced. Likewise, the development of an inflammation of the vertebral bodies can hardly be influenced.
Back pain are one of the most common symptoms of today, around 60 to 80 percent of Germans have suffered from back pain at least once in their lives.
The causes for back pain are numerous. Often are for example Muscle tension or Herniated discs. In rare cases there is one inflammation of the back, or the vertebral bodies, vertebral ligaments, vertebral joints or the sacrum joint cause of back pain, which is why we speak of inflammatory back pain. Inflammatory back pain is usually triggered by rheumatic diseases to which the Bechterew's disease, reactive joint inflammation (including the Reiter syndrome), Joint inflammationwhich with other diseases, like inflammatory bowel disease (for example Crohn's disease or ulcerative colitis) or the psoriasis (Psoriasis) or the undifferentiated joint inflammationwhich often occur in children or adolescents count.
Inflammations of the back or the vertebral joints with rheumatic cause are also called Spondylarthritis designated.
An inflammation of the back or the vertebral body caused by a Infection with bacteria or other germs is called Spondylitis designated.
There a early start of therapy can improve the prognosis of an inflammation of the back and have a positive influence on the course of the disease, a doctor should be consulted in the event of persistent back pain. Depending on the cause of the inflammation in the back, i.e. rheumatic or infectious, come different therapy concepts into consideration. They range from conservative treatment approaches, with medication and physiotherapy, to surgical interventions.