Ankylosing Spondylitis (AS)
Ankylosing Spondylitis (AS) is a type of chronic (long-term) arthritis that affects parts of the spine, including bones, muscles and ligaments.
It often affects men more than women and comes on in late teen early twenties. There can often be a long delay in diagnosis. Treatment options have greatly improved in recent years with the advent of TNF blocker drugs. Exercise and physiotherapy remain a critical part of patient care however.
Back Pain (from neck to hips)
Backache is most common in the lower back, although it can be felt anywhere along your spine, from your neck down to your hips.
There are many causes of back pain, including degeneration of the spine, fractures, inflammation in the back from conditions such as Ankylosing Spondylitis. Nerve root compression and disc protrusion. There are man treatment options available for patients. Early assessment and treatment to prevent long term problems is important.
Osteoarthritis
Osteoarthritis (OA) also known as degenerative arthritis is a condition typically affecting, hands, hips and knees. The spine is often involved. In the past it has been typically referred to as ‘ageing’ however recent research reveals that OA is a separate disease entity and not just about getting old.
New therapies are now being tried and tested for this common condition affecting up to 2 million in the population. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. The mainstay of treatment is exercise, physiotherapy and weight control. Anti inflammatory tablets and paracetamol also have a role.
There is evidence that injections with hyaluronic acid can be beneficial to your joints if you are affected.
Ask your doctor for more information on degradation of joints, including articular cartilage and subchondral bone.
Osteoporosis
Osteoporosis (OP) is a silent disease that leads to thinning of bones and consequently an increased risk of fracture. Patients may not experience any symptoms unless a fracture occurs.
There are several ways to detect which patient may be at risk of osteoporosis including calculation of the 10 year risk using the internationally validate FRAX score. Ultrasound when used properly under the guidance of a clinician experienced in its use and familiar with OP can be helping in detecting patient at risk. It also has no radiation exposure for a patient.
There are many treatments for OP including bisphosphonates which lower the rate of bone turnover, denosumab which has a similar effect and strontium which in addition can strengthen the outside or cortex of the bone. More advanced therapies includes Teriparatide which is injected daily for a period of time.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation in your joints. It’s main symptoms are joint pain and swelling. It’s the second most common form of arthritis in the UK affecting up to 1% of the population.
RA can affect not just the joints but the eyes, lung, heart nerves, blood vessels and brain. It can have a profound effect on the quality of life of those affected. Treatments include anti inflammatory drugs, pain killers, steroids and importantly disease modifying agents such as methotrexate. Recently the advent of a new category of drugs called the biologic agents have revolutionised the treatment of patients who suffer from RA.
Female Athlete Triad
The Female Athlete Triad (FAT) is a syndrome in which eating disorders lower energy availability, amenorrhea/oligomenorrhea and decreased bone mineral density (osteoporosis and osteopenia) are present.
It is especially common in female long distance runners and dancers. All athletes should be aware of the risk of this disorder and maintain a balanced nutrition. Assessment of bone health is very important to avoid osteoporosis fracture and reduced performance.
“I have an ultrasound in my clinic at The Physicians’ Clinic London to give an indication of increased fracture risk in young athletes. We then generally follow up with a DEXA scan and if bone loss is apparent, treatment then involves working with Consultant Orthopaedic Surgeon Mr Gavin Jennings and Sports Medicine Physician Dr Julian Widdowson in a multidisciplinary setting. Our team has been screening male and female athletes at risk and we recently presented our findings from a cohort of rugby players at an international dance symposium. The evidence we have is that ultrasound does detect fracture risk in elite athletes – even if it can’t give a definitive diagnosis of osteoporosis.”
Early diagnosis can prevent serious long term problems for the athlete.
