Watch your back: What is AxSpA, the so-called 'disease of the young'?

MANILA, Philippines — Due to the pandemic, many have changed, including the transition of work arrangements to work from home (WFH). But while WFH or "workcation" has its perks, it also has its perils — and among those is a result of sitting all day in front of the computer: back pain.

Back pain can easily be dismissed as a result of over-exertion from a previous physical activity or as a natural occurence as one ages. Two men, however, urges the young ones who constantly suffer from chronic back pain to have it checked as soon as possible if they want to live a life free of debilitating pain and co-morbidities. 

'Bamboo spine' and living in constant pain

Percival M. Escarda had always had lower back pains and he was among those who had been dismissive about it as his friends would also joke about their back pains. He was shaken out of his "complacency" in 2017 when a chiropractor pointed out he had "bamboo spine" based on his X-ray. 

According to Arthritis Health website, Bamboo spine is an advanced case of ankylosing spondylitis where the complete fusion of the bones of the spine occurs. This leads to the spinal column to look like "one long bone that resembles a bamboo stalk." 

Engr. Clark B. Ferrer, meanwhile, grew up as an active kid. He used to play a lot of sports that included lawn tennis, basketball and badminton. When he graduated from college, he wanted to go to flying school and be a pilot. This dream, however, is now physically impossible for him to fulfill.

Engr. Ferrer, like Escarda, is a patient who lives constantly in pain. They have been living with Axial Spondyloarthritis.  

'Disease of the young'

Axial Spondyloarthritis or AxSpA is a chronic, immune-related, inflammatory arthritis characterized by inflammation of the sacroiliac joints, spine, or both. It is often used as the umbrella term for two sub-types of the disease: the non-radiographic AxSpA and Ankylosing Spondylitis. The difference between the two is the visibility of the damages or changes on the spine seen on the X-ray. 

"It is said that AxSpA is the disease of the young. This appears in teens, twenties or thirties that's why sometimes this goes unnoticed," said Dr. Sheila Marie M. Reyes of the Philippine Rheumatology Association at last month's webinar hosted by the Department of Health (DOH) and Johnson&Johnson Philippines, Inc. 

The webinar was held to celebrate the World Ankylosing Spondylitis Day on May 7.  

"People around this age are very active, working, or building up their careers. If they do experience back pain, they wouldn't really think it's something that could be dangerous because they are young," she added.

Dr. Bernadette Heizel B. Reyes, a professor of the Department of Medicine at the University of the Philippines - Philippine General Hospital, shared the same information. 

"Patients are mostly young when they started developing symptoms. In our cohort of patients, they were mostly in the mid-20s during the onset of their symptoms. On the average, it takes about 5.8 years before they get diagnosed correctly," said Dr. Heizel in another webinar. 

Dr. Heizel Reyes, together with Engr. Ferrer, were involved in the cross-sectional study titled, "Philippine Map of AxSpA: Patient and Disease Profile."

The study was conducted from July to October 2021 with 128 respondents aged 18 and up. The mean age of respondents is 38.7. Most of them were male (76.6%), residing mostly in the National Capital Region (42.2 %).

Dr. Heizel added that it takes longer for women with the condition to be diagnosed, at 6.5 years, because of the earlier misconception that AxSpA is a disease that occurs in males. 

Dr. Sheila stressed that if AxSpA is left untreated or undiagnosed, it could lead to complications. These can include clinically silent or symptomatic cardiac disease, myocardial infarctions, cardiac arrest, stroke, renal disease and osteoporosis or brittle bones. 

Genetic predisposition?

Dr. Juan Javier Lichauco,  President of the Philippine Rheumatology Association and co-investigator of the study, said that there is a genetic component to AxSpA. 

"It is hereditary pero the risk to transmit from parent to child is low. Siguro mga 15 to 20% kasi hindi lang ito isang condition about genes. Tulad ng ibang template na tinatawag namin na auto-immune na sakit, it is not a purely genetic condition. It is a combination of genes and environment," Dr. Lichauco said. 

He added that they are still trying to find out what triggers the gene that causes AxSpA. 

Early diagnosis and misdiagnosis

Engr. Ferrer and Escarda said that more than living in constant pain, it is the mental and emotional burden that concerns them. 

Engr. Ferrer admitted it is hard to live with AxSpA because it limits his mobility. Even the simplest task of tying his shoes is difficult. Whenever he goes on errands and people notice his slow movements, he patiently explains his condition. He admitted to have had depressive thoughts and once thought of giving up on his life. 

Escarda, on the other hand, lamented how his early diagnosis could have avoided his "bamboo spine." 

"The one sad part of this disease is late diagnosis and wrong diagnosis. Bakit? Years before I went to the chiropractor and the rheumatologist, I've been to different hospitals and seen several doctors. I've gathered a number of x-ray films but the diagnosis and prescriptions and results are the same. I have bulging discs and mild scoliosis. If I had been informed before of this auto-immune disease by a medical doctor, the medicines available then could have helped me. They could have helped my spine from becoming bamboo-like. That's my sentiment," he said. 

Dr. Heizel shared that global studies on AxSpA have found the significant impact of the disease on mental health. Apart from sleep impairment (28%) that affects productivity during waking hours, patients in their study also reported anxiety (25.9%) and depression (25%). Some filed for sick leave (55.8%) while more than half (67.9%) had to leave or lost their jobs because of their condition. 

There is also an economic burden due to the cost of healthcare. One of the treatment to the pain or condition are biologic drugs. Drs. Heizel and Lichauco are optimistic about these drugs, which are administered through injection or intravenous infusion. Dr. Lichauco said that these drugs can delay the progression of the arthritis but they are expensive and some patients cannot afford them. 

Awareness is a must

Engr. Ferrer and Escarda are members of the Axial Spondyloarthritis Association of the Philippines (ASAPH). The association started with 14 members around 2018 to 2019. It now has almost 200 members diagnosed with AxSpA. 

The doctors are all in agreement that more work has to be done. There are only 240 rheumatologists in the country with a population of 110 million. 

ASAPH is actively campaigning for the disease's awareness on its Facebook page. Patients and the public can also log on to www.rheumatologyph.org to find a rheumatologist nearest their area. Clarrio is downloadable on the App Store or Google for those who want to know more about back pains and AxSpA. 

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