Back Pain In Children and Teens

Approximately 90 to 95% of low backaches are due to mechanical reasons including bad posture while working or resting. However, if a young male gets up in the morning with low backache along with stiffness which remains more than 30 to 45 minutes, he may be suffering from Ankylosing Spondylitis (AS) which is a form of inflammatory arthritis of the back. It may also involve the neck region. 

As the physical activity increases during the day time, the stiffness and pain on the low back reduce however with prolonged rest, even in the day time, again aggravates these symptoms. The symptoms are also increased during winters or sleeping in an airconditioned room with low temperatures. The incidence is low in females. It may also be hereditary.

The common symptoms are a pain the buttocks, difficulty in performing daily living activities like bending forward to pick up objects from the ground, tying of laces, putting up of socks, looking at them sideways,  taking off and putting up things on the shelf, getting up from the chair and changing the position while sleeping. If the disease is not treated timely it may result in fusion of the sacroiliac joints and vertebrae resembling bamboo spine on X-Rays affecting the mobility of the spine.

Sometimes the backache is also accompanied by the involvement of peripheral joints like pain and swelling of knee joints and hip joints. Rarely eyes are affected causing recurrent red eyes and difficulty in vision.

Systemic effects can also there like loss of appetite, loss of weight, night sweats,  feverish feeling and generalized weakness.

We don’t know it causes however it is known that this disease occurs more in individuals with HLA B-27  gene protein ( Human Leukocytes Antigens ). People with HLA B-27 are more susceptible.  However, all people with HLA B-27 will not develop ankylosing spondylitis. Smoking aggravates the symptoms.

For the early diagnosis of AS, Magnetic Resonance Imaging ( MRI ) is required as Xray changes may take years to develop.

There is no permanent cure of AS however if it is diagnosed early then the group of drugs known as biologics like Infliximab, Adalimumab, Etanercept and other agents can halt the progress of AS. The only drawback is that all of them are quite costly. If AS is associated with peripheral arthritis the addition of sulfasalazine helps the patient. Simultaneous physical exercises of the spine and limbs also contribute to the well being of the patient.

Hence any backache in young individuals, especially males, should not be taken lightly and must report to a physician or a rheumatologist.

 

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