September, 2011 — BJC Health Connected Care
Ankylosing Spondylitis: What is it?
By Dr Roberto Russo, Rheumatologist
Inflammatory Back Pain
Ankylosing Spondylitis (AS) is an inflammatory rheumatic condition that is one of a number of diseases that are characterised by inflammation of the spine termed Spondyloarthritis.
The inflammation that occurs particularly affects the sites at which tendons or ligaments join onto bone. The most commonly affected region is the sacroiliac joints, which is where the spine joins onto the pelvis. However, any joint can be affected and, in addition, sites where tendons join onto bone elsewhere are also commonly involved, such as at the insertion of the Achille’s tendon into the calcaneus (heel bone). Furthermore, inflammation can occur at other organs in addition to the musculoskeletal system, such as at the eye, intestines, and lungs.
AS afflicts a small proportion of the population, estimated at about 0.5%, but is commonly under recognized in those suffering with back pain.
Consequently, the average time to diagnosis can be quite long, which some have estimated to be as long as 7 years or more. The ability to diagnose this condition early continues to be a significant challenge despite the fact that the disease has been present in humans for thousands of years, as shown in the remains of three Egyptian pharaohs, and the first specific description of the disease being published in 1693.
Therefore, a current focus in Ankylosing Spondylitis is how to identify those suffering with the condition at an earlier point in their disease course, at which time the condition is termed Axial Spondyloarthitis.
Spondyloarthritis encompasses a group of conditions that share the common clinical manifestation of inflammatory back pain.
These conditions include Ankylosing Spondylitis, Reactive Arthritis, Psoriatic Arthritis, and Enteropathic-associated arthritis.
There are differences between these conditions that may not be evident early in the disease and only become apparent over time. However, the emphasis in this early phase of the condition is to determine the presence of an inflammatory spinal disease, rather than differentiating between these specific conditions.
Ankylosing Spondylitis is the most common of the Spondyloarthritides. The condition is symptomatically more common in men, with the usual age of onset being in the 3rd and 4th decades of life (average age at onset is 26 years). It is unusual for the disease to commence after the age of 50.
Overall, AS is more common in the Caucasian population. There is a familial predisposition to the disease, whereby the risk of developing AS is increased if a first degree relative is affected, especially if HLA B27 (a genetically determined cellular marker) is present.
The consequence of the inflammation present within the spine and other musculoskeletal structures is subsequent uncontrolled increase in bone formation that results in stiffening and ultimately fusion of the joints.
It is this process that gives the condition its name of Ankylos – Greek (Gr) for stiffening; Spondylos – vertebra (Gr); itis – inflammation (Gr).
The fusion that occurs in the spine commonly causes the affected to have a stooped (flexed hip) posture, that ultimately has a significant impact upon their ability to look forward and walk.
Dr Roberto Russo is both a rheumatologist and a nuclear medicine physician, as well as a director of BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.
Did your doctor miss the point?
By Irwin Lim, Rheumatologist
Have you ever felt that your doctor missed the point?
Your knee is sore and you’ve been told that it’s due to osteoarthritis. It’s reached a point that you find that you avoid stairs.
When you finally visited the orthopaedic surgeon, he suggested that you were too young for surgery and that you should only come back when the pain was terrible or after you were 60 years-old? You leave his consulting room and then it strikes you.
It’s great that you don’t need surgery but you’re still in pain! It’s still limiting you. You can’t play tennis anymore, you can’t squat down without discomfort and you surely don’t feel like going for a long walk.
What’s the solution?
This is unfortunately a common scenario. Healthcare can be a maze and negotiating the right path for you is often complicated, time-consuming and frustrating. Healthcare professionals unfortunately often work in disparate, un-coordinated ways.
It’s the reason BJC Health makes Connected Care our priority.
As a rheumatologist, I see the goal as providing a solution for the problem that apatient presents with.With knee pain, especially when the answer is not surgery, there are many options. Pain relief is required. That’s just step 1.
Step 2 is the need to address the underlying cause if possible and more realistically, if its osteoarthritis, to slow down progressive damage. That might involve sometimes confronting discussions about the need to get serious about weight loss and/or the fact that you may be deconditioned & unfit. We may need an appropriate, focussed exercise program to strengthen the knee.
Maybe the problem is not just the knee. The whole lower limb biomechanics and gait needs to be assessed as we work out ways to prevent the other joints suffering the same fate.
We recognised that the way forward in improving the treatment of arthritis & other musculoskeletal complaints would involve a coordinated, comprehensive service that no one doctor or allied health professional could reasonably provide.
BJC Health‘s team of doctors, exercise physiologists, dietitian, nurse and physiotherapists work together.
Connected Care.
Have you been in a situation where your doctor missed the point?
Dr Irwin Lim is a rheumatologist and a director of BJC Health.
BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
Spinning A Habit
Spin Class. For the uninitiated, this involves a dark studio in a gym, rows of stationary bikes, and a pounding beat, heavy on the volume and bass.
The instructor out at the front cajoles and drives you through spurts of speed and tests your endurance with simulated mountain climbs. Some instructors are better motivators than others. One, I remember, stretched belief a little in trying to make us feel we were part of the Tour De France.
I started this about 3 months ago. Closing in on my 5th decade of life, and with the pants feeling a little tighter, it was time to up the ante and be less hypocritical. I had started to use the gym a couple of times a week already but my workouts, in truth, were relaxingly slack, with the main aim of allowing me to unwind. I don’t think my fitness was improving much.
I’ve never particularly cared for exercise, but except it as a necessary chore. Over the last decade, I can point to the usual excuses of busy work life, young kids, and a general lack of time. But, this year, I’ve made more time for myself and exercise does get some protected space in the diary.
Yesterday morning, I found myself in a group of about 10, spinning. The instructor was a stand-in. She told us she was over 50. Still lean, and happy to show that she was still fit.
In a class, I find that I push myself. Pride and competitiveness play some part.
It’s hard to slacken off when the couple of over-70s in front of me are putting the work in. It’s hard not to try to keep up with the slightly overweight females around me spinning in pace with the instructor. It’s hard not to go with the beat and the constant encouragement.
I still finish the class tired and my legs still feel a little rubbery the rest of the day. The mild nausea I felt with the initial classes has passed. In general, I feel good after a session.
It’s becoming a habit, this spinning. A good one.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
The 26th Summer Universiade, Shenzhen, China
By Errol Lim, Physiotherapist
After my efforts over the past 8 months and achieving my initial goal of losing 10 kg and reducing my blood pressure in hope of being more healthy, I set my sights on being as fit and healthy as some of the athletes I would be treating at The World University Games in Shenzhen.
I was amazed how injured and deconditioned some of our athletes were. I was even more amazed how well they performed despite their physical condition.
Sporting skill, sports specific fitness and a strong mindset obviously count for a lot.
So 3 weeks in Shenzhen: was I going to be able to keep up the good work in the stifling heat and humidity?
From previous university games experience, I knew the days would be long – opening the clinic at 8am and finishing around 10pm. Fortunately, we were well staffed with capable physiotherapists, doctors and massage therapists. Luck would have it that the Chinese provided a fully equipped gym (outsourced to a local company) in the athletes village. The first I had seen in the past 5 universiades. Exercising was now no issue.
With the sun rising early at 5.45am, there was now no excuse not to head to the gym daily. Seeing numerous athletes going through their routines was motivating. I managed a 7km run in 35 minutes, the first such run in the past 13 years. This says something about finding the right training partner or exercising in the right environment for that extra motivation. So the exercise component was covered.
What about food intake for the next 3 weeks?
At the last games in Serbia, the food was atrocious. Again, lady luck was on my side in Shenzhen. There was an abundance of food to choose from in the dining hall with many healthy options. Monica (my dietitian) would be extremely proud as I stayed away from the pizza, pasta, soft drinks and ice-creams, instead reaching for the lentils and legumes on offer.
The Chinese did throw up a big challenge. For the first time, McDonalds was at the universiade in the dining hall and it was FREE!
I made it through two and a half weeks without reaching for my McDonalds card. However, I wilted under the pressure of the golden arches succumbing after two weeks of solid exercising. The guilt did set in after the fourth consecutive day especially when I was sinking my teeth into a burger for breakfast.
However, it was fortunate that I was able to burn off the excess calories with no detriment to the waistline.
Final outcome: A successful 26th Summer Universiade for me and for The Australian team. The newly named Uniroos performed the best ever with a total of 16 medals (5 gold, 3 silver and 8 bronze). It was an honour to be part of this team.
Errol Lim is a physiotherapist and a director of BJC Health.
Errol’s Health Update
By Errol Lim, physiotherapist
It has been nearly 2 months since the last blog from Korea. I have just returned from the 26th Summer Universiade in Shenzhen, China. It will take another blog to report in detail my experiences whilst working as a physiotherapist for the Australian team.
Whilst in Korea recently, a daily exercise regime and a concerted effort not to over eat and to watch what I ate allowed me to nullify any potential weight gain.
I said I would post some pics of where I exercised so here they are:
My nephew’s school grounds made for a great running track and with the sun rising early, the locals were out and about at 6am. It was pleasing to see so many people exercising regularly, typically in the older age group. This could be one of the reasons why I don’t see as many obese or overweight people on the streets of Seoul as I do back in Sydney.
Another reason is Koreans are very health conscious. I may disagree with many of their Asian medicine persuasions but on the whole they believe in healthy eating. Their diet consists mainly of vegetables with some meat or fish and the staple of rice. They tend not to eat desserts nor do they care for sweet treats or overly salty snacks. Typically, they start their day with a substantial breakfast of rice, soup and perhaps some side dishes. Something we don’t really do in the Western world.
There is much we can learn from how the Koreans live despite the hustle and bustle of Seoul life. They eat well, I don’t see them starve themselves if not they seem to overeat but yet they manage to keep their weight in check.
It can’t just be their metabolism, can it?