Stiffness or pain in the lower back that is present in the morning and gradually diminishes as the day progresses or with exercise may indicate inflammatory back disease.
"The easing of stiffness and pain as the evening approaches suggests the early stages of spondylitis, which affects about two people per 1,000 in the United States," said Dr. Hal Mitnick, a rheumatologist at New York University Medical Center.Spondylitis is a rare form of arthritis that can be progressive. It affects the joints that connect the bones that form the spinal column. The inflammation damages the joints, which causes the backbones to fuse together.
An article in an upcoming issue of the New York University Medical Center Health Letter explains that more than 90 percent of people with spondylitis are men. The disease usually occurs in men between the ages of 20 and 40, but it can occur in adolescents as well.
In adults, the first joints to be affected are usually the sacroiliac joints, which connect the base of the spine to the pelvis; the pain may spread from the lower back to the buttocks.
Pediatric patients usually first have symptoms in their lower extremity joints - the hip, knees, and ankles.
The active phase of the disease can last 30 or more years, during which a gradual calcification of the connective tissue of the spine leads to bony bridges between the vertebrae and then fusion.
"People become more restricted in terms of the motion of their spines," Mitnick said. "The exact progression of the disease varies greatly from patient to patient."
In severe cases, the joint inflammation may affect the ribs where they join the spinal column, which can restrict breathing.
A strong genetic predisposition exists in ankylosing spondylitis - 90 percent of all people with the disease carry the HLA-B27 antigen, he said.
Treatment relies on nonsteroidal anti-inflammatory agents to reduce inflammation and relieve pain.
"Indomethacin is very potent in treating symptoms," Mitnick said. "Sulfasalazine has been shown to produce relief in the inflammatory stage, although its effect on the disease's long-term progression has not been established." Nonsteroidal anti-inflammatory agents are often used with acetaminophen.
Also important is physical therapy.
"Spinal extension exercises are helpful in maintaining better spinal alignment and posture," maintained Mitnick, associate professor of clinical medicine at the Medical Center.
"A program of home exercise under the direction of a physician and a physical therapist is important so that in the event of fusion, the vertebrae fuse in the most functional position possible."
Mitnick added that while exercise is generally beneficial for people with spondylitis, fatigue is often a part of any systemic arthritic condition and that rest is also a key part of the therapeutic program.