Rheumatological disorders of the spine are a kind of disease where your
own immune system, instead of protecting you, starts attacking it your
spine. It's a process of self destruction in which the auto-antibodies
produced by the body's own
immune system
act against the spine, destroying the proteins and molecules located
inside the bones, joints, inter vertebral disc (IVD) and muscles of the
spine.
The result is permanent destruction of the joints, which can cause deformity of the spine (spondylitis).
Its
symptoms can range from fatigue, redness, inflamed or stiff joints and high fever.
This
process of self destruction starts at a very young age, causing early and rapid inflammatory degeneration of the connective tissues in the body, which results in rapid
ageing and spondylitis of the vertebral column. Thus rheumatological diseases of the spine are also sometimes called
connective tissue disorders.
The majority of the changes caused by this autoimmune destruction of
the connective tissues of the vertebral column are irreversible, leading
to permanent loss of function and stiffness of the back bone. This
condition was once thought to be incurable and the patient had to live
with a permanent disability for rest of their life. Considering the
very young age of these patients and high incidence and prevalence of
these rheumatological disorders, the quantum or magnitude of these
connective tissue diseases and its psycho-socio-economic impact on the
patients and family's life is immense and often underestimated.
Rheumatological disorders lead to immense loss of working
capability in young people and thus pose a great economic burden to
society, by lowering economic productivity. The classically
available treatment options are very expensive, thereby adding to the
financial burden, and they are also not very effective in curing the
condition permanently. At best, they are able to provide some
incomplete, temporary symptomatic relief for a brief duration of time.
There are different forms of rheumatoid diseases. Among these,
rheumatoid arthritis
is the most common. It occurs more frequent in females and typically
starts in the early twenties. It progresses rapidly, causing gross
destruction and deformity of all the major joints by the fourth decade
of life. One more common rheumatological disease is
Reiter syndrome,
which affects the vertebral column. This condition is more common in
males and typically begins in the teenage years. Another disorder
called
ankylosing spondylitis
is typically more common in males and starts in the early twenties.
The back bone becomes grossly deformed with forward bending or kyphosis
of the whole spine. This condition can also result in the formation of a
rounded hump called "
kubad", which makes it extremely difficult for the patient to walk. Then there is
soft tissue rheumatism,
which is common in women and starts in the early twenties. Similarly,
there are many other forms of rheumatoid conditions, which manifest in
men and women differently, at different ages.
Traditionally,
treatment of almost all rheumatological diseases started with strong
anti-inflammatory medicines. To add to the potency, enzymes were are
also given. Doctors further administered long acting steroids in the
form of pulse therapy, in short intermittent periods. Additionally,
disease modifying drugs (DMDs) were given on a continuous basis. All of
these have not been able to permanently cure the condition, and offer
only symptomatic treatment. But there is now new hope for the patients.
New
chemotherapeutic drugs introduced early in the course of the disease
are known to give long term remissions and control the progression of
these rheumatological disorders. Further, specific targeted
gene therapy in ankylosing spondylitis patients with defective genes
gives these patients some amount of control over the progression of
their condition and the associated loss of function. Similarly, a new
technique by the name of
immunomodulation
(cytokines and leucotrienes), which specifically targets immunotherapy
against antinuclear antibodies and double stranded DNA antibodies, help
destroy these auto antibodies that damage the joints.
Immunomodulation can regulate the body's
immune system
and prevent damage from harmful antibodies. Further, certain
regenerative medicines that are available can help with the regeneration
or reformation of the damaged cartilage and degenerated intervertebral
disc (IVD) leading to reversal of the disease process. Autologous bone
marrow stem cell transplant is another effective treatment.
In
case the above measures are not effective, the option of surgery does
exist. Minimally invasive surgery in the form of key hole or endoscopic
surgery using a gamma knife, cold diode and carbon dioxide lasers can
be used.
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