From Chronic Low Back Pain to Axial Spondyloarthritis

Dr. Reveille

ATLANTA—Research into possible genetic drivers of the axial spondyloarthritis (axSpA), including the role of the genetic marker HLA-B27, is advancing, John D. Reveille, MD, professor and vice chair of medicine at the University of Texas McGovern Medical School, Houston, told attendees at the 2019 ACR/ARP Annual Meeting. Dr. Reveille delivered the Philip Hench, MD, Memorial Lecture, sponsored by the Rheumatology Research Foundation.

This annual lecture honors Dr. Hench, who, along with along with his Mayo Clinic co-worker Edward Calvin Kendall and Swiss chemist Tadeus Reichstein, discovered the hormone cortisone and identified its role in the treatment of rheumatoid arthritis. For this work, the trio received the Nobel Prize for Physiology or Medicine in 1950. Dr. Hench died in 1965.

Dr. Reveille explained that for most people, lower back pain lasts only for a few days to a few weeks and tends to fade away on its own. However, when it lasts for 12 weeks or more, it is considered chronic back pain and can adversely affect quality of life.

Low Back Pain

Most acute low back pain is mechanical in nature, meaning that a disruption occurs in the way the components of the back, including the spine, muscles, intervertebral discs and nerves, fit together and move. Data from the National Health and Nutrition Examination Survey (NHANES) for 2009–10 reveal that about 20% of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.¹ For the lucky ones, treatment resolves the pain, but for others pain persists despite medical and surgical treatment. A smaller subset may have pain resulting from axial spondylo­arthritis (axSpA).

“The magnitude of the burden from low back pain has grown worse in recent years,” said Dr. Reveille. “In the mid-1990s, a study ranking the most burdensome conditions in the U.S. in terms of mortality or poor health as a result of disease put low back pain in sixth place; in 2010, low back pain jumped to third place, with only ischemic heart disease and chronic obstructive pulmonary disease ranking higher.”^2-4

Many patients simply live with their condition and don’t seek treatment, Dr. Reveille said. “Although population-based estimates of the prevalence of axSpA and the subset, ankylosing spondylitis (AS), in the United States suggest [the] prevalence [is] as high as 1.4% and 0.57%, respectively, estimates from what is encountered by rheuma­tologists are much lower, possibly because the overwhelming majority of patients with chronic back pain are never seen by rheumatologists.”⁵