What causes the painful, inflexible spine?

There are 364 joints in the spine and there are many possible ways things can go wrong

There are 364 joints in the spine and there are many possible ways things can go wrong

The spine is important to the structure of your body, allowing you to stand up straight and do yoga. This flexibility comes from 33 interlocking vertebrae. It’s a marvel of evolutionary and engineering design, seeing us humans through performance with stress and strain. Olympic-quality javelin throwers, 20 years after retiring from the grind of training and competition, have no more back-related problems than the rest of us ( Bone and Joint Diary

The Pain Spectrum

A chiropractor will tell you that there are 364 joints in the spine – there are many possible ways things can go wrong, leading to back pain that spans the entire spectrum of pain, from gnawing to crippling.

An inflammation of the bones in the spine is called spondylitis. A severe, arthritic form of spondylitis is called ankylosing spondylitis (AS). The term ‘ankylosing’ refers to the formation of new bone that leads to the bonding of a series of adjacent vertebrae, usually in the lower back. Spondylitis is different from spondylosis, which is the wearing away of the spine.

Ankylosing spondylitis is associated with the kind of low back pain that worsens when you rest (meaning the patient may wake up from sleep with pain). X-rays show obvious signs of damage to the spine or to the joints connecting the spine to the pelvis. Other parts of the body — the jaw, rib cage, or even the heels — can hurt too. AS affects approximately 0.2% of the world’s population.

Your immune system responds to problems — whether it’s a bacterial infection or a new wound — by sending inflammatory cells to the problem site. This initiates an aggressive response aimed at overpowering the bacteria or starting the healing process. The acute reaction causes short-term pain and swelling, which subsides when the foreign invaders are overcome (or the wound is healed).

An important component of the immune system, the human leukocyte antigen (HLA) complex helps distinguish self from non-self – normal proteins that are part of your body versus proteins that come from invasive organisms, or even damaged or distorted versions of your own normal proteins. The HLA complex accomplishes this by presenting a particularly ‘strange’ looking piece of a bacterial molecule (the antigen) to other components of the immune system that hunt for anything resembling this piece. As an analogy, if there were a gang of thieves in your town wearing red and white plaid shirts, the HLA complex displays this plaid shirt to a police patrol.

genetic determinants

The exact trigger for AS is unknown. It has a genetic component, as it is known to run in families, but not everyone in these families is equally affected. Some variants of the HLA gene (eg HLA-B27) are prone to AS and other conditions that cause chronic inflammation of the joints of the spine. These variant HLA proteins are not ‘manufactured’ correctly, changing their shapes and contours in such a way that they appear ‘foreign’.

Coming back to our thief analogy, this sentry molecule itself appears to be wearing a similar checkered shirt. The immune system decides that this HLA variant must be removed by any means necessary, including the destruction of cells carrying this protein. The consequences are disastrous – the immune system remains in activated mode even when there is no real danger. The result is chronic inflammation.

Molecules that play key roles in maintaining healthy bone mass and in fracture repair are also involved in cementing vertebrae together in AS ( scientific progress

The HLA-B27 variant is itself very polymorphic, meaning it has many sub-variations. Manni Luthra-Guptasarma’s group, who works at the Postgraduate Institute of Medical Education and Research in Chandigarh, examined the mind-boggling differences in AS severity in people with the disease and showed that mild forms of AS are caused by HLA variants that are easily cleared by the body’s machinery for breaking down worn-out proteins. Other malformed HLA variants accumulate as aggregated masses in cells, and the body’s inability to clear them results in severe forms of AS. † Frontiers in Immunology

management strategies

Pain-relieving medications, immune system modifiers, and sometimes surgery are used to manage this chronic condition. Individual management strategies – exercise routines, firm and flat pillows, and avoiding ‘trigger’ foods such as artificial sweeteners are of great help.

The article was written in collaboration with Sushil Chandani who is involved in molecular modeling. sushilchandani@gmail.com

dbala@lvpei.org

SOURCE – www.thehindu.com

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