Temporal Patterns of Symptom Onset in Ankylosing Spondylitis and Their Clinical Implications

Abstract

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton that often begins gradually in early adulthood. Variability in the timing and sequence of symptom onset frequently leads to diagnostic delay. Understanding these temporal patterns is essential for differentiating inflammatory and non- inflammatory back pain and for optimizing early clinical intervention.

Aim of the study: This study examined the therapeutic outcomes and temporal patterns of symptom onset in individuals with ankylosing spondylitis (AS). The primary goal was to investigate the relationship between the disease's evolution and impact and identify patterns in the development of symptoms.

Methods: This prospstudy was conducted in 2020. Between 2019 and 2020, participants from BSMMU's Department of Physical Medicine and Rehabilitation were selected from their patient database. The study included a total of 112 patients who met these criteria. Patients were divided into two categories. Fifty-six patients were categorized for either NSAID medication or NSAID treatment along with McKenzie exercise. The McKenzie extension exercises lasted 50 minutes, thrice weekly, for 12 to 24 weeks. All the data was collected data from electronic medical records (EMRs), including demographic information (age, gender, ethnicity, and family history of AS), details of symptom onset (age at onset, type of initial symptoms such as back pain, stiffness, and peripheral arthritis, and duration between symptom onset and diagnosis).

Result: In the NSAID plus McKenzie group, there was a moderately positive correlation between the time it took to diagnose and the age at which symptoms onset (correlation coefficient = 0.30, p-value = 0.01). The association was statistically significant but marginally diminished in the group that received NSAIDs alone (correlation coefficient = 0.28, p-value = 0.02). In both groups, there was a robust correlation between the nature of early symptoms and the delay in diagnosis. The results of this study indicate that a prolonged duration until diagnosis is associated with an earlier onset of symptoms in both treatment groups, and specific early symptoms and the age at which they occur are related to elevated levels of inflammation.

Conclusion: This study's findings highlight the importance of early detection and intervention in the timely diagnosis and treatment of ankylosing spondylitis. The observed delay in diagnosing medical disorders stresses the importance of primary healthcare institutions having updated information and diagnostic procedures.