EN 
ES Among the many challenges we face in the practice of medicine without distinction of branch or specialty, we find the so-called silent diseases; those that drain and undermine the health of patients, who because of ignorance of them carry a life practice with their backs to the dangers that lie in wait for them.
Rheumatology does not escape this difficult reality, since in it there are invisible diseases that go unnoticed for years, either because of their low prevalence or because of the confusion in the presentation of their symptoms, causing negative consequences for those who suffer them. This is the case of ankylosing spondylitis (AS), which although it is the best known within the family of spondyloarthritis, continues in the anonymity in our country with a worldwide prevalence of 0.9% and with unknown statistics in the Dominican Republic.
It is one of the few diseases in rheumatology that have greater involvement in men than in women, with an age of onset of symptoms that is around 30 years, although it also has a youthful presentation, representing another reason why it is delayed diagnosis, because when speaking of rheumatic disease or rheumatism, everyone thinks that we are talking about elderly people, forgetting that arthritis is not old.
It is a chronic inflammatory disease that affects the spine and sacroiliac joint generating bone growth, complete fusion and immobilization of the joint, which decreases the flexibility of the patient in advanced stages of the disease.
Regarding the cause, its origin is still unknown, but a clear association with the HLA B27 gene has been seen, since 90% of patients present it.
The main symptom of the disease is inflammatory back pain and it is important to highlight the characteristics of it, since it is a pain totally different from back pain that we can present after a long workday or trauma. For these, the pain increases with rest, worsening at night at bedtime or in the early morning hours and improves with physical activity throughout the day.
They can also present inflammation of large joints (knees, ankles, hips), a feature that differentiates rheumatoid arthritis that most often affects the small joints of hands and feet; or pain at the level of tendons and ligaments in different parts of the body, which often creates confusion with the painful points of fibromyalgia, especially if it is a woman. At the extra-articular level it can cause ocular inflammation or uveitis and -in occasion- affectation of the heart valves.
By having a characteristic of pain very different from the usual, it makes it harder for family and friends to understand or believe that they suffer from them, which is why they often arrive at the psychiatry clinic, not finding a logical justification for their pain.
How is the disease treated?
Although it seems hard to believe, for years the cornerstone in the treatment of this disease have been anti-inflammatory drugs, at least in patients in whom there is only an affectation at the level of the spine. In those with joint and extra-articular disorders, we use the so-called disease-modifying drugs, such as methotrexate or sulfasalazine.
When this is not enough and the patient continues with data of disease activity; in our country we have the program of high-cost medicines, which supplies the patient with biological therapies such as tumor necrosis factor-blocking drugs or Antitnf, including Infliximab, Adalimumab, Golimumab, Etanercept or the newcomer anti-interleukin 17A therapy How is Secukinumab?
Steroids are less used in this disease and when they are required, they are often used for local infiltrations in affected joints or tendons. As an adjunct to treatment there is physical therapy with swimming pool, yoga, pilates and aerobic exercises. In addition, in case of having a significant joint involvement, surgical treatment with arthroplasty is often resorted to.
Published in: Today Digital
