Pain gripped M's lower back as she was lying on her bed, trying to sleep. What started off as an occasional occurrence had gradually begun to crop up every night.
This was especially worse in the mornings when she woke up.
But strangely, her back pain often lessened as the day wore on.
She had also begun to experience alternating pain in her buttocks and heels. One day, she was shocked to find her right eye red and painful, prompting her to seek medical attention immediately.
After an examination by her doctor, laboratory tests and X-ray scans, a diagnosis of ankylosing spondylitis was made.
She was shocked. How could she be suffering from a chronic medical condition in her 20s?
Like many young people, M was free of medical problems until recently. At first glance, she seems to be too young to be told such devastating news but, sadly, this is typical of those suffering from the disease.
Ankylosing spondylitis is often referred to as an autoimmune disease, where cells involved in protecting our body against infection turn against us, resulting in pain and stiffness in our lower backs.
Back pain in ankylosing spondylitis often begins before one reaches 40. It happens gradually, and gets better with exercise.
Early morning stiffness is common. Joints of the hands, feet, along the chest wall (also known as costochondral joints) and the Achilles tendon can also become swollen and painful, and patients may also experience inflammation of the eyes, lungs and heart.
The condition occurs in one in 200 people, and affects more men.
A gene known as HLA-B27 is present in more than 90 per cent of sufferers. The condition thus has a strong genetic link.
First-degree relatives of such patients have an 8 per cent risk of having the same condition. In addition, smoking has been shown to increase the amount of inflammation by up to five times in patients than those who do not smoke.
Some well-known sufferers include Taiwanese musician Jay Chou, guitarist Mick Mars of Motley Crue and British golfer Ian Woosnam.
Given that the disease is known to affect mainly men, women may have their diagnosis delayed, some of them by up to eight years.
CHALLENGES FOR WOMEN
Most women are often in the reproductive age group when they get diagnosed, and many have never heard of the disease, for which currently there is no cure.
However, there are many new medications that can alleviate one's suffering and prevent the disease from getting worse.
Many of them, however, cannot be used during pregnancy.
On the bright side, many patients respond to treatment, including the latest targeted therapies. So, often, the sufferers are able to lead relatively normal lives.
Allied health workers also play an important role in a patient's care.
A physiotherapist can tailor exercise programmes to keep the patient mobile and limber; an occupational therapist could advise him on joint protection and treat painful joints; and podiatrists can assess if one requires special footwear to avoid foot deformities.
After M started to take medicine and exercise regularly, she has been able to have proper rest at night, and has returned to work.
The disease flares up from time to time, and the symptoms are addressed by making slight adjustments to her medication regimen.
She has also got married and given birth to a healthy baby girl.
When M was planning for a family, she had to temporarily stop her medication, which is known to cause birth defects. Thankfully, her disease did not trouble her too much during her pregnancy.
Today, she goes for regular walks but she avoids contact sports as sufferers of ankylosing spondylitis tend to develop osteoporosis and spinal fractures.
There is still much to learn about this disease and a pressing need to discover targeted therapeutics, especially drugs which are safe to use during pregnancy.
It is also important to consider this diagnosis in young women with chronic back pain, especially if they have close relatives with ankylosing spondylitis.
Dr Warren Fong is an associate consultant at the department of rheumatology and immunology at Singapore General Hospital.
This article was first published on July 7, 2015.
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