Bechterew's disease (ankylosing spondylitis) is a chronic systemic disease of the joints, in which the process is localized mainly in the sacroiliac joints, as well as paravertebral soft tissues and joints of the spine. In Russia, it is detected in 0.3% of the population.
What causes this pathology? What symptoms indicate its development? Is it possible to cure? This article is devoted to the answers to these questions.
Reasons
Unfortunately, to date they have not been fully clarified. Most researchers believe that the key cause of this disease is the increased aggression of immune cells shown by them in relation to their own joints and ligament tissues.
Bechterew's disease (ankylosing spondylitis) develops in people who have hereditarypredisposition. They have identified a certain antigen - HLA-B27, due to which the notorious changes in the immune system occur.
What is the trigger in the development of this pathology? Usually this is a chronic or acute infectious disease or a decrease in the body's defenses resulting from hypothermia. Also, the development of the disease can provoke an injury to the pelvis or spine.
Risk factors for Bechterew's disease (ICD-10; M08.1, M45, M48.1) include hormonal disorders, chronic intestinal inflammation, urinary tract infections, and allergic reactions.
Pathogenesis
It is necessary to understand how this pathology develops. As everyone knows, the mobility of the spine is provided by elastic intervertebral discs that are located between the vertebrae. The pillar itself is made stable by dense ligaments located on its lateral, front and rear surfaces. Each vertebra has four processes - upper and lower. They are also connected to each other by movable joints.
What happens in Bechterew's disease (ICD-10; M08.1, M45, M48.1)? Due to the aforementioned aggression of immune cells, a chronic inflammatory process begins to develop. It affects intervertebral discs, ligaments and joints.
Because of this, connective tissue structures are slowly replaced by hard bone tissue. The result is a loss of mobility of the spine.
It should be noted that this process also affects the jointslower limbs. Rarely, it spreads to the urinary tract, kidneys, lungs, and heart.
Classification
It is also worth paying a little attention to its consideration. Forms of Bechterew's disease (ankylosing spondylitis) are determined by the nature of the damage to systems and organs. The following are distinguished:
- Central form. In this case, only the spine is affected. The disease can be of two types: kyphotic (in parallel, there is a curvature of the thoracic region and a defect in the cervical) and rigid (there is a smoothing of the lumbar and thoracic curves, as a result of which the back becomes even, like a board).
- Peripheral shape. The disease affects not only the spine. Peripheral joints are also affected - elbows, knees and ankles.
- Rizomelic form. Accompanied by changes occurring in the root joints. Shoulders and hips are usually affected.
- Scandinavian uniform. The clinical picture is similar to that of rheumatoid arthritis. The joints are not deformed or destroyed. But defeats, nevertheless, are present. They affect the small joints of the hand.
Some physicians additionally allocate another visceral form of ankylosing spondylitis. Ankylosing spondylitis in this case is characterized not only by lesions of the spine and joints, but also by changes occurring in the internal organs. They affect the urinary tract, heart, aorta, kidneys, eyes and more.
Symptoms
Before we turn to the issue of treating Bechterew's disease in womenand men, it is necessary to study the signs by which this pathology manifests itself.
Symptoms come on gradually. Some patients experience drowsiness, chronic weakness, irritability, and volatile muscle and joint pain for months, even years. During this period, the clinical picture is so weak that people do not even think about going to the doctor.
More worrisome, but also a rare preliminary symptom, are difficult-to-treat, recalcitrant eye conditions. Usually these are iridocyclitis, iritis and episcleritis.
The more typical symptom is severe pain and a feeling of stiffness, localized in the lumbar region. These symptoms occur in the evening, closer to the night, and intensify in the morning. They can be eliminated with the help of physical exercises and a hot shower.
Daytime, by the way, these sensations can also occur if a person is at rest for a long time. After active movements, they disappear.
Over time, the pain begins to spread up the spine. The person notices that the curves of the back are smoothed out, there is a pronounced stoop of the thoracic region. Muscles are in constant tension due to inflammation in the ligaments and joints.
In men and women after 40, Bechterew's disease in the later stages is manifested by ossification of the intervertebral discs. This is due to the fact that their joints grow together. A kind of "bridges" between the vertebrae begin to form, which are clearly visible on radiographs.
All these changesdevelop very slowly over years. A person may be disturbed by periods of exacerbations, which are replaced by remissions.
Very often, inflammation of the joints of the sacrum, known as sacroiliitis, becomes an alarm signal. This condition is characterized by pain localized in the depths of the buttocks, which periodically spreads to the upper thigh and groin. Often this symptom is perceived as a sign of a hernia, inflammation of the sciatic nerve, or sciatica.
The advanced stage is accompanied by changes in the internal organs and eyes. According to statistics, they occur in 30% of cases.
Female cases
This topic needs special attention. The fact is that women are more likely to experience this pathology, but they tolerate it more easily than men. There are six characteristic features that manifest the disease in patients:
- Ankylosing spondylitis often begins to develop during pregnancy - during an increased load on the body.
- Accompanied by the occurrence of multiple polyarthritis, which is characterized by lesions of large joints.
- Women have very long remissions - lasting from 5 to 10 years.
- The disease is extremely rarely accompanied by immobilization of the joints. But in men, limited free movements are observed much more often.
- The sacrum becomes inflamed on one side only. For men, both. As a result, the process also involves the costovertebral joints.
- In women, pathology may be accompanied by the development of aortic insufficiencyvalve, which causes dizziness, palpitations, pulsations in the neck and head. In men, another consequence is observed - inflammation of the sacroiliac joints.
What is the forecast? Symptoms of ankylosing spondylitis in women are not as diverse and severe as in men. Therefore, they are much less likely to have serious conditions. If the pathology develops, then mobility is lost only by the elderly, even senile age - and even then, rarely. Men can become immobile by the age of fifty.
Diagnosis
It starts with a consultation with a neurologist and an orthopedist. An x-ray, as well as CT and MRI of the spine, is mandatory, which allows to detect ankylosing spondylitis.
It is also important to take a general blood test, in which, in case of illness, an increased erythrocyte sedimentation rate is detected. If the case is in doubt, the patient may be referred for a procedure to detect the notorious HLA-B27 antigen.
In men and women after 40, Bechterew's disease can be similar in symptoms to other ailments, and therefore, as part of the diagnosis, it must be differentiated from pathologies of a degenerative nature. This refers to osteochondrosis and spondylosis.
After that, the form of the disease is determined, for which additional studies may be prescribed.
Disability
There is no cure for this disease. But if a person seeks help in time, the doctor will prescribe a competent treatment for him, with the help of which he will be able to slow downdevelopment of pathology.
There is a logical question about whether ankylosing spondylitis is a disability? Yes, but subject to the following conditions:
- The disease progresses rapidly.
- Relapses are fixed, remissions between them do not last long.
- Acute attacks occur regularly and are characterized by an average duration. At the same time, other organs are affected, which stimulates the development of other diseases.
- Disturbed functionality of the joints of the shoulders or hip area.
The following categories of disability can be issued:
- Third group. When the patient loses the opportunity to work in their profession. It is also issued if the disease develops at a slow pace with short, rare relapses. In general, a violation of the functionality of the skeleton of the initial stage is already a reason for the third group. The patient receives more accurate information on an individual basis.
- Second group. It is issued if a person cannot fully and stably work in his profession. The exception is manual labor. The second group is formed if the pathology progresses actively, and relapses last a long time. Skeletal disorders are graded 2-3, negative effects on internal organs are detected.
- The first group. It is issued to patients in whom disorders of the musculoskeletal system have already reached extremely severe or irreversible consequences. Such people are chained by their illness either to a wheelchair or tobed.
The team is appointed by a panel of physicians who perform a full assessment of the patient's he alth status. It includes a therapist, a neuropathologist, a vertebrologist, a traumatologist and other specialists whose knowledge can help diagnose all disorders observed in the human body.
Anti-inflammatory therapy
The causes and symptoms of Bechterew's disease were described above. Treatment should also be mentioned. Of course, the therapy is complex and lengthy, prescribed by a doctor on an individual basis.
It is mandatory to carry out anti-inflammatory therapy, which is aimed at stopping the destructive processes running in the joints. Non-steroidal drugs help eliminate pain, ease the period of exacerbation and further prolong remission.
However, long-term use of NSAIDs is fraught with serious consequences. Studies have shown that their harm far outweighs the benefits. That is why now they do not prescribe pills - they prescribe the use of suppositories and injections. Non-steroidal drugs must be injected directly into the focus of inflammation. So injections are placed precisely in the area of \u200b\u200bthe affected tissues of the joints. They are painful but very effective.
"Methotrexate": instructions for use and price
As noted earlier, therapy is always prescribed by a doctor on an individual basis. But there are especially common drugs, the action of which must be discussed separately. "Methotrexate" is one of those.
It is a folic acid antagonist that stimulatesthe synthesis of adenosine, affects the immune and inflammatory reactions, destroying the cells that provoke these processes. It is considered to be an effective anticancer drug and cytostatic agent, which also has an immunosuppressive effect.
How much does the injection cost? Its price starts from 350-360 rubles. Instructions for use "Methotrexate" is not universal - the dosage varies from 6.5 to 26 mg, depending on the state of the disease and the degree of neglect. They usually start with a minimum dose, after a while (2-3 weeks) increasing it.
The doctor puts an injection once a week. In some cases, a fractional dose may be prescribed - one dose is divided into 2-3 times with an interval of 12 hours.
Relief of symptoms is observed 5-6 weeks after the start of therapy. The maximum effect manifests itself after six months.
Leflunomide
Instructions for the use of this drug should also be studied. Because this tool is considered almost the only drug on the market, the safety and effectiveness of which is confirmed from the standpoint of evidence-based medicine. However, it comes in tablet form.
The instructions for use of Leflunomide describe in detail the effect that this remedy has on the human body. Using it, you can achieve anti-inflammatory, antiproliferative and immunomodulatory effects.
It is forbidden to drink these pills for people with immunodeficiency, liver pathologies, anemia,thrombocytopenia, impaired hematopoiesis, leukopenia, renal failure, hypoproteinemia, as well as pregnant and lactating women. The prognosis of Bechterew's disease in such patients will be unpleasant if they neglect the instructions.
How is the drug taken? Tablets are swallowed with clean still water. Treatment begins with a dosage of 10 mg at a time per day. The next day, everything repeats - the doctor simultaneously monitors the patient's condition, can adjust the timing and dosage. Based on the reaction of the body, further long-term treatment with the drug is prescribed.
Prednisolone
The third drug that deserves attention. It is used to treat chronic infectious or inflammatory diseases characterized by severe pain and swelling.
How to take "Prednisolone" for ankylosing spondylitis? Given that it is available not only in the form of tablets, but also in the form of a solution for injection, intra-articular injections are preferred.
Contraindications are pregnancy, infectious diseases, periarticular osteoporosis, arthroplasty, pathological bleeding and the presence of an inflammatory process of bacterial origin in the joint.
The drug is quickly absorbed, and therefore the effect comes quickly. "Prednisolone" has anti-toxic, anti-inflammatory, anti-allergic, anti-shock and anti-exudative effects.
Other recommendations
Well, the above was briefly told about a serious and, fortunately, quiterare disease. Finally, it is worth considering clinical recommendations that help to cope with ankylosing spondylitis, not mentioned earlier. You can select them in the following list:
- Therapy necessarily includes taking antimicrobial agents. Most often it is Sulfasalazine.
- Corticosteroids are given if NSAID injections have failed.
- As a prophylaxis, compresses with Dimexide should be applied.
- Physiotherapy should not be neglected - massage, therapeutic baths, mud therapy and exposure to cold.
And, of course, moderate physical activity is encouraged. It is best to make a choice in favor of physiotherapy exercises (the program is individually selected by the doctor) or the pool.
It must be remembered: timely treatment prescribed by a specialist can slow down the development of the disease. And this means that the patient will be able to lead a full life until old age.
