Bekhterev's disease (ICD-10: M45) is an inflammatory process that affects the intervertebral joint, which leads to the formation of ankylosis. As a result of the development of the disease, the patient's spine is enclosed in a rigid corset of bones, which significantly limits mobility. This disease is scientifically called ankylosing spondylitis, and all because the term "ankylosis" means fusion.
According to statistics, this disease is more common in the male half of humanity, besides, women are much easier to tolerate the disease. The disease is diagnosed most often in the age group from 15 to 30 years. In older people, the disease is rare.
The first manifestations are very much like osteochondrosis, but ankylosing spondylitis is dangerous because it provokes complete immobilization of the joint in the spinal column, which is very dangerous. How to treat ankylosing spondylitis, prognosis and best diagnostic methods further.
Shapes
Doctors divide the disease into several forms, which depend on which part of the spine wasstartled:
- central - the disease affected only one area - the spine;
- rhizomelic - not only the spine suffers, but also large joints;
- peripheral - the disease affected, in addition to the spine, also the knee, ankle and elbow;
- Scandinavian - strongly resembles rheumatoid arthritis, but small joints do not suffer;
- visceral - not only the spine is affected, but also many other systems and organs of the human body.
All these forms are manifested by similar symptoms, so only a doctor can, after an examination, make an accurate diagnosis and accurately answer the question of how to treat Bechterew's disease in a particular case.
Causes of disease
This disease is classified as an idiopathic pathology, which means that while science cannot say exactly what are the causes of Bechterew's disease. Symptoms also may not always indicate the development of this disease. But after lengthy research, it became known that in more than 90% of people the disease develops due to a damaged gene of the HLA system. It is he who is responsible for the normal reactions of the immune system to various ailments.
Genes are damaged due to the aggressive impact on the body of pathogenic flora, as a result of which it is transformed into an antigen. It is transmitted from parents to children.
Coming into contact with he althy cells, the antigen forms complexes that the immune system perceives as foreign, it begins to attack them, resulting in inflammation.
There are a number of factorswhich can provoke the rapid development of ankylosing spondylitis:
- inflammatory processes in the genitourinary system;
- damage to the intestines and other organs, provoked by the presence of microorganisms - Klebsiella and Streptococcus;
- dysfunction of the endocrine system;
- pelvic fractures;
- hypothermia.
But not only a gene mutation can cause the development of the disease. Today, scientists still cannot say exactly how microorganisms affect the development of the disease, because antibiotics are not used in therapy. But violations in the immune system occur precisely at the genetic level.
Recent studies in mice have made scientists understand that the disease develops in the presence of infection, antibodies and T-lymphocytes that circulate in the patient's blood. Based on this, we can say for sure that only the presence of these three factors can provoke the development of Bechterew's disease.
First signs of illness
You can recognize the development of the disease by the following signs:
- pain and stiffness in the lumbar and sacrum, possible irradiation to the lower extremities and buttocks, pain may worsen in the morning;
- at a young age, pain may appear in the heel;
- stiffness extends to chest area;
- CBC shows increased ESR.
If all these signs are observed in a patient for several months, thenthey should force a person to seek advice from a rheumatologist.
Manifestations of disease
Symptoms of ankylosing spondylitis are manifested in the form of pain, which is concentrated in the spine, and then other signs appear. It is important to determine the symptoms in the early stages, not only for the doctor, but also for the patient.
Features of the pain syndrome:
- pain manifests itself in the sacrum, it is especially pronounced in the morning, after waking up for half an hour a person cannot move his limbs;
- A distinctive feature of the disease is that after the cessation of movement or physical exertion, the pain does not subside, but only intensifies;
- the nature of the pain depends on the form of Bechterew's disease, with rhizomelic and central pain localized in the spine, during the progression of the disease there is a stoop, but in the peripheral form, swelling of the joints of the legs is considered the first symptom.
You can recognize the disease by the time of manifestation of the pain syndrome. At night, they are intense, and during the day they are almost inaudible.
Internal Organ Disorders
Initially, small joints of the spine begin to suffer, which connect the iliac bones with the vertebrae of the sacral region and the joints of the pubic articulation. The bone tissue that forms the joint begins to break down as the disease progresses, resulting in acute inflammation, and then chronic.
Cells to form cartilage proliferate, joint surfacesare fused, and then bone tissue grows into them. Ligaments also ossify. As a result, a person can no longer move naturally, and when the form is running, he becomes completely immobilized.
In the early stages, other joints do not suffer so much, everything happens with periodic relapses. But as Bechterew's disease develops, the symptoms become more pronounced. Chronic inflammation occurs when connective tissue is replaced by fibrous tissue. As a result, the joints of the chest and limbs undergo ankylosis.
A quarter of patients suffer from inflammation of the membranes of the eyes, subsequently observed secondary glaucoma.
Inflammation can affect the upper part of the lungs. Cavities can form in them, as in cavernous tuberculosis. The kidneys and liver are affected, they gradually stop working normally.
How does the disease progress in men?
Ankylosing spondylitis in men is much more common than in the beautiful half. In addition, their flow is much heavier. The lesion in a short time extends to the entire trunk of the spine and covers the joints.
In men, there is a strong swelling of the joints, accompanied by severe pain. Patients have to wake up in the middle of the night to get up and stretch, the only way to relieve pain and stiffness. If the sacrum is affected, then the pain radiates deep into the buttocks.
Ankylosing spondylitis in young men does not affect the spine, but the joints. But if no measures are taken, then in the future the defeat extends tospinal column, limiting its mobility. Typical aching pain in small joints.
Men also often have damage to other internal organs. If the eyes are affected, iritis can develop, and if the heart is affected, then aching pain appears in its area.
The causes of the development of the disease in men may be:
- injury to the pelvic organs;
- hypothermia;
- inflammatory processes in the genitourinary system;
- hormonal disorders;
- diseases of the stomach and intestines.
After the diagnosis is accurately made and the foci of the spread of pathology are identified, it is possible to accurately answer the question of how to treat Bechterew's disease in men in order to relieve pain and remove symptoms.
How is the disease in women?
In beautiful ladies, this disease is 9 times less common than in the strong half. That is why it is much more difficult to diagnose them. And this is due to the fact that the form of Bechterew's disease in women is different. After the first symptoms of skeletal damage, the disease may not remind of itself for a long time.
The disease begins mainly with the thoracic spine, it can also initially affect the shoulder girdle. This is what confuses a specialist when he conducts an examination and tries to make an accurate diagnosis. Polyarthritis is often misdiagnosed. Most often, an accurate diagnosis in women (Bekhterev's disease) can be made no earlier than 10 days after the onset of the first symptoms. And this is due to the fact that changes in the spine occur much later.and not as intense as the stronger half.
In rare cases, ossification is observed, mobility in the joints persists for a long time. Damage to other organs occurs in rare cases, especially the liver, kidneys and heart.
Diagnostic methods
It is important to make a correct diagnosis so as not to confuse the symptoms of Bechterew's disease in women and men with other pathologies. This is the only way to start timely treatment. To detect sacroiliitis, functional tests are recommended:
- Kushelevsky's symptom I. The patient lies on his back. The specialist puts his hands on the iliac crests and presses on them. If there is inflammation, then this pressing will cause pain.
- Kushelevsky's symptom II. The patient lies on his side, the specialist presses on the iliac bones, as a result, the body responds with pain.
- Makarov's symptom. The pain appears at the moment when the doctor taps the knee and iliac joints with a hammer.
The doctor also conducts tests to determine mobility restrictions:
Pain when pressing fingers along the spinous processes of the vertebrae
- Forestier's symptom. The patient becomes close to the wall, trying to press the heels, head and torso against it. If a person has ankylosing spondylitis, then one of the parts will not touch the surface.
- To determine the mobility of the spine in the cervical region, the patient is asked to reach his chest with his chin. If the disease progresses, then the distance between the chin and the sternumwill increase.
- Thomayer test. Helps to assess the mobility of the entire spine. The patient needs to lean forward and try to reach the floor. It is considered normal when a person reaches the floor.
Also, in addition, the patient is recommended to undergo instrumental diagnostics:
- x-ray;
- MRI;
- CT.
We must not forget about laboratory research:
- CBC may indicate elevated ESR;
- biochemistry will show high C-reactive protein, globulin, fibrinogen;
- genetic analysis for the presence of the HLA B27 gene.
Only when an accurate diagnosis is made, therapy can begin.
Treatment of ankylosing spondylitis
The main goal of therapy is to reduce pain and inflammation. It is also necessary to prevent and reduce the stiffness of the spine, to keep the person active.
Therapy should be constant and fully consistent with the severity of the process. It will be better for the patient if he regularly visits a rheumatologist who will monitor the development of the pathology, the first symptoms of which were described by our academician Bekhterev. The disease requires constant monitoring, and in the period of exacerbation - observation in the hospital.
Drug treatment involves taking non-steroidal anti-inflammatory drugs. They are presented in two groups: non-selective and selective.
Non-selective:
- "Diclofenac" is prescribed mainly in tablets of 50 mg three times a day.
- "Ketoprofen","Ibuprofen" or "Indomethacin" can be a replacement for "Diclofenac", because it has many contraindications and side effects.
Selective:
- The most popular drug from this group is Nimesulide. It is allowed to take no more than 400 mg per day.
- Other drugs may also be prescribed: Celebrex, Meloxicam.
In addition, glucocorticosteroids are prescribed. They are recommended for the most severe manifestations of the disease and in cases where non-steroidal anti-inflammatory drugs have not given the desired result. Taking hormones helps relieve severe pain, reduces inflammation.
Another good drug from the group of sulfonamides is "Sulfasalazine". It is recommended to take 3 mg per day if the inflammation is severe.
Also, a patient with Bechterew's disease is recommended to take antimetabolites. "Methotrexate" has been used by rheumatologists for more than 50 years in the treatment of this disease. The drug is the strongest anti-inflammatory agent.
Azathioprine, Cyclophosphamide are used as immunosuppressants, which are recommended to patients if other drugs have not helped.
In addition to drug therapy, specialists add physiotherapy exercises, but only during remission. It would be good for the patient to go swimming. The main basis of treatment is regular physical activity. For each individual patient, a set of exercises is selected, independing on its form and stage of the disease. Gymnastics must be done twice a day for 30 minutes.
Excellent relieves pain and inflammation physiotherapy. Patients are advised to:
- ultrasound;
- Bernard currents;
- paraffin therapy;
- balneotherapy;
- reflexology.
Ankylosing spondylitis, reviews of doctors and patients confirm this fact, it cannot be cured, like any other rheumatic disease, but a long-term remission can be achieved. To do this, you need to carefully follow all the recommendations of the doctor.
With the right approach, people with this disease live a full life, deny themselves little.
Lifestyle advice from doctors
The basic rule that must be followed is regular physical activity. Be sure to do exercises in the morning and evening, but not very debilitating. Physical activity will help maintain mobility in the joints.
Sleep only on a hard bed, no sagging mattress. Pillow minimum.
Choose clothes according to the principle - as warm as possible, but breathable. If the cervical region is especially sensitive to cold, then sweaters and turtlenecks are the best choice. Shoes should have thick, elastic soles, with cushioning while walking.
Food should be he althy. Excess weight has a bad effect on the spine, an additional load is placed on it. Cut down on sugary and fatty foods.
When working forYou need to sit on a chair with a hard back, the Workplace should be properly organized so that you do not have to bend over or crane your neck.
When pain appears that does not go away after rest, but only intensifies, immediately go to the doctor to start therapy on time and prevent a serious relapse.
Forecast and prevention
Patients with such an ailment can live a full life, the main thing is to follow the doctor's recommendations, but as for prevention, there is none. It will not work to protect yourself from the disease, because, as scientists say, it is a genetic pathology and is laid down in the womb. Women generally may not notice that they have this disease if they have taught themselves to eat right and exercise from an early age.
