Ankylosing spondylitis, or Bechterew's disease, is a disease of the whole system of joints: sacroiliac, intervertebral, etc. Pathology is accompanied by their permanent inflammation and severe limitation of mobility.
Essence of pathology
The disease is progressive and ends with ankylosing of the joints (immobility due to the infection of the articular cavity), syndesmosis (connection of bones by fibrous tissue) and loss of elasticity of the ligaments.
The spine is the first to suffer from Bechterew's disease. Then the inflammation goes to the joints of the legs and arms. The process goes from big to small - from large to small joints.
Bekhterev's disease code according to ICD-10:
- M08.1 - juvenile ankylosing spondylitis.
- M45 - ankylosing spondylitis.
- M48.1 - ankylosing hyperostosis.
Frequency of occurrence
Spondyloarthritis2% of the world's people suffer. In Africans and Asians - the disease occurs much less frequently than in Europeans. Men are predominantly ill - almost 10 times more often than women. The age of patients, mostly under 30 years old, often the disease begins at puberty.
After 50 years, Bechterew's disease is a rarity. Pathology can occur in children due to poor heredity. The frequency of pathology in Russia is up to 9 patients per 10 thousand population. The first description of the pathology was made in 1892 by the neuropathologist Bekhterev.
Ankylosing spondylitis is largely the behavior of the body's immune system. The second name is due to the fact that this pathology is expressed in ossification of the ligaments and growth of bone osteophytes at the edges of the vertebrae. Severe arthralgia, a sharp limitation of the motor activity of the spine, and in the later stages - its complete immobility (ankylosis) are noted. The spine of this kind is called bamboo, it is cruel and inflexible. Patients in the later stages develop 2 characteristic postures by which this disease is easily recognized:
- Supplicant pose - back bent, knees bent and head down.
- Rose of the proud - the column of the spine is only vertical and the head is thrown back.
Regardless of the final position, the quality of the patient's life is reduced so much that he simply cannot serve himself and needs care.
Etiology of disease
The true causes of Bechterew's disease have not been established even today. There are only a few hypotheses.
Nowpopular theory of psychosomatics. It was revealed that many patients often, for various reasons, had the habit of restraining negative emotions. This is aggression, and the prevailing unpleasant and even tragic circumstances, and a sense of guilt. Such negativity leads to flexion of the spine.
Another group of scientists attaches great importance to genetic heredity. Most patients have an altered HLA B27 gene (in 95% of cases). Human immunity, for some unknown reason, begins to perceive the cells of the spine as foreign and attacks them. This process has long been known to medicine as an autoimmune disease. Therefore, the most plausible theory remains that Bechterew's disease is an autoimmune disease.
Research has shown that there is a situation where the immune system gives up on its cells and begins to destroy them. The established mechanism for the development of pathology in this case: the disturbed HLAB27 gene is present in the cartilage of the vertebrae and their articular surfaces. The gene is immune to infection. When she arrives, he meets her. And then, for some unknown reason, the immune system suddenly becomes hostile to the cartilage of the native spine. Cells are actively attacked by leukocytes and macrophages, which the body directs to fight the stranger. An inflammatory reaction occurs. Discs and joints begin to break down from within.
To maintain the shape of the spine, the body tries to compensate for the loss of cartilage tissue by creating new tissue. Since cartilage cannot be regenerated, it is replaced with bone tissue. The whole process is often started afterinfections.
From this it follows that a person who is a carrier of the HLAB27 gene should protect himself as much as possible from colds, not be exposed to drafts, hypothermia, not to contact with influenza patients.
Risk groups
The risk of getting spondyloarthritis in the presence of the altered gene named above is 20%. Although it is impossible to stop the pathology, it is possible to undergo a medical genetic consultation in time and determine whether there are prerequisites for the onset of the disease. The risk group includes representatives of the stronger sex aged 20 to 40 years.
Mechanism of development of spondyloarthritis
The vertebrae are interconnected by elastic cartilage discs. This gives the spinal column flexibility.
Long dense ligaments run around all surfaces of the spine. This is necessary for the stability of the spine. Each vertebra has 2 upper and 2 lower processes. These processes of successively connected vertebrae are movably articulated. Attacks of macrophages cause inflammatory reactions in the tissues of not only the discs, but also the ligaments, as well as the vertebral bodies themselves.
As a result, elasticity is lost, collagen and elastin begin to be replaced not even by connective tissue, but immediately by bone. The vertebrae fuse together and the vertebral column becomes immobile. In addition, the legs suffer - the hip joints, knees, ankles. In autoimmune processes, internal important organs always suffer - the heart, lungs and kidneys.
Classification of pathology
In placethe appearance of inflammation, 4 forms of clinical variants are distinguished:
- Central variant - occurs more often than others. The load of the lesion affects only the spine, especially its lower part.
- Rizomelic (root) form - this variant affects women. The upper shoulder girdle and hip joint are affected.
- Peripheral form - inflammation is descending - damage to the joints of the knees and feet.
- Scandinavian form - the smallest joints suffer - fingers and toes. Often this form is diagnosed as a rheumatic lesion.
Stages of Bechterew's disease
There are three of them:
- In the initial stage, there are no changes on the x-ray, mobility is practically not impaired.
- Second stage (moderate) - the joint space narrows and there is a beginning of a decrease in the mobility of the spine, the risk of ankylosing becomes real. Arthropathy is clinically increasing.
- Third stage (late) - the bones are fused and the process is irreversible. Ligaments ossify, s alts are deposited in them.
Symptomatic manifestations
Each stage of Bechterew's disease has its own clinic. Often the symptoms resemble in their signs the onset of sepsis: temperature (up to 40 degrees), the patient sweats profusely, myalgia, arthralgia are observed, the person weakens and loses weight.
The danger of spondyloarthritis is that it masquerades as other pathologies of the spine, so the final diagnosis may be delayed. In advanced cases of ankylosing spondylitistherapy has little to no effect.
Early symptoms
First, inflammation of the sacrum begins. Then the signs of Bechterew's disease move higher - they capture the lower back, chest, cervical region. With further inflammation, the joints of the limbs are also affected, which makes the patient disabled.
Even the cartilage of the fingers can ossify. The inflammation is accompanied by swelling and passes to the ligaments of the lower leg, knees and feet. It often happens that pain in the heels can be the first signal of the onset of the disease.
Features of early manifestations
In the region of the sacroiliac joints there are regular pains, at night they intensify, and by the morning they become sharp, in the morning the spine simply refuses to move. Then, during the day, a person makes a lot of movements, which leads to a decrease in pain. But the process of inflammation continues and rises higher and higher. The patient feels especially sharp pains in the heels. It is noteworthy that diabetics and hypothyroidism may not have pain. Well reduces the discomfort of a hot shower.
When inflammation spreads upward, pain in the sternum occurs. The person begins to breathe with the diaphragm. His pain is aggravated by the slightest exertion - sneezing, coughing, taking a deep breath. This indicates the involvement of costovertebral joints in the inflammatory process. The rectus dorsi muscles are also stiff due to soreness. There is a decrease in performance and fatigue. In a blood test, ESR these days can rise to 30-40 mm / h.
Advanced symptoms
As the process progresses, changes increase and becomeirreversible: the spine is sharply limited in movement, even simple inclinations in any direction become impossible for the patient. The pain is like sciatica. There is numbness in the legs and arms. The chest is also sharply limited in its movements.
The work of the respiratory system is disturbed - suffocation appears, pneumonia and tuberculosis join. The heart muscle is compressed, the pressure rises. The spinal muscles are no longer just stiff, they atrophy. The brain suffers due to insufficient oxygen supply, cephalalgia, dizziness, nausea appear. Decreased flexibility of the spine.
The physiological curves of the skeleton are smoothed out, as a result, the above characteristic postures develop. There is kyphosis of the thoracic spine. The legs are bent at the knees because the body is trying to compensate for the forward movement of the body's center of gravity. The iris of the eye, the pericardium becomes inflamed.
The listed symptoms of ankylosing spondylitis are accompanied by a sharp decrease in working capacity and constant increased fatigue. The patient becomes an invalid who needs outside care.
The course of the disease in women
Although the pathology is less common in women than in men, it has its own characteristics that you need to know about. Many researchers believe that the incidence of spondyloarthritis in women is grossly underreported.
Features of the course of the disease in the fairer sex:
- Vertebral ossification affects only the lumbosacral region, so even in the last stages of the disease, women remain mobile.
- In women, the variant of the lesion is such that the shoulders and hip joints are involved in the process of inflammation - a rhizomyelic form.
- The attacks of pain continue for hours and months.
- The development of pathology is slower - 10-15 years. Remissions are long.
- Internal organs are practically not affected.
- Heel bones and tendons are also very rarely affected.
Although the symptoms of ankylosing spondylitis in women differ, treatment during exacerbations is similar to that in men.
Possible Complications
Since there is no strict scheme for the development of the disease in patients, the complications are also different for everyone. The most common ones:
- The heart and aorta are affected.
- In 35% of cases, the kidneys suffer - amyloidosis (a violation of protein metabolism) and glomerulonephritis. This ends with the development of kidney failure.
- Aortitis occurs in 6% of cases.
- Aortic valve lesions occur in 8% of patients, pericarditis - in 11%. These pathologies lead to HF (heart failure).
- Due to the limited mobility of the ribs and respiratory muscles, inflammation of the lungs joins, and tuberculosis can even develop.
- Pulmonary fibrosis occurs in 10% of cases.
- In many patients, the organs of vision are involved in inflammation - the eyeballs become inflamed in 30% of patients. The process is characterized by an acute onset - pain in the eyes, blurred vision, blurred vision, irritation in the light. Such an acute period can last 2 months. There is no cure, the process just becomes chronic. Often it is inflammation of the eyeapple allows early diagnosis of spondyloarthritis.
- Intestinal inflammation.
- Osteoporosis.
Diagnostic measures
The diagnosis of Bechterew's disease in patients is made on the basis of X-ray examination of the spine, CT and MRI. KLA - allows you to identify the acceleration of ESR. If the clinic is not clear, a laboratory analysis is carried out for the presence of the HLA-B27 antigen in the blood.
Treatment of ankylosing spondylitis
Complete recovery does not occur, but inflammation can be slowed down and long-term remissions achieved. With early diagnosis, you can avoid complications, maintain the flexibility of the vertebral joints of the back and performance for the rest of your life.
Treatment of ankylosing spondylitis will give results only if it is carried out comprehensively. Its purpose is to stop the ankylosing process. When the inflammation subsides, the patient is sent to he alth procedures: physiotherapy, exercise therapy, balneotherapy. Skiing, swimming, water aerobics with the development of limbs in water, underwater spinal traction are very useful.
The right bed is important: the mattress should be flat and firm. The pillow is absent in the initial stages so that there is no cervical lordosis. At other times, a roller or orthopedic small pillow is used. It is advisable to sleep on your stomach with straightened legs. With active treatment of Bechterew's disease, running and static loads are prohibited.
Drugs
Selection of medicinesindividual. Medicines are taken for life. There are 3 main areas of treatment: medication, physiotherapy and surgery.
From medicines used:
NSAIDs (non-steroidal anti-inflammatory drugs), GCS (Glucocorticoids) - "Urbazon", "Medrol" capsules, antirheumatic drugs "Azathioprine", immunosuppressants.
TNF inhibitors block the synthesis of inflammatory mediators. They are injected subcutaneously. They are first line drugs. These include "Adalimumab", "Infliximab".
exercise therapy
Helps the patient and therapeutic exercises. The program is individual for each patient. It must be done daily.
Physiotherapy treatments
From physiotherapy, phonophoresis with hormones, electrophoresis with calcium chloride and lithium, ultrasound, UHF, ozocerite, paraffin treatment, radon gas and radium isotopes are shown.
Most effective treatments:
- Stay in a cold cell followed by exercise.
- Mud wraps and baths.
- A warm bath before bed.
- Infrared irradiation.
- Back massage - relieves muscle tension and pain.
Massage is prescribed in courses every six months. Very effective underwater massage.
Prevention measures
There is no special prevention. To prevent ankylosing spondylitis, the recommendations are:
- Rehabilitation of carious teeth.
- Avoiding colds.
- Prevention of back injuries.
- Medical examination in the clinic.
- Exclusion of physical inactivity and moderate exercise.
- When sitting for a long time, you should check your posture by leaning against the wall - your heels, back, buttocks and shoulders should be in line.
- Maintaining immunity at the proper level.
It is useful to refer the patient annually to spa treatment with radon and sulfide waters. Disability in Bechterew's disease is given necessarily - from 3 to 1 group. ITU is engaged in this (medical and social expertise). Patients with this diagnosis are exempted from conscription.
