Seronegative spondyloarthritis: is it possible to prevent progression to disability?

Ankylosing spondylitis (ICD 10 code – M45) is a chronic inflammatory disease of the sacroiliac joints and small joints of the spine, which, as it progresses, leads to immobility of the joints, calcification of the spinal ligaments, limited mobility of the spinal column and changes in the patient’s posture. The first manifestations of the disease appear at 18-30 years of age. For the diagnosis of ankylosing spondylitis, all conditions have been created at the Yusupov Hospital:

• Patients are in cozy rooms with a European level of comfort;
• Rheumatologists at the Yusupov Hospital use modern research methods;
• Patients are examined using the latest equipment from European and American manufacturers;
• Severe cases of illness are discussed by professors, associate professors, and doctors of the highest category at a meeting of the Expert Council;
• Leading specialists in the field of rheumatology are collectively developing tactics for managing patients suffering from ankylosing spondylitis;
• Doctors carry out complex therapy for the disease, use the latest medications for ankylosing spondylitis, which are registered in the Russian Federation, are the most effective and have a minimal range of side effects;
• Rehabilitators use innovative methods of rehabilitation therapy.

Doctors at the Yusupov Hospital for ankylosing spondylitis follow clinical recommendations for treating the disease, but each patient receives individual therapy.

General information

Ankylosing spondylitis , or ankylosing spondylitis , is a chronic systemic disease that affects the joints. The pathological process is predominantly localized in the sacroiliac joints, spinal joints and paravertebral soft tissues. As the disease progresses, calcification of the spinal ligament gradually develops. The ICD-10 code for ankylosing spondylitis is M45. Its main clinical manifestations were described by V. M. Bekhterev in 1982, proposing to distinguish the disease as a nosological form. This disease belongs to a group collectively called seronegative spondyloarthropathy or seronegative spondyloarthritis .
According to Wikipedia, the incidence of the disease is 0.8-0.9%. It mainly develops in men 20-30 years of age. This disease affects men approximately 3-4 times more often than women. If the spine and peripheral joints are damaged, the patient may become disabled. You can learn more about the disease from this article.

Symptoms

The most typical symptom of the disease is pain in the lower back (in the area of ​​the sacrum and on the sides of it) of an inflammatory nature, i.e.
occurring early in the morning or after standing still. The pain can be subtle, like discomfort or a feeling of heaviness, often accompanied by morning stiffness (stiffness), and can radiate to the buttocks, but very often the pain forces the patient to wake up at 4-5 o’clock in the morning.

Symptoms usually progress very slowly (years or even decades), and patients are often observed with a diagnosis of osteochondrosis. The doctor or patient should be alert to the persistent nature of the pain, young age (up to 45 years) and lack of improvement after rest.

After affecting the sacroiliac joints, AS next affects the vertebrae. Usually the process goes “bottom up”, but less often there may be a different order. In this case, inflammatory changes in the vertebral bodies are first observed, and then intervertebral “bone bridges”—syndesmophytes—develop. Together with calcification of the spinal ligaments, this creates a characteristic “bamboo stick” picture on the x-ray, and during an external examination, the doctor observes the “petitioner’s pose”: the vertebral curves are smoothed, the patient’s head is tilted forward, lateral movements in the spine are possible only by turning the entire torso. The rheumatologist can see such a patient “from afar”, but, unfortunately, at this stage the treatment options are extremely limited. Therefore, modern diagnostic criteria are aimed at the earliest possible diagnosis of AS.

The “classical” instrumental study is an X-ray of the pelvis, which reveals bilateral sacroiliitis - inflammation of the sacroiliac joints. But symptoms on X-rays appear no earlier than after 4-5 years, so for early diagnosis, as the key to effective treatment, the MRI method is used. If sacroiliitis is detected on MRI, but not on radiography, it is called non-radiological. The main symptom of sacroiliitis is swelling of the bone marrow in the area adjacent to the sacroiliac joints.

The laboratory criterion for AS is the HLA-B27 antigen. Remember that, unlike MRI, this is not a sign of a disease, but a marker of PREDISPOSITION to it. Having HLA B-27 is not a death sentence! In general, in the population, HLA B-27 can be found in 8-15% of the population, and only every twentieth of its carriers will have any manifestations associated with this gene.

Other traditional inflammatory changes - an increase in ESR and C-reactive protein - can be observed in only 30% of patients with AS, so normal readings of these tests do not exclude or confirm the presence of the disease.

Unfortunately, the presence of HLA B-27 can be associated not only with AS, but also with damage to other organs. The classic reminder for a rheumatologist is “musculoskeletal system – skin – eyes – intestines.” And how this mosaic will develop in which of the patients is unknown. And since this gene is inherited, one family member may have skin manifestations, while another, for example, may have a combination of AS and intestinal lesions.

In addition to damage to the spine, pathology of the musculoskeletal system associated with HLA B-27 can manifest itself as so-called “enthesitis” - inflammation in the area where the tendon attaches to the bone. The favorite localization in this case is pain in the heel area (on the side or side of the foot) at the insertion of the heel ligament or Achilles tendon.

Another manifestation of the musculoskeletal system may be dactylitis (translated as “inflammation of the finger”), although only the tendons become inflamed, not the joints. In this case, the finger takes on the appearance of a sausage. Inflammation of the joints itself - arthritis: often asymmetrical with greater involvement of the lower extremities, is also a symptom that will direct the doctor to search for HLA B-27. By the way, if the “mosaic” in a particular patient develops in such a way that only the peripheral joints are inflamed without involving the spine, then the disease will acquire the name “peripheral spondyloarthritis.”

Sometimes the manifestation of the disease is anterior uveitis - inflammation of the anterior chamber of the eye. Symptoms: severe pain and redness of the eye, lacrimation, blurred vision (blurred vision), photophobia. A combination with AS may be intestinal damage, accompanied by abdominal pain, weak or loose stools, which may contain mucus or blood. A colonoscopy may diagnose Crohn's disease or ulcerative colitis. Another target organ for HLA B-27 may be the skin, so the doctor will certainly ask about the presence of psoriasis.

Thus, a combination of the patient’s complaints and medical history, conducting specific tests, and analyzing instrumental and laboratory data allows the doctor to diagnose AS and begin therapy.

Pathogenesis

In ankylosing spondylitis, immune cells, whose function is to intercept pathogens entering the body, attack the sacroiliac joints, joints and other tissues. This leads to inflammatory processes and, as a consequence, to deformation and loss of mobility of the spine and joints.

In ankylosing spondylitis, damage to the axial skeleton during the disease dominates over damage to the peripheral joints. The joints of the “cartilaginous” type are mainly affected - the sacroiliac joints, sternoclavicular and costosternal joints, small intervertebral joints. The development of the inflammatory process in the joints is associated with immunological mechanisms. This is confirmed by infiltration of lymphocytes and macrophages , as well as the active development of scar fibrous tissue. In this case, no gross destructive changes occur in the joints.

There is evidence that some strains of Klebsiella and other enterobacteria play a role in the development of peripheral arthritis in patients with ankylosing spondylitis. Also an important factor in pathogenesis is familial location, the marker of which is the histocompatibility antigen HLA-B27. During the research, it was found that the presence of this gene increases the risk of developing this disease by 80 times.

necrosis alpha (TNF-alpha) also plays an important role in the development of the disease This is a protein that is part of the group of cytokines and supports inflammatory processes in tissues. It stimulates the processes of collagen synthesis, fibroblasts and the activity of the gene that determines the development of bone erosion. TNF-alpha activity causes bone tissue to be destroyed and also to be formed in abnormal locations and in abnormal amounts.

Spine in ankylosing spondylitis

Causes and mechanisms of development of ankylostenosing spondylitis

Ankylostenosing spondylitis develops in people with a family history. Carriers of the HLA-B27 gene are more likely to get sick. Hidden infections play a certain role in the development of the disease. It is provoked by injuries, hypothermia and viral infections. The occurrence of ankylosing spondylitis can be triggered by the characteristics of the patient’s psyche and nervous system, severe or prolonged stress.

With ankylostenosing spondylitis, the inflammatory process initially affects the junction of the sacrum and ilium, then spreads to the lumbar spine and “rises” up the entire spine. Inflammation may occur in other joints. Most often, the knee or ankle joints, as well as the tendons of the heel area or Achilles tendons, become inflamed. Sometimes damage to the Achilles or heel tendons and pain in the heels in general are the first manifestation of ankylosing spondylitis.

Over time, “ossification” occurs; spinal ligaments, intervertebral joints and discs. Gradually, the vertebrae fuse together, the spine loses flexibility and mobility. If proper treatment is not carried out, complete immobility of the spine may occur within a few years, because almost all vertebrae fuse into one rigid bone structure. This condition is called ankylosis.

Classification

There are three stages of the disease:

• The first is pre-radiological. At this stage, there are no reliable radiological changes in the spine and sacroilial joints, but according to MRI there is reliable sacroiliitis .
• The second is expanded. There are no clear structural changes in the spine in the form of syndesmophytes, but a reliable SI is determined on the radiograph.
• The third one is late. The radiograph reveals clear structural changes in the spine and reliable SI.

According to the activity of the development of the disease, its following forms are determined:

• low;
• moderate;
• high;
• very high.

There are also several forms of the disease depending on the characteristics of the pathology.

• Central . Only the spine is affected. The disease develops unnoticed by a person, slowly. First, the sacrum begins to hurt, after which the pain gradually spreads to the spine. With movement and stress, the pain intensifies. They can occur at night. Changes in posture gradually occur. The curvature of the cervical spine becomes more convex forward, and the thoracic spine becomes more convex backward. The chin approaches the chest, the head tilts. The spine is bent in the thoracic region, which limits the respiratory movements of the chest. With this condition, in the later stages of the disease, movement can be significantly limited. Convulsions and asthma attacks develop blood pressure .
• Rhizomelic . With this form, large joints are affected. As a rule, the pathological process develops in the shoulder and hip joints. The disease progresses gradually. Pain can occur in the hip joint, thigh, or buttocks, depending on the affected joint. The pain sometimes radiates to the knee, groin, shoulder.
• Peripheral. The pathology initially develops in the sacroiliac joints. After this, months or years later, the ankle and knee joints are affected. They develop deforming arthrosis . This form is most often diagnosed in adolescents.
• Scandinavian . Symptoms resemble the peripheral form, but the small joints of the hands and feet are also affected. The pain with such lesions is not severe.

Symptoms, complications and diagnosis of ankylosing spondylitis

Ankylosing spondylosis debuts in 10% of cases with signs of lumbar or cervical radiculitis. The patient feels a sharp “shooting” pain either from the lower back in one or both legs, or from the neck to the arm. Much more often, ankylosing spondylitis begins gradually, gradually.

At first, the symptoms of the disease may resemble signs of osteochondrosis. The patient complains of moderate pain in the lower back, which intensifies after rest and relaxation, and when the weather changes. After warming, massage and light exercise, the discomfort decreases.

Initially, the pain decreases after taking non-steroidal anti-inflammatory drugs. After several months of anti-inflammatory therapy, the pain not only does not decrease, but gradually increases. They intensify in the second half of the night, between three and five o'clock in the morning, and subside slightly during the day, after noon. Patients complain of pronounced morning stiffness of the lower back, which disappears by lunchtime.

In 50% of patients, at the onset of the disease, ophthalmologists determine inflammation of the eyeball. They are concerned about the feeling of sand in the eyes and redness. Body temperature may rise and weight may decrease. In 60% of patients suffering from ankylostenotic osteoarthritis, inflammation of the vertebrae is combined with damage to the joints.

The most characteristic sign of ankylosing spondylitis is progressive stiffness of the spine and limited mobility of the chest during breathing. Limiting chest excursion leads to congestion in the lungs. This negatively affects the patient’s general well-being and provokes various complications: bronchitis, pneumonia. Ossification of the spine causes the back to lose its flexibility over time. The patient is forced to bend and turn with his whole body.

The appearance of a patient with ankylosing spondylitis is characteristic. In the initial stage of the disease, the normal lumbar curve of the spine disappears, and the lower back becomes straight and flat. At a later stage, the so-called “supplicant pose” is formed - the patient’s legs always remain slightly bent at the knees when walking.

Ankylosing osteoarthritis is characterized not only by the fact that over time it immobilizes the entire spine and joints, but by the following complications:

• In 20% of patients, lesions of the heart and aorta occur. They are manifested by shortness of breath, chest pain and heart rhythm disturbances;
• 30% of patients develop amyloidosis, a degeneration of the kidneys that leads to kidney failure;
• Reduced chest mobility contributes to lung diseases and the development of tuberculosis.

In order to prevent complications, it is necessary to identify, diagnose and treat the disease as early as possible. If ankylosing spondylitis is suspected, the rheumatologist will refer the patient for an x-ray of the spine and sacrum. On an x-ray you can see signs of inflammation of the sacroiliac joints and emerging “ossification” of the spine.

Clinical and biochemical blood tests determine an increase in the erythrocyte sedimentation rate and the level of C-reactive protein. If the diagnosis is in doubt, the patient is referred for a specific test to identify the HLA-B27 antigen characteristic of ankylosing osteoarthritis.

Causes

At the moment, the exact causes of ankylosing spondylitis are not clear. It is generally accepted that the cause of the disease is a disturbance in the function of the immune system. As a result, autogenous cells are damaged. This is why ankylosing spondylitis is sometimes called an autoimmune disease.

Several predisposing factors to the development of the disease have been identified:

• Heredity. To answer the question of whether this disease is inherited, you need to take into account that the significance of the heredity factor is about 20%.
• Previous infections of the genitourinary system or intestines.
• Klebsiella . Increased activity of the species Klebsiella pneumoniae, as well as some strains of Yersinia enterocolitica.

Also, recent research has revealed the influence of some other factors on the development of ankylosing spondylitis:

• restless legs disease;
• low birth weight (up to 3 kg);
• infectious diseases suffered in childhood.

Publications in the media

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease primarily affecting the spine and sacroiliac joints. There are primary (idiopathic) AS and secondary (associated with reactive arthritis, psoriasis or inflammatory bowel diseases). Statistical data. The predominant age is 15–30 years. The predominant gender is male (3:1). Incidence: 3.9 per 100,000 population in 2001.

Etiology unknown.

Genetic aspects •• HLA-B27 Ag is detected in 90% of patients •• There is a hereditary form of the disease (*106300, 6p21.3 AS gene, Â, higher penetrance in men) • Previously popular theories of “molecular mimicry” and “receptor theory” are currently in doubt.

Clinical picture • Symmetrical bilateral sacroiliitis •• Subjective signs ••• pain in the gluteal region ••• pain at night ••• morning stiffness ••• physical exercise reduces the severity of pain •• Physical signs (Kushelewski-Patrick symptoms) ••• pain when pressing with the palms on the crests of the iliac bones with the patient lying on his side and on his back ••• in the supine position, one leg is abducted as much as possible, bent at the knee and the heel is placed above the knee of the second, not bent, leg. When pressure is placed on the bent knee joint and on the opposite iliac crest, pain occurs in the sacroiliac joint of the bent leg • Damage to the spine •• Pain in the thoracic and cervical spine •• Impaired mobility of the spine, cervicothoracic kyphosis (in the later stages - posture " petitioner") ••• Schober test to determine the mobility of the lumbar spine: when the patient bends forward, measure how much the distance between the spinous process of the V lumbar vertebra and a point located 10 cm above has increased; with normal full flexion, this distance increases by at least 4–5 cm ••• Ott’s sign (if the thoracic spine is affected): a distance of 30 cm is measured from the first thoracic vertebra, with maximum forward flexion it increases to 33–34 cm • • When the process spreads to the costovertebral joints, girdle pain appears in the chest, intensifying with a deep breath, coughing and often regarded as pleuritic. Measurement of chest wall excursion: maximum respiratory excursion of the chest wall in the IV intercostal space is less than 5 cm (based on changes in chest circumference) • Damage to peripheral joints: shoulder and hip (40%), knee (15%), ankle (10%), wrist and joints of the foot (5%) • Damage to periarticular tissues, more often - achillobursitis, calcaneal fasciitis, symphysitis • Systemic manifestations: •• eye lesions - acute anterior uveitis: iritis, iridocyclitis (25%) •• CVS lesions - aortic insufficiency (1% ), complete AV block (up to 8%) •• lung damage - apical fibrosis (rare) •• kidney damage - IgA nephropathy •• amyloidosis •• neurological disorders - cauda equina syndrome (rare).

Laboratory data • Increased ESR, moderate anemia, correlating with disease activity • The presence of RF is not typical • The presence of HLA-B27 (90% of patients) • Synovial fluid of the inflammatory type: leukocytes more than 2000 in 1 μl, neutrophils more than 50%.

Instrumental data • X-ray examination •• Sacroiliac joints: in the early stages, subchondral sclerosis, blurred contours are revealed, later - erosion, narrowing of the joint space, ankylosis •• Symphysitis, “fluffiness” of the ischial tuberosity •• Spine - syndesmophytes, calcification of the anterior collateral ligament , “bamboo” spine, erosions in the anterosuperior corners of the vertebrae; the changes are most pronounced in the thoracolumbar junction •• Peripheral joints - narrowing of the joint space, erosive changes in large joints, pericapsular ossification.

Differential diagnosis • Unlike reactive arthritis, psoriatic arthritis in AS sacroiliitis is symmetrical, the process extends to all parts of the spine, there is pronounced pain syndrome from the spine • Forestier hyperostosis (ossification of the spinal ligaments in elderly people) - absence of inflammatory activity, height of intervertebral discs without changes • Osteochondrosis of the spine - pain increases after physical activity, there is no inflammatory activity, damage to peripheral joints, osteoporosis and sacroiliitis.

Diagnostic criteria • Clinical criteria •• History of inflammatory pain in the back or lumbar region. Inflammatory pain is considered to be pain with a gradual onset in patients under 40 years of age, lasting at least 3 months, accompanied by morning stiffness, increasing at rest and decreasing with physical activity •• Limitation of movements in the lumbar spine in the sagittal and frontal planes •• Limitation of respiratory excursion of the chest less than 2.5 cm at the level of the IV intercostal space • X-ray criteria •• Bilateral sacroiliitis stage II–IV •• Unilateral sacroiliitis stage III–IV. To make a diagnosis, one of the clinical and one of the radiological criteria is sufficient (sensitivity 83.4%, specificity 97.8%).

TREATMENT

General recommendations • Active lifestyle. Special exercises are required to maintain correct posture and maintain mobility of the spinal column, breathing exercises, and swimming. Sports with a fixed position of the body (cycling) are contraindicated • Hard bed, it is recommended to sleep on the stomach or on the back without a pillow • Physiotherapy: ultrasound, diadynamic currents, inductothermy, massage • Radon, hydrogen sulfide, mud resorts.

Drug treatment

• NSAIDs •• Indomethacin 100–200 mg/day at night •• Diclofenac 75 mg/day (50–200 mg/day) •• Meloxicam 22.5 mg/day.

• GK •• orally rarely •• inside the joints (the effect is less than in rheumatoid arthritis). The possibility of introducing GC into the sacroiliac joints •• periarticular administration in the treatment of damage to periarticular tissues is being studied.

• Sulfasalazine (for peripheral arthritis and high inflammatory activity), starting at 0.5 g/day, increasing weekly by 0.5 g/day to 2–3 g/day. Sulfasalazine has been suggested to reduce the incidence of uveitis.

• Less commonly, •• azathioprine 1–2 mg/kg/day and •• methotrexate 7.5–15 mg/day are used for immunosuppression.

• In the presence of foci of severe hypertonicity - central muscle relaxants, for example tolperisone 0.05–0.1 g 2–3 times a day.

Surgical treatment (prosthetics) is used mainly for severe damage to the hip joints.

Complications • Cervical spine fracture, atlantoaxial joint subluxation, cauda equina syndrome (rare) • Peripheral joint ankylosis • Cardiac: conduction disorders (20%), aortic insufficiency (2%) • Uveitis leading to blindness.

Prognosis • Most patients remain functional. Disability is caused mainly by damage to the hip joints (10–20% of patients). Mortality does not exceed 5% and is associated with subluxation of the atlantoaxial joint, cardiac pathology, and amyloidosis.

Synonyms • Ankylosing spondylitis • Ankylosing spondylitis–Marie–Strumpell disease.

ICD-10 • M08.1 Juvenile ankylosing spondylitis • M45 Ankylosing spondylitis • M48.1 Forestier ankylosing hyperostosis

Symptoms of ankylosing spondylitis

Initially, symptoms are associated with damage to the ligamentous apparatus of the spine. The patient complains of the development of pain in the sacrum and lower back, notes a state of stiffness at rest, especially closer to the morning. With movement and exercise, the stiffness becomes less pronounced.

As the disease progresses, the symptoms of ankylosing spondylitis in men and women manifest themselves as increased pain and an expansion of the boundaries of pain throughout the entire spine. There is pain and increased mobility in the hip joints. At this stage, one of the characteristic signs may already appear - an arched curvature of the spine and chronic stoop. These symptoms appear more often in men. Later, ankylosis of the intervertebral joints is observed, the growth of the chest is limited and the person’s height sharply decreases.

In the peripheral form, the disease manifests itself as damage to large joints. Intra-articular manifestations of the disease may also be observed. Iritis and iridocyclitis develop . Cardiovascular symptoms are noted: aortitis , pericarditis , aortic valve , heart rhythm disturbances. Kidney amyloidosis is possible .

Thus, the symptoms of ankylosing spondylitis in women and men can be as follows:

• feeling of stiffness in the morning;
• pain and stiffness in the spine, sensations intensify at rest;
• asymmetric oligoarthritis , affecting the hip, shoulder, large joints of the lower extremities, as well as small joints of the feet and hands;
• bilateral sacroiliitis ;
• enthesopathies - an inflammatory process of ligaments, tendons and places where they are attached to bones;
• intermittent pain in the buttocks.

Extra-articular lesions can affect a number of systems:

• respiratory;
• digestive;
• cardiovascular;
• visual (mucous membranes of the eyes).

If you read this or that commentary with descriptions of the course of the disease, you can get confirmation that in all patients the disease progresses differently, as evidenced by each thematic forum of patients. Symptoms appear less frequently in women than in men.

Some patients suffer more from pain, others from stiffness. Sometimes the disease progresses indolently, so the diagnosis is difficult to establish. In some cases, its course is aggressive, so the person is forced to go on disability. The disease occurs with periodic relapses, which are followed by improvement. The ossification of the spine gradually progresses and it becomes deformed. osteoporosis may develop .

What is spondyloartitis

Ankylosing spondylitis is a chronic inflammation of the axial skeleton - the spine and iliosacral joints, leading to gradual ossification of the joints and limitation of their mobility (ankylosis - stiffness of the joint due to fusion of bones with each other). The term “ seronegative spondyloarthritis ” refers to a whole group of diseases, the common clinical manifestation of which is inflammatory damage to the spine, and the laboratory manifestation is a negative rheumatoid factor (i.e., seronegativity for this factor).

The following diseases are types of seronegative spondyloarthritis:

• Ankylosing spondylitis (ankylosing spondylitis);
• reactive arthritis;
• psoriatic spondylitis;
• spondyloarthritis in Crohn's disease;
• undifferentiated spondyloarthritis.

Common manifestations of this group of diseases include:

• pain and stiffness in the lumbar spine and buttocks (projections of the sacroiliac joints), increasing at rest and decreasing with movement;
• presence of the HLA-B27 gene;
• pain and swelling in the joints of the lower extremities, often asymmetrical;
• frequent damage to ligaments and tendons (discomfort in the heels, Achilles tendon).

A distinctive feature of ankylosing spondylitis is changes in the ligaments of the spine, their compaction and gradual ossification. This leads to the fact that the human spine loses its flexibility and becomes as rigid as bamboo.

Unfortunately, at the initial stage of the disease, spinal spondyloarthritis is confused with osteochondrosis and incorrect treatment is prescribed. It can often take several years for a correct diagnosis to be made. If treatment for ankylosing spondylitis is not started on time, it can lead to immobilization of the spine and joints, complications such as interruptions in the functioning of the heart, damage to the lungs and kidneys. Disability due to spondyloarthritis is by no means uncommon in the case of improper or delayed treatment.

Bekhterev's tests and diagnostics

In the early stages, diagnosis is complicated by the fact that the disease is difficult to recognize. At this stage, the doctor’s experience and assessment of clinical indicators are important. Just a few years ago, doctors could confirm this diagnosis only 7-8 years after the onset of the disease, since one of the important signs of the disease was sacroiliitis , which develops years after the onset of ankylosing spondylitis. It was only detected by radiography.

Modern specialists are able to determine the diagnosis at an early stage using MRI of the sacroiliac joints, which can detect sacroiliitis in the early stages.

An X-ray examination is also carried out for comparative analysis as the disease develops and other pathologies are excluded.

During laboratory tests, it is important to determine the indicators of ESR and C-reactive protein (CRP) in order to understand how active the inflammatory process is.

If there is a suspicion that the patient has spondyloarthropathy, a test for HLA-B27 carriage is performed; if the test for the presence of this gene is positive, this is considered an important argument in favor of confirming ankylosing spondylitis.

It is important to differentiate ankylosing spondylitis from osteochondrosis , spondylosis, rheumatoid arthritis .

Symptoms of spondyloarthritis

The symptoms of spondyloarthritis are quite varied. According to various estimates, the onset of the disease in 75% of cases is accompanied by lower back pain, in 20% by joint pain, in 5% by eye damage and other symptoms.

The picture is complicated by the fact that the time from the onset of the disease to the manifestation of typical symptoms of ankylosing spondylitis in men is 4-5 years, in women - 10-20 years. And the interval between relapses can range from several months to several years.

Symptoms of ankylosing spondylitis often resemble manifestations of osteochondrosis. The patient feels a sharp pain in the lower back, radiating to the leg, or pain in the neck, radiating to the arm. At the initial stage of spondyloatritis, pain may disappear for a while after massage or taking non-steroidal anti-inflammatory drugs. However, unlike osteochondrosis, with ankylosing spondylitis, after some time, previously effective drugs are powerless, and the person begins to think about treatment.

Over time, the mobility of the spine decreases and a hump appears. This is what leads to the formation of the “petitioner pose” characteristic of this disease.

In the future, damage to the eyes and kidneys may develop.

The disease has a chronic course. A few years after the onset of the disease, in half of the patients the cervical spine is involved in the process.

Complete ossification and immobility of the spine can occur within 14-20 years.

1 EchoCG

2 ECG

3 MRI joints

Treatment with folk remedies

Treatment with traditional methods can alleviate the patient’s condition. It is recommended to drink herbal teas, take baths, make compresses, etc. Before using any of the remedies listed below, you should consult your doctor.

• Therapeutic baths. Baths made from medicinal plants will help alleviate the condition. It is necessary to take equal proportions of alder, wild rosemary, sweet clover, elm, cinquefoil, speedwell, birch, pine, currant, dandelion, rue, strawberry, and cherry. Mix everything and pour 300 g of the mixture into a cotton bag, then pour in 5 liters of water and cook for 20 minutes. After 2 hours, pour the broth into a bath of water at a temperature of 40 degrees. Such baths should be carried out 2 times a week for 3 months.
• Herbal decoction. To prepare, take one part each of calendula, celandine, hop cones, 2 parts each of rosehip, string and motherwort. Grind everything and mix. Take 3 tbsp. l. mixture and add 1 liter of water. Boil and leave for 6 hours. Drink 100 g of decoction three times a day before meals.
• Other fees. Similar to the previous one, you can prepare other herbal decoctions. The first is oregano, string, hop cones. The second is hawthorn (fruit), St. John's wort, mint, pine buds, oregano, thyme, eucalyptus, violet.
• Herbal decoction (second option) . Take two parts each of linden flowers, meadowsweet, parsley and elderberry roots, three parts each of black poplar buds, birch leaves and buds. 2 tbsp. l. pour 0.5 liters of boiling water over the mixture and cook for 10 minutes. Leave for 1 hour, strain. Add 1 tbsp. l. honey Drink 100 g 3 times a day before meals. The course of treatment is 2 months.
• Sunflower infusion . This remedy has a positive effect on joint mobility. You need to take 6 young sunflower baskets (pluck them before they bloom), chop them, pour in 1 liter of vodka and leave in the sun for a month. Take tincture 1 tbsp. l. three times a day before meals.
• Rubbing agent. Grate a bar of baby soap, add 15 g of camphor, 60 g of ammonia, 0.5 l of vodka. Shake everything until you get a homogeneous mixture. Rubbing with this tincture helps reduce joint pain and relieve swelling.
• Rubbing agent (second option). Mix 50 g of mustard and camphor with 100 g of alcohol. Mix everything until smooth and add 100 g of whipped egg white. Shake everything and rub on the affected areas before going to bed.

Prevention

To prevent relapse of the disease, it is very important for people with ankylosing spondylitis to follow some rules. Most of these recommendations are also relevant for healthy people - they can reduce the risk of developing the disease.

• The patient needs full rest at night. You should sleep in the correct position on a comfortable and firm mattress. At the early stage of the disease, you need to sleep without a pillow, later use a thin pillow.
• You should practice optimal physical activity and exercise, performing the exercises recommended by your doctor. It is very important to start the morning with therapeutic exercises. If you need to sit or stand in one position for a long time, you need to periodically take a break and warm up. If a person’s disease is in an advanced stage, it is contraindicated for him to run or engage in any contact sports. Do not place a static load on the spine. Swimming is very beneficial during this period.
• It is useful to harden yourself by practicing dosed procedures.
• All diseases should be treated promptly to prevent the presence of foci of chronic infection.
• It is necessary to maintain correct posture while sitting and standing. You need to sit upright, extending your spine as much as possible in the lumbar region.
• You should use a headrest when driving a vehicle. It will support your neck.

Treatment

The patient needs to obtain as much information as possible from the doctor and strictly follow clinical recommendations.
Despite the fact that the list of groups of drugs that affect the course of the disease is small, it is quite possible to avoid ankylosis of the spine and the development of extra-articular complications from other organs and systems. A very important role is played by daily gymnastics, which is indicated for absolutely everyone, regardless of the activity of the disease and the development of ankylosis. Its goal is to slow down the progression, prevent and treat deformities, and improve overall well-being. The main exercises are stretching the spine and strengthening the paravertebral muscles. If we evaluate the arsenal of drugs proven against AS (Attention! Now we are talking only about the spine), then there are two main classes of drugs.

First of all, these are non-steroidal anti-inflammatory drugs (NSAIDs). They should be prescribed to the patient immediately after diagnosis, regardless of the stage of the disease, should be taken for a long time and without interruptions, and can not only reduce pain, but also slow down the progression of AS.

In other words, the fusion of vertebrae with each other occurs four times slower compared to those patients who used NSAIDs only “on demand”. The selection of NSAIDs is carried out by the attending physician, taking into account many factors, including the patient’s concomitant diseases, the characteristics of the drug’s purpose and its possible side effects.

Genetic engineering therapy

– these are TNF-α blockers (infliximab, golimumab, adalimumab, certolizumab pegol, etanercept) and antibodies to interleukin-17 (secukinumab, netakimab). Effective at any stage of AS development (but at an early stage more than at a late stage) both for reducing activity and for preventing deformities. As a rule, they are prescribed if the effect of NSAIDs is insufficient. Taking into account the availability of several drugs from the group of genetic engineering therapy, the doctor has the opportunity to “switch” the patient to another drug if the first one is ineffective.

In the event that extra-articular lesions of the eyes, intestines or skin occur, the doctor’s arsenal in terms of effective therapy expands even further.

Severe complications arise either when the patient presents late or when he ignores the recommended treatment.

Nowadays, therapy allows us to avoid the rapid and pronounced progression of ankylosing spondylitis and make the classic “supplicant pose” a thing of history.

Diet

Diet for ankylosing spondylitis

• Efficacy: therapeutic effect, stable remission
• Terms: lifelong
• Cost of products: 1500-1700 rubles per week

Patients with this disease should have a balanced and nutritious diet. It is important to formulate a diet so that nutrition does not lead to weight gain, as this increases the load on the joints and spine. However, if a person loses weight during the acute stage of the disease, this is an alarming sign. In this case, it is important to consume foods high in iron (buckwheat, apples, pomegranate, greens).

The menu should include foods containing large amounts of vitamins, minerals and antioxidants.

The following foods should be excluded from the diet:

• Alcohol.
• Drinks with caffeine.
• Margarine, spread, mayonnaise.
• Sausage and semi-finished meat products. Meat should not be eaten more than 2 times a week.

Consequences and complications

The following diseases and conditions may appear as complications:

• Atherosclerosis.
• Osteoporosis.
• Amyloidosis.
• Aortic heart disease.
• Syndesmophyte fracture.
• Cervicothoracic kyphosis .
• Dysfunction of the hip joints.