Bechterew's disease (Ankylosing spondylitis)

Ankylosing spondylitis (ankylosing spondylitis) is a chronic inflammatory disease of the spine and joints. The cause of ankylosing spondylitis is the aggressiveness of the immune system against the tissue of its own joints and ligaments. (inadequate immune response). The reason is a genetic predisposition in people who are carriers of a certain antigen (HLA-B 27); in this case, the immune system mistakenly perceives some tissues of the body as foreign, which is the cause of aggression.

Ankylosing spondylitis. Why and how joints, ligaments and spine suffer.
Symptoms, examination and diagnosis of ankylosing spondylitis
How to relieve pain and maintain mobility of the spine and joints with ankylosing spondylitis
Gymnastics for ankylosing spondylitis
Diet for ankylosing spondylitis
Ankylosing spondylitis and infections
Ankylosing spondylitis and mental stress
What is useful and what is harmful in ankylosing spondylitis
Treatment of ankylosing spondylitis (ankylosing spondylitis) at the Echinacea clinic

Ankylosing spondylitis. Why and how joints, ligaments and spine suffer

Favorite targets of ankylosing spondylitis are the joints and joints of the sacrum and spine, costovertebral joints. Inflammation of the joints of the extremities and peripheral enthesopathies (inflammation of the sites of attachment of tendons to the bone) are also often observed; less often – symptoms of damage to internal organs.

The basis of the disease is inflammation of the joints, tendons and ligaments. In addition, inflammatory changes occur in the synovial membrane of the joints and changes in bone tissue. Long-term uncontrolled inflammation of the articulations and joints of the spine leads to calcification and the development of ankylosis - immobility. Therefore, we strive to reduce the aggressiveness of the immune system and relieve inflammation as quickly as possible - this is the only way to maintain mobility and relieve pain in the back and joints.

Why us

Doctors. The appointment is conducted by a highly qualified rheumatologist with extensive experience in Russia and abroad.
Safety. Philips' advanced digital imaging systems provide high-precision, full-length images of the spine with little or no X-ray exposure (MRI).
A complex approach. Treatment of ankylosing spondylitis is carried out in close cooperation between different specialists of our medical center (rheumatologists, orthopedists, spinal surgeons, foreign consultants).
Innovation. The possibility of effective treatment of severe forms of the disease with the latest genetically engineered biological drugs and methods of extracorporeal hemocorrection.
Individual approach Specialists draw up an individual treatment plan for each patient, corresponding to the activity of the disease, and carry out constant monitoring, adjusting therapy in a timely manner.
Efficiency. Quick relief of back pain, preservation of spinal mobility, prevention of the development of severe disabling complications.

Symptoms, examination and diagnosis of ankylosing spondylitis

Diagnosis of ankylosing spondylitis

We often see patients with an “experience” of ankylosing spondylitis of 10 years or more, with an unknown diagnosis, and therefore who have not received the correct treatment. In the early stages, it is indeed difficult to recognize ankylosing spondylitis: early radiological signs are familiar only to specialists. In any case, if you have been experiencing morning pain and stiffness in the lower back and back for a long time, you should rule out ankylosing spondylitis. For early diagnosis of ankylosing spondylitis, we perform x-rays in special projections and laboratory tests, including genetic ones.

Symptoms of spinal damage:

An important early symptom is pain and stiffness in the lumbar spine; often occurring at night and worsening in the morning, it can last more than 2 hours after waking up and decreases after exercise and a hot shower. During the day, pain and stiffness in the spine with ankylosing spondylitis are observed at rest, in the morning and decrease with movement, sometimes disappearing in the afternoon. Spinal damage is a mandatory symptom.
As the disease progresses, the inflammatory process with pain and stiffness spreads to the overlying parts of the spine.
The physiological curves of the spine are gradually smoothed out and pathological kyphosis (stooping) of the thoracic region is formed, so that in some cases the correct diagnosis can be made “at a distance”, based on the characteristic posture of the patient. The course of this form of the disease is usually slow, many years, with periods of exacerbations and improvements.
As a reaction to the inflammatory process in the spine, painful tension in the back muscles occurs.
In the later stages, in the absence of treatment, the limitation of mobility in the spine is aggravated due to fusion of the vertebral joints and ossification of the intervertebral discs, with the formation of intervertebral “bridges”, clearly visible on x-rays.

Symptoms of joint damage:

An important manifestation of ankylosing spondylitis is inflammation of the joints of the sacrum - sacroiliitis. In this case, pain can be felt deep in the buttocks. Pain is often mistaken for a symptom of radiculitis or herniated disc, inflammation of the sciatic nerve.
More than half of patients with ankylosing spondylitis have damage to the joints of the extremities, most often the hip and shoulder. Pain and stiffness in the joints, as well as in the spine, are more intense in the first half of the day.
Less common is inflammation and swelling of the small joints of the hands and feet. The period of inflammation of the joints of the extremities with Ankylosing spondylitis is most often short-lived (1 – 2 months), but sometimes it can drag on for a long time. Even in these cases, unlike rheumatoid arthritis, destruction and deformation of the joints does not occur (with the exception of the hip joints in advanced cases without adequate therapy).

Non-articular symptoms of ankylosing spondylitis

About a third of cases of ankylosing spondylitis are accompanied by non-articular symptoms. With ankylosing spondylitis, inflammation of the eye tissue (uveitis, iridocyclitis), inflammation of the heart tissue (myocarditis, possible formation of valvular heart defects), aorta (aortitis), lungs, kidneys, and lower urinary tract occurs.

Ankylosing spondylitis usually begins at the end of the second, beginning of the third decade of life, but recently it has become increasingly common in adolescence.

In childhood or adolescence, the disease most often begins with damage to peripheral joints and is accompanied by a slight increase in body temperature.

Treatment

Therapy for this pathology is long-term and must be comprehensive. The goal of treatment is to stop or slow the progression of the disease. It is necessary to maintain continuity at all stages of treatment: hospital (department of traumatology, rheumatology) – clinic – sanatorium. Glucocorticoids and non-steroidal anti-inflammatory drugs, therapeutic blockades are prescribed. For severe treatment, immunosuppressants are prescribed.

The most important part of therapy is rehabilitation. Exercise therapy is the basis of therapy; it is what will prevent your health from deteriorating.

Individual exercises for therapeutic gymnastics are compiled, which must be performed daily. It is recommended to sleep on a hard bed without a pillow and regularly engage in sports that strengthen the back muscles (swimming, skiing). To maintain chest mobility, it is necessary to perform breathing exercises, and be sure to practice diaphragmatic breathing.

Physiotherapeutic treatment

In addition to medications and gymnastics, physiotherapeutic treatment is added, which should be carried out taking into account the stage of the disease, its form and the degree of activity of the pathological process.

With high activity of ankylosing spondylitis, ultraviolet (UV) irradiation of the spine is indicated, which stimulates the function of the adrenal cortex, the reticuloendothelial system, enhances phagocytosis, and accelerates immunological reactions. The result is an analgesic, anti-inflammatory and hyposensitizing effect.

In cases of severe pain, electrophoresis with novocaine has a good effect.

In the presence of active inflammation of peripheral joints, UHF therapy is recommended for the affected joints.

For ankylosing spondylitis in the stage of moderate or low activity, as well as in the inactive phase of the disease, physiotherapy methods are used much more widely.

In these stages, inductothermy, microwave and decimeter therapy, ultrasound, and ultraphonophoresis with hydrocortisone are indicated.

With an average degree of activity, a good effect is achieved by mud therapy in combination with the use of anti-inflammatory drugs, microwave, ultrasound therapy, acupuncture, Lyapko application therapy, massage, visceral abdominal massage according to Ogulov A.T. (massage of internal organs through the anterior abdominal wall), lymphatic masses abdomen according to Shishova O.I., et al.

How to relieve pain and maintain mobility of the spine and joints with ankylosing spondylitis

How to relieve pain and maintain mobility with ankylosing spondylitis?

The treatment tactics are logical and quite feasible. The following is required:

Reduce the aggressiveness of the immune system , and as soon as possible, because inflammation of the joints and ligaments leads to decreased mobility of the spine and joints (ankylosis);
Control possible risks of exacerbation (infections, intoxications, and other factors that increase the aggressiveness of the immune system);
Perform gymnastics to restore and maintain mobility;
Avoid weight gain (overload your joints!); if necessary, we will help you lose weight.

Statistics and etiology of the disease

Ankylosing spondylitis is one of the most common forms of spondyloarthropathy. In many cases, the disease has mild symptoms, which greatly complicates diagnosis and makes appropriate statistics impossible.

Previously, it was believed that ankylosing spondylitis occurs in men 3 times more often than in women. This error is associated with milder symptoms in women than in men regarding ossification or hardening of the spine. The first symptoms usually appear between the ages of 20 and 25 and only in 5% of cases after 40 years.

The onset of the disease is closely related to HLA-B27, an antigen that plays an important role in the function of the immune system. For this reason, it is assumed that this is a hereditary pathology.

Observation

A rheumatologist and an orthopedist monitor the patient’s condition throughout the treatment. To monitor the effectiveness of the therapy, the doctor performs regular diagnostics using the latest generation equipment. If necessary, treatment is adjusted.

Gymnastics for ankylosing spondylitis

Physical activity is the main condition for proper treatment, so we teach gymnastics to each of our patients . Exercises are selected individually, after assessing mobility impairments. We recommend performing the exercises daily, and if pain occurs, we adjust the gymnastics regimen.

Sometimes you have to develop mobility through the sensation of pain. With irregular exercises, when in the interval between training there is time for a change in the ligamentous apparatus with the formation of dense, sedentary areas in the ligaments and muscles. In these cases, massage helps well. Massage requires quite a long time and frequent courses, so we teach patients and their loved ones massage and self-massage techniques.

Objectives of exercise therapy for ankylosing spondylitis:

Reducing the progression of ankylosis (if the patient is immobilized, ankylosis occurs quickly)
Prevention of deformities
Treatment of existing deformities
Increasing muscle strength in weakened muscle groups
Reducing muscle spasm and muscle pain
Development of correct compensation, correct functional stereotype
Increased respiratory capacity of the lungs.

What symptoms should you be wary of? Signs of spondyloarthritis

Spondyloarthritis is a disease of young people. And if it is not treated, a person can become disabled in a few years. According to expert estimates, up to 2.5% of the population suffers from spondyloarthritis, which represents a huge army of hundreds of thousands of patients. A real guide to this disease, where all its symptoms are described very accurately and colorfully, can be... Nikolai Ostrovsky’s novel “How the Steel Was Tempered.” The writer himself suffered from spondyloarthritis, which is why he so vividly described all the manifestations of the disease in the main character of his book, Pavka Korchagin. The novel tells how Pavel struggles to get out of bed every morning and suffers from a feeling of complete helplessness; how he gradually loses the ability to move; how one begins to lose vision; how he develops heart and kidney complications...

Diet for ankylosing spondylitis

As with any chronic inflammatory disease, nutrition must be balanced and compensate for the body's costs. Nutrition should not lead to weight gain, which can increase the load on the spine and joints of the lower extremities. Sufficient consumption of protein foods is mandatory, with preference given to fish dishes and dairy products.

Since patients often have to be prescribed NSAIDs (non-steroidal anti-inflammatory drugs), which have undesirable effects on the mucous membrane of the stomach and intestines, to relieve pain and inflammation, a more gentle diet should be followed.

Your doctor will recommend certain types and caloric intakes of food based on your age, gender, weight, and other important factors.

Diagnostics

It is possible to obtain a comprehensive picture of the disease and clarify the area of its localization using the following research methods:

radiography, which will show pathologies of the sacroiliac region, where the development of the disease begins;
Magnetic resonance imaging;
gene diagnostics for the presence of HLA-B27 antigen in the body;
a general clinical blood test, where the inflammatory process is indicated by a sharp increase in the erythrocyte sedimentation rate.

Ankylosing spondylitis and infections

In the development of ankylosing spondylitis, the aggressiveness of the immune system against the tissue of one’s own joints and ligaments plays a role (a genetically predisposed perverted immune response to a certain microbial agent). The aggressiveness of the immune system can be maintained at a high level by various types of chronic infections , and this is a common cause of prolonged exacerbations and difficulties in treatment. Pathogenic microbes may not cause any symptoms, but their very presence in the body irritates the immune system.

In case of ankylosing spondylitis , we identify and treat chronic infections , which allows us to reduce the activity of the disease with minimal doses of medications.

Frequent cases of hidden infections:

Chronic tonsillitis and pharyngitis (inflammation of the tonsils and pharyngeal mucosa);
Chronic inflammation of the paranasal sinuses;
Herpes (recurrent rashes on the lips and/or genitals);
Intestinal dysbiosis and intestinal parasites;
Infections of the genitourinary system (prostatitis, urethritis, cystitis, etc.);
Inflammatory cysts in the area of tooth roots.

Seasonal viral infections can also cause arthritis to worsen.

Mechanism of disease development

Despite active study and collected statistics, the origin of the disease remains unclear. Most experts are inclined to the version of genetic predisposition: the presence of the HLA-B27 antigen in patients passes to first-degree relatives in 25-30%, and occurs within the family only in 7-8% of cases. In residents of the equatorial regions, the pathology is practically not diagnosed, and as we move towards the poles, its frequency increases to 30-40%.

Describing the causes of ankylosing spondylitis, experts talk about an inadequate immune response to the musculoskeletal system of the spinal column. Its tissues are perceived by the body as foreign, and the effect of their rejection occurs, characteristic of all autoimmune diseases. The subsequent inflammatory process is triggered by a cytokine substance consisting of TNF-α peptide signaling molecules called tumor necrosis factor alpha. Due to its active influence, the spine gradually becomes ossified and immobilized. Confirmation of the negative effect of the TNF-α molecule is the maximum concentration of the cytokine in the sacroiliac joint.

Concomitant pathologies or unfavorable external factors can accelerate the transition of ankylosing spondylitis to new stages. These usually include chronic infectious diseases, hypothermia, pelvic or spinal injuries, the consequences of which could not be completely eliminated. At risk are persons with hormonal disorders, infectious and allergic diseases, chronic inflammatory processes in the pelvic and intestinal organs.

What is useful and what is harmful in ankylosing spondylitis

Useful for ankylosing spondylitis:

Swimming (swimming – work of the spine and joints without gravitational load);
Regular gymnastics, slow exercises - “toffees”;
Massage (out of exacerbation);
Dosed and systematic implementation of hardening procedures.

Harmful for ankylosing spondylitis:

It is contraindicated to engage in traumatic sports; running, jumping, and sudden movements are not recommended;
Hypothermia is contraindicated, so we recommend conducting rehabilitation exercises in comfortable conditions;
Physiotherapy and massage are not recommended during an exacerbation; massage (not sports, but therapeutic) is prescribed when the inflammatory activity of the disease subsides; It is recommended to conduct courses at least 4 times a year;
Treatment with immunostimulants (leads to exacerbation);
Nervous and physical fatigue.

Symptoms of the disease

The main symptom of the disease is pain in the joint apparatus. In the morning you feel stiffness and pain in the spine. Your health may improve with activity. Although the disease affects the spine, pain is possible throughout the entire back area. The reason for this is that the sensory roots of the spinal cord emerge from the spinal column. Because of this, the entire torso, upper and lower extremities are innervated. Therefore, pain can spread throughout the body.

Objectives of physical therapy

Exercise therapy classes help maintain and normalize the following:

maintain flexibility of joints and spine;
strengthen your posture;
increase the excursion of the diaphragm and chest;
restore coordination;
normalize breathing, the functioning of the heart and blood vessels, as well as the gastrointestinal tract.

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Contraindications and side effects

Some physical activity and sports activities are strictly contraindicated for ankylosing spondylitis:

Jumping;
Step aerobics;
Run;
Dynamic games;
Lifting loads;
Prolonged fixation in a forced position (for example, when playing table tennis).

Sometimes, during training, pain increases, shortness of breath and general weakness appear. In this case, you need to figure out what exactly caused the deterioration in your health. Such reasons may be:

Excessively intense or prolonged exercise;
Lack of rest between approaches or strength exercises following each other in a row;
Contraindicated types of loads;
Inconsistency of the gymnastic complex with the stage of the disease.

If the main problem is identified, you need to adjust the lesson plan yourself or after consulting a physical therapy doctor.

It is necessary to remember that ankylosing spondylitis is an insidious disease, it begins unnoticed, with a slight pain syndrome, which many simply do not pay attention to, and only get to the doctor in the later stages. Therefore, it is very important to be attentive to your health and sound the alarm in time. And competent physical activity, along with basic treatment, will help cope with the pathology.