Other names used to refer to ankylosing spondylitis include “Strumpell’s disease” and “ankylosing spondylitis.” This is a systemic chronic pathology of the joints, which is localized in the following anatomical structures:
- sacroiliac joints;
- spinal joints;
- paravertebral soft tissues.
Despite its progressive nature, proper treatment of ankylosing spondylitis can significantly slow down and even stop its development. According to statistical data, ankylosing spondylitis occurs 5 times less often in women than in men.
At CELT you can get a consultation with a traumatologist-orthopedic specialist.
- Initial consultation – 3,000
- Repeated consultation – 2,000
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Etiology
The exact reasons for the appearance of symptoms of ankylosing spondylitis in women and men have not been established to date. There is evidence that 96% of patients with it have the HLA-B27 antigen. However, its presence in the body will not necessarily lead to the development of this pathology, although it is a sign of genetic predisposition. It is also customary to identify factors that are provoking in this case:
- prolonged hypothermia;
- inflammation of the genitourinary system;
- disruption of the endocrine system;
- injuries of the pelvic bones (fractures).
Diagnostic signs
Diagnostic signs of ankylosing spondylitis according to the recommendation of the Institute of Rheumatology of the Russian Academy of Medical Sciences, 1997.
- Low back pain that does not go away with rest, decreases with movement and lasts more than three months.
- Limitation of mobility in the lumbar spine - when bending back and forth and left and right.
- Limitation of the respiratory excursion of the chest (the difference between the circumference of the chest at full inspiration and maximum exhalation) relative to normal values in accordance with age and gender.
- Bilateral sacroiliitis (inflammation of the sacroiliac joint) stage II-IV.
The diagnosis is considered reliable if the patient has the fourth sign in combination with any other of the first three.
Late diagnosis of ankylosing spondylitis is explained by the general symptoms of rheumatological diseases.
X-ray examination and magnetic resonance imaging are mandatory. The main criterion is changes in the sacroiliac region.
Gene diagnostics for the presence of HLAB27 antigen is mandatory.
The diagnosis of AS is made on the basis of a comprehensive examination, including examination of the patient, analysis of complaints, clinical, laboratory and instrumental diagnostics, X-ray examination and MRI data.
Clinical manifestations
It is worth noting that the symptoms of ankylosing spondylitis differ in women and men. At the initial stage, symptoms in men manifest themselves vividly with short intervals between attacks, in women - weakly, with intervals between relapses of several years. Thus, the time period from the onset of pathology to the manifestation of symptoms in men is about five years, in women - from ten to twenty.
As for the clinical manifestations themselves, they include:
- pain localized in the sacrum and lumbar region;
- a feeling of stiffness that occurs when the patient is at rest;
- tension in the back muscles along with their soreness;
- limited movement of the spine.
As the disease progresses, there is an increase in pain and coverage of the entire spine. In addition, it appears:
- characteristic arched curvature of the spine;
- chronic stoop;
- immobility of intervertebral joints;
- decreased growth.
Clinical picture
The course and manifestations of ankylosing spondylitis are unpredictable. In some cases, it progresses so quickly that after a few years it leads to disability, in others (more often in women) it may not provoke significant changes in the condition of the joints for ten years.
At the same time, diagnosing the pathology in the early stages is quite problematic, since it often develops unnoticed. And in the future, its manifestations can easily be mistaken for signs of osteochondrosis and other degenerative diseases of the spine.
The main symptoms of ankylosing spondylitis are:
- impaired mobility, which affects gait;
- fast fatiguability;
- discomfort of varying degrees of intensity in the lower back, and subsequently throughout the entire back, often occurs at night and in the morning, and then gradually disappears during the day;
- elimination of pain when changing body position;
- irradiation of pain to the buttocks and heels;
- discomfort in the ligaments and places of their attachment to the bones;
- thickening of fingers;
- gradual involvement of an increasing number of joints in the pathological process.
The spine is the first to suffer, and not all at once, but in separate areas. Mild discomfort intensifies and turns into severe pain in the affected area. Often the knee joints or hands are among the first to be affected. This is accompanied by pain, redness of the skin around them and swelling.
Depending on how the onset of the disease occurs, there are several types of its debut:
- by type of radiculitis;
- by type of mono- or oligoarthritis;
- by type of rheumatoid arthritis;
- febrile type;
- according to cardiological type, etc.
The progression of the disease provokes curvature of the spine, which causes intercostal neuralgia and impaired lung function. As a result, the patient may experience difficulty breathing. If the joints of the cervical spine begin to suffer, headaches, nausea, and attacks of dizziness often occur. In advanced cases, it is possible to form a hump (thoracic kyphosis) and change the position of the head: it drops lower and moves forward.
Ankylosing spondylitis is characterized by alternating periods of remission and exacerbation. The duration of each of them can be several years. But it is dangerous to consider a decrease in the intensity of manifestations until their complete disappearance as recovery. Ankylosing spondylitis does not stop developing, and under the mask of calm the first signs of destruction of other joints and the occurrence of complications may be hidden. It is especially dangerous to miss a lesion of the sacral joint.
Symptoms
The pathology appears unexpectedly, and the first symptoms can begin 1-2 years before the exacerbation. People report irritability, lack of strength, joint pain, and drowsiness. Due to mild symptoms, people put off visiting a specialist until the last minute.
When the spine is affected, severe pain and stiffness appear in the lower back. Symptoms disappear after exercise and a hot bath, and appear at night. During the day, pain appears spontaneously and disappears after physical activity. Then the pain moves to the thoracic region, the person begins to stoop, and there is constant tension in the back. A serious complication is ossification and fusion of the vertebral discs. This process can take several years if treatment is not started.
When joints are affected, a person experiences acute pain in the buttocks, upper thighs, and pelvic organs. Often, a neurologist mistakenly diagnoses inflammation of the sciatic nerve or radiculitis. In approximately 50% of cases, people report severe pain in large joints, which limits movement and subsides in the afternoon.
Extra-articular symptoms appear in 30% of people. These are disturbances in the functioning of internal organs and severe pain in the eyes. The cardiovascular, respiratory and genitourinary systems are often affected.
Rapidly progressive form of AS
Processes of changes in connective tissue lead to irreversible processes and severe symptoms.
- These processes in the spine lead to fusion of the vertebrae (ankylosis).
- With ankylosis, the pain syndrome gradually decreases. But vertebral fusion increases the risk of fractures, especially in the cervical region.
- Disorders in the spine lead to changes in mobility and balance of the body. With severe kyphosis, it becomes difficult to straighten the torso and keep the back straight. The process of standing and walking is especially disrupted when the hips are involved in the pathological process.
- A pronounced forward tilt of the spine can cause breathing problems due to limited mobility of the chest. In addition, inflammatory changes can affect lung tissue, leading to pulmonary fibrosis and increased susceptibility to infection. The risk of lung infections is higher in smokers.
- Scarring processes in the eyes can lead to poor vision and glaucoma.
- In rare cases, damage to the myocardium and valve apparatus occurs, which leads to impaired contractile function and, as a consequence, to heart failure. Damage to the aorta and its expansion are also possible.
- Sometimes there is a connection between intestinal inflammation and AS. Some patients develop Crohn's disease.
- Possible kidney damage is largely associated with long-term use of medications prescribed for AS.
- In some patients (with pronounced changes in the distal spine) cauda equina syndrome occurs. This syndrome is manifested by impaired sensitivity in the groin area and dysfunction of the pelvic organs.
Ankylosing spondylitis has much in common with a whole class of joint diseases called arthropathy. For example, this is psoriatic arthritis, reactive arthritis (Reiter's syndrome), enteropathic arthritis. But in these diseases, spinal lesions are not as pronounced as in AS.
Classification of ankylosing spondylitis
There are 4 forms of ankylosing spondylitis:
- Rhizomelic - changes occur in the root joints of the spine, including the shoulder and hip.
- Central - affects the rigid and kyphotic part of the spine, which leads to unnatural straightening of the back.
- Scandinavian - similar to rheumatoid arthritis and affects only the small joints of the hand.
- Peripheral - leads to damage to the elbow, knee, ankle joints, as well as the spine.
Researchers often note the fifth form and call it visceral. The name is associated with the nature of the pathology, since degenerative changes in the spine and joints affect the urinary tract, heart, kidneys, eyes, and large arteries.
Classification of forms
Based on research data, experts distinguish the following forms of the disease:
- central, localized on the spine;
- kyphosis, in which inflammation affects the vertebrae of the cervical and thoracic spine;
- rigid, leading to smoothing of the natural curves of the back;
- rhizomelic, the area of localization of which is the spine and root joints;
- peripheral, involving the joints of the lower extremities;
- Scandinavian, which is characterized by damage to the joints of the hands;
- visceral, which combines the symptoms of any of the listed forms with simultaneous inflammation of the kidneys, heart or arteries.
Diagnostics
Before starting treatment for ankylosing spondylitis, specialists at the multidisciplinary CELT clinic conduct complex diagnostic studies, which, in addition to examination by a specialist and medical history, include radiography and MRI.
The specialist conducts a comprehensive examination and medical history, and also prescribes additional studies - MRI or spine. Additionally, a referral to a neurologist and orthopedist is given. A full range of tests is prescribed, including a blood test to assess the erythrocyte sedimentation rate (with ankylosing spondylitis, an increase in ESR is observed). If it is difficult to establish a diagnosis based on the diagnostic results, then an analysis is prescribed to identify the histocompatibility gene HLA-B27.
It is imperative to distinguish pathology from degenerative diseases of the spine, including osteochondrosis and spondylosis. These pathologies usually appear in older people, and ankylosing spondylitis in young men. Degenerative diseases of the spine limit physical activity and cause pain throughout the day. It is important to conduct a CT scan and a blood test for ESR, since with this pathology there are no serious disorders in the structure of the spine and there is no increase in the erythrocyte sedimentation rate.
Differential diagnosis of the Scandinavian form from rheumatoid arthritis is also carried out. With this pathology, subcutaneous nodes and symmetrical joint damage often appear. Women are at risk, since this disease is rarely found in men.
Diagnostic methods
The effectiveness of therapy largely depends on when the correct diagnosis was made. To diagnose ankylosing spondylitis in the early stages of development, an x-ray examination is sufficient, but the difficulty lies in differentiating it from other neurological and rheumatological diseases.
Only an experienced rheumatologist who is well acquainted with the clinical picture of the disease will be able to quickly recognize ankylosing spondylitis and select the optimal treatment regimen. At SL-Clinic you will find specialists who are familiar with the manifestations of pathology first-hand and are able to diagnose the disease in the early stages based on a score of existing symptoms and data from laboratory and instrumental examinations.
During the examination of the patient, the rheumatologist performs a series of functional tests to detect sacroiliitis and determine the limitation of mobility. Also assigned:
- rheumatic tests;
- UAC;
- blood chemistry;
- genetic testing to detect HLA-B-27;
- X-ray of the pelvis, as well as the spine in direct and lateral projections;
- CT;
- MRI.
The price of each diagnostic procedure can be found in diagnostic laboratories. And our specialists will help you decipher the research results as soon as possible.
Treatment
Since it is impossible to completely eliminate the pathology, CELT specialists focus their efforts on eliminating pain symptoms and inflammation. For this purpose, drug treatment is prescribed, which includes the use of:
- NSAIDs;
- glucocorticoids;
- immunosuppressants.
During periods of remission, physiotherapy, breathing and therapeutic exercises are used. Exercise therapy exercises are selected on an individual basis. In addition, manual therapy gives good results.
Ankylosing spondylitis can be cured only with complex therapy over a long period of time. Experts prefer non-steroidal anti-inflammatory drugs or glucocorticoids. If the disease has reached a severe stage, then immunosuppressants are used.
Additionally, physical therapy is prescribed. For each person, the program and frequency of training are selected individually. It is recommended to sleep on a hard surface or firm mattress without a pillow. You definitely need to do breathing exercises to strengthen the diaphragm and play sports. The best choice is swimming, as it strengthens the back muscles and does not put destructive stress on the joints.
It is advisable to undergo treatment at a sanatorium, which will include taking nitrogen and hydrogen sulfide baths, as well as reflexology and massage. Not in all cases it is possible to get rid of the pathology 100%, but complex therapy will lead to a significant improvement in the condition and help avoid exacerbations.
Adequate treatment prescribed by our specialists can slow down the development of pathology and improve the quality of life.
WHAT IS ANKYLOSING SPONDYLOARTHRITIS
Systemic immune disorders lead to inflammation of the sternoclavicular, sacroiliac joints in the spine, and small intervertebral joints. In the affected areas, fibrous tissue quickly forms, firmly holding the vertebrae together. The more joints and joints are affected, the less mobile the spine is.
The disease progresses slowly, in some cases it is discovered by chance: for example, age-related kyphosis turns out to be ankylosing spondylitis. At the same time, other joints remain working. Joint destruction is secondary to the underlying disease.
If you do not treat ankylosing spondylitis, the spine gradually loses mobility. The pain cripples at the slightest bending and turning. Over time, even deep breathing or sneezing causes discomfort. The stooping becomes more and more obvious, back pain torments around the clock. In the end, the vertebrae finally fuse with each other, depriving the patient of the opportunity to straighten.
A characteristic posture for a patient with progressive ankylosing spondylitis is a spine twisted in the shape of a question mark, arms bent at the elbows, legs at the knees.
Orthopedics and traumatology services at CELT
The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7
| Service name | Price in rubles |
| Appointment with a surgical doctor (primary, for complex programs) | 3 000 |
| X-ray of the thoracic spine | 2 200 |
| MRI of the cervical, thoracic and lumbar spine | 16 000 |
All services
Make an appointment through the application or by calling +7 +7 We work every day:
- Monday—Friday: 8.00—20.00
- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
- Enthusiast Highway
Driving directions
Diagnosis and treatment of ankylosing spondylitis at ON CLINIC in Ryazan
The diagnosis of Bechterew's disease is made by a rheumatologist based on x-rays. In addition, the presence of inflammation in the body can be judged by changes in the results of the patient’s general blood test. If, for some reason, making a diagnosis is a complex undertaking, as well as in cases where the attending physician has doubts about its correctness, a special analysis can be performed to determine the presence of a specific antigen in the patient’s body.
If we talk about the treatment of ankylosing spondylitis in our medical center, then first of all it may include taking anti-inflammatory non-steroidal drugs according to the regimen prescribed by the attending physician. The course of treatment will likely take a lot of time, so the patient will need to be patient and disciplined. The outcome of treatment largely depends on this.
An inadequate response from the body's immune system can provoke the presence of sluggish infectious diseases. This could be herpes, cystitis, prostatitis, tonsillitis, etc. If we talk about effective therapy aimed at eliminating all the symptoms of ankylosing spondylitis, then it should begin with the treatment of these and other infectious diseases, including chronic ones.
Treatment with medicinal leeches - hirudotherapy - has proven itself to be excellent in alleviating the condition of patients suffering from this disease. The fact is that the secretion secreted by the salivary glands of leeches contains special enzymes that have a “softening” effect on the patient’s joints and spine. In addition, they prevent the spread of inflammation and help boost immunity.
If we talk about exercises that are effective for ankylosing spondylitis, our doctors recommend to their patients a specially designed complex that prevents ossification of the spine and makes it more flexible. Patients with ankylosing spondylitis can do exercises regularly at home - this can effectively resist the progression of the disease.
In addition, various types of physiotherapy, as well as acupuncture treatment methods, massage, etc., can be extremely effective in combating this disease. Do you want to know the price of treatment for ankylosing spondylitis in Ryazan in our clinic? Just call us, consult and make an appointment with a specialist! We also effectively treat rheumatism, gout and other diseases.