Ankylosing spondylitis: what do doctors advise?

Features of the composition and pharmacological action of Rumalon

The instructions indicate that the main active component of the drug is a glycosaminoglycanopeptide complex; additional ingredients include purified water and metacresol. Rumalon is produced in ampoules of 1-2 ml, each package contains 25 units.

The active component of the drug is included in the subgroup of biogenic stimulants of animal origin. When used, a temporary protective effect is observed; most enzyme substances that destroy the cartilaginous surfaces of joints are suppressed.

The medication inhibits catabolism, improves the production of sulfated mucopolysaccharides, and stabilizes metabolic processes in hyaline tissues. The drug is based on an extract from the cartilage and bone marrow of young animals.

Rumalon helps restore cartilage cells due to the active production of collagen and glycosaminoglycan, which are building materials for tissues. Therapy reduces the effect of enzymatic substances that destroy cartilage, increases the production of secretions used to reduce joint friction, and improves the nutritional processes of articular and cartilaginous elements.

When therapy is started in a timely manner, the medication slows down the development of osteoarthritis, which provokes changes on the outer side of the cartilage of the joint and thinning of the cartilaginous plate.

Reviews from doctors about Alflutop and Rumalon

Karina, 43 years old, Moscow, orthopedist: “I consider chondroprotectors based on substances obtained from animal and fish cartilage as products with unproven effectiveness. These include Rumalon and Alflutop. Most experts believe that the actions of drugs are based on the effect of self-hypnosis. In addition, Alflutop is not registered as a medicinal product. I do not advise my patients to use biological supplements. Instead of benefit, they can cause harm to the body.”

Mikhail, 39 years old, Kaliningrad: “Alflutop and Rumalon are means of auxiliary therapy for diseases of the musculoskeletal system. They help slow down the development of osteochondrosis and osteoarthrosis. I recommend that my patients administer the drug intramuscularly. Intra-articular use is associated with a high risk of infection. When administered for the first time, you need to monitor the body’s reaction. Initial doses of medications should not exceed 0.3 ml.”

Contraindications, indications for treatment

The instructions recommend the use of Rumalon for degenerative lesions of the joints:

• for arthrosis, spondylosis, coxarthrosis;
• meniscopathies – pathologies of cartilage in the knee joints, accompanied by functional disorders and pain;
• spondyloarthrosis, gonarthrosis;
• chondromalacia – necrosis of cartilage cells.

The medicine is contraindicated in patients:

• with individual intolerance to the component composition;
• rheumatoid arthritis, thrombophlebitis;
• tendency to spontaneous bleeding.

Rumalon is not prescribed to pregnant and lactating women and minor patients. During lactation, the medication can be used provided that the newborn is transferred to artificial nutrition.

Particular caution and supervision by the attending physician is needed during treatment with the drug in patients with blood clotting disorders, diabetes mellitus, renal, and hepatic pathologies. The same requirements apply to women planning pregnancy and overweight or obese patients.

Are chondroprotectors as effective as we are told?

According to manufacturers, chondroitin and glucosamine restore cartilage tissue in the joint and protect it from destruction. They contain components that replicate the structure of hyaline cartilage, which explains this effect. To get any results, you need to take the drugs for a long time, several months.

Many patients note that even after a long period of use, chondroprotectors did not give any result at all. This is also confirmed by x-rays, in which the size of the joint space remained the same, and sometimes decreased.

Drugs with a chondroprotective effect only help people with early stages of arthrosis. At stages 2 and 3 of coxarthrosis or gonarthrosis, there is no result from them: stronger drugs are needed. In such cases, it is advisable to undergo a course of intra-articular injections of Noltrex or decide on endoprosthetics if the joint is severely damaged and conservative treatment does not help.

Proponents of chondroprotectors often remain silent about what side effects are possible after long-term use of these drugs. Watch the video on this topic and draw your own conclusions:

Adverse reactions

Therapeutic procedures can provoke non-standard responses of the body, manifested by:

• dizziness, cephalgia, erythema;
• nettle fever, eczema, maculopapular rash with itching or swelling;
• dyspeptic disorders, nausea with vomiting;
• allergies, anaphylaxis, Quincke's edema;
• painful sensations in the joints - the disorder does not require discontinuation of the medication and goes away spontaneously;
• local bleeding - in the area of ​​drug administration.

The occurrence of side effects during therapy with Rumalon requires additional consultation with a doctor. The patient must describe in detail the deviations that have arisen, and the specialist must select a more suitable drug.

What the Research Says

Over the past few years, studies have regularly appeared that confirm poor results or their complete absence in the treatment of osteoarthritis with chondroprotectors.

• In 2006, an English medical journal published data that chondroitin, glucosamine, and any combination of them were not more effective than placebo. The studies were conducted on a group of patients of 1583 people.
• In 2007, American scientists concluded that chondroitin does not provide any improvement in the symptoms of arthrosis.
• In 2010, large-scale studies were carried out on a group of patients of 3800 people, which also equated the effect of chondroprotectors to placebo.

Chondroprotectors in many countries have already been equated to placebo - they don’t work

If chondroprotectors do not give the desired effect, then is it worth spending a lot of money on them and taking pills for many months, waiting for the result? Indeed, unlike this method, intra-articular injections of synovial fluid prosthesis give an almost instant effect. They pose no health risks in the short or long term. Therefore, many doctors in developed countries no longer recommend chondroprotectors to their patients, but immediately, after confirming the diagnosis, send them for injections.

Nuances of Rumalon therapy

The instructions recommend intramuscular injections according to a specific scheme:

• the first day - 0.3 ml;
• the second – 0.5 ml;
• the remaining 1.5 months - 1 ml three times a week.

The frequency of treatment procedures is limited to two courses per year. For complex pathologies, therapy is repeated up to 4 times within 12 months, and can last for several years in a row.

If the recommended injection volume is accidentally exceeded, symptoms of overdose occur. Patients develop hemorrhages at the injection site, signs of allergy with redness, itching, swelling and skin rashes. Treatment consists of suppressing symptoms after stopping the medication.

Analgesic properties of the drug Alflutop in the treatment of chronic back pain

A.B.Danilov, T.R.Zharkova, L.T.Akhmetdzhanova Department of Nervous Diseases of the First Moscow State Medical University. I.M. Sechenova Pain in the lower back is the fifth most common reason for visiting a doctor. In most cases, it occurs against the background of degenerative-dystrophic diseases of the spine, which are found in 90-95% of the adult population. The main problem in treatment is chronic pain, which does not always correlate with the pathology of spinal structures detected by neuroimaging [1-3]. Alas, today there is no one universal effective method or drug that has clearly proven its effectiveness in the treatment of chronic back pain. This determines the search for new treatment options. One of these areas is the use of chondroprotectors. Interest in this group of drugs as potential analgesics is due to their anti-inflammatory properties and safety of use. The effectiveness of these drugs in the treatment of joint pathology has been well studied [4], while in the treatment of chronic back pain they are used much less frequently [5]. Special studies have shown that components of chondroprotective drugs such as glucosamine and chondroitin, in large doses, have certain anti-inflammatory effects and reduce pain [4, 6]. Traditionally, drugs of this series existing on the market are in tablet forms and are used for a long time in the complex treatment of joint diseases. In these cases, the therapeutic effect is usually expected within several months. Injectable drugs containing chondroprotective components look more attractive from the point of view of pain therapy.

In recent years, several studies have been published on the effectiveness of the injection drug Alflutop for osteoarthritis and back pain [7-13]. Alflutop is an original injection drug, which is an extract from marine fish that contains glycosaminoglycans, including hyaluronic acid, chondroitin sulfate, dermatan sulfate, keratan sulfate. The drug has a chondroprotective and anti-inflammatory effect, regulates metabolism in cartilage tissue. Its chondroprotective effect is associated with inhibition of the activity of hyaluronidase and other enzymes that take part in the destruction of the intercellular matrix and normalization of the biosynthesis of hyaluronic acid and type II collagen. Alflutop inhibits the biosynthesis of inflammatory mediators and reduces capillary permeability. The proteoglycans included in its composition have a trophic effect and have a replacement effect, significantly increasing the indices of magnetic resonance imaging (MRI), hydrophilicity, cartilage height and bone tissue homogeneity.

Very intriguing is the analgesic effect of the drug, which, according to many authors, manifests itself quite quickly. An open multicenter study assessing the effectiveness and safety of Alflutop in patients with vertebrogenic cervicobrachialgia demonstrated its ability to reduce the severity of pain and increase mobility in the cervical spine and shoulder joint [9]. In general, a positive result was observed in 82% of patients, and the analgesic effect appeared within the first 2 weeks after the start of treatment. In a special double-blind, placebo-controlled study on the use of the drug Alflutop for chronic lumbar sciatica, its high effectiveness was also demonstrated [10]. In these and other studies on the use of the drug Alflutop, it was clearly demonstrated that the onset of the analgesic effect begins in the 2nd week of therapy [7, 8, 12, 13]. It is unlikely that the reduction in pain during these periods is associated with the restoration of cartilage tissue or other structural changes in the tissues of the spine or joint. Thus, the question remains insufficiently clear about the mechanisms of the analgesic effect of the drug Alflutop, which appears quite quickly and persists throughout the entire course of treatment and after its completion. Effectiveness research

The purpose of this study is to clarify the mechanisms of the analgesic effect of the drug Alflutop in the treatment of patients with chronic pain in the lower back. Material

The study involved 30 patients (7 men and 23 women, mean age 40.6±10.8 years). Inclusion criteria: 1) patient age from 25 to 70 years; 2) chronic pain syndrome in the lower back lasting at least 3 months, not due to specific causes (oncology, infection, etc.) against the background of confirmed degenerative changes in the spine according to radiography, computed tomography (CT) and MRI; 3) pain intensity of at least 4 points on the visual analogue scale (VAS). In 13.3% of patients, protrusion of the intervertebral disc without root compression was diagnosed, in 23.3% - facet atropathy, in 16.6% - pathology of the iliosacral joint, in 10% - radiculopathy due to disc herniation. 12 patients had pain at the level of the neck and shoulder girdle, and 18 patients had pain at the lumbar level. The control group included 15 practically healthy people (8 men and 7 women), whose average age was 44.37±10.3 years. Treatment

All patients received monotherapy with Alflutop 1 ml intramuscularly daily for 20 days. Before therapy, patients received non-steroidal anti-inflammatory drugs - NSAIDs (83.3%), muscle relaxants (60%), physiotherapeutic treatment (53.3%). 3 days before the start of the study, in accordance with the protocol, previous pharmacotherapy for pain was stopped. Physiotherapy, massage and manual therapy were not used during treatment. Research methods

The intensity of pain was assessed using VAS at each week of treatment and 1 month after its completion. The presence of a neuropathic component of the pain syndrome was assessed using the DN4 questionnaire before and after treatment [14]. The Beck Inventory was used to determine the level of depression. To assess the level of reactive and personal anxiety, the Spielberger test, modified by Hanin, was used. The Quality of Life questionnaire (SF 36) used in the study assessed the degree of adaptation disorders of patients [15]. To assess the degree of activity impairment, the Roland-Morris Activity Impairment Scale was used [16].

To assess the functional state of nociceptive and antinociceptive systems before and after treatment, the nociceptive flexor reflex (NFR) technique was used [17, 18]. NFR belongs to the group of protective reflexes and is interesting because it allows you to objectively and quantitatively assess a person’s pain threshold. It has been proven that in a healthy person there is a close connection between the threshold of subjective pain sensation and the threshold for the occurrence of this reflex. This reflex also allows us to assess the state of nociceptive and antinociceptive systems in humans, to study the role and influence of various neurotransmitters and drugs involved in pain control. Description of the NFR technique

The subject should sit in a comfortable chair, legs as relaxed as possible, knees bent at an angle of 130o, and the foot at the ankle joint should be at an angle of 90o. To reduce emotional stress, it is necessary to inform the subject about the conditions of the experiment. Stimulating electrodes are placed behind the ankle or slightly lower along the peroneal nerve, at a distance of 2 cm from each other, the cathode is proximal, the anode is distal. Recording electrodes are placed on the abdomen of m. biceps femoris capitis brevis (cathode) and on the tendon of this muscle (anode). The ground electrode is placed midway between the stimulating and recording electrodes. The stimulus used is a trend (packs) of stimuli with a total duration of 20 ms, with a frequency of 300 Hz and a duration of each stimulus of 1 ms. To avoid habituation, it is recommended that the stimulus packets be presented in an irregular order. The study begins with low-intensity stimuli, gradually increasing it, and observing the appearance of muscle responses. When a response appears, its threshold (reflex threshold - Pr) is recorded, i.e. the magnitude of the electric current at which it appeared. The threshold of subjective pain (pain threshold - Pb) is also recorded, i.e. the magnitude of the electrical stimulus at which the patient first indicates the appearance of localized acute pain in the area where the stimulating electrodes are located. In healthy individuals, the pain and reflex thresholds usually coincide or the first is slightly lower than the second. To accurately determine the relationship between pain and reflex threshold, the coefficient is calculated - pain threshold/reflex threshold (Pb/R), which in healthy people is approximately 0.9-1.0.

After treatment, a general assessment of the results of therapy was carried out by the patient and the doctor using a 10-point system: 0 - no effect, 10 - very high effectiveness. Statistical processing was carried out using the standard software package Statistica 6. Research results

The average duration of the disease in the group ranged from 3 months to 2 years (8.6±5.5 months), the pain intensity was 5.7±1.3. The patients' complaints included the following types of pain: shooting (10%), pressing (33.3%), aching (50%), nagging pain (6.7%). The dynamics of pain intensity according to VAS during treatment with Alflutop by week are shown in Fig. 1. A significant decrease in pain according to VAS was noted already in the 2nd week of treatment. During further treatment, a decrease in pain intensity to an average of 3.2 points was noted. 1 month after completion of treatment, pain intensity did not differ significantly from VAS parameters immediately after completion of the course of injections.

A highly significant decrease in the degree of activity impairment was revealed during treatment according to the Roland-Morris activity impairment scale (before treatment 4.9±2.8, after treatment 3.3±1.4; p<0.009). There were no significant decreases in the severity of anxiety and depression during treatment (Table 1).

According to the SF36 questionnaire, during treatment there was a significant improvement in the quality of life of patients (before treatment 82.2±8.9, after treatment 86.7±4.9; p<0.02). When analyzing the data from the DN4 questionnaire, the average score among the examined patients was 1.93±1.87. The presence of a neuropathic component was detected in 20% of patients. There was no significant decrease in the number of points, according to the DN4 questionnaire, during treatment, but there was a tendency towards its decrease (before treatment 1.93±1.87, after treatment 1.6±1.5; p=0.4) .

According to the NFR study, pain thresholds and nociceptive reflex in the examined group were significantly lower than in healthy people. The Pb/Pr ratio did not differ significantly from healthy people. After treatment, there was a significant increase in pain and reflex thresholds to the level of normative values. The results of NFR before and after treatment are shown in Fig. 2 and in table. 2. According to the doctor’s assessment, the effectiveness of treatment on average for the group was 7.8±1.6 points, the assessment of the effectiveness of treatment by the patient himself reached 7.9±1.7 points.

The drug was well tolerated by patients. No side effects were identified during the study. Discussion

One of the important peripheral pathogenesis factors that predetermine the tendency to chronic back pain is the destruction of cartilage tissue, involving both intervertebral discs and intervertebral joints. It causes persistent biomechanical disorders that contribute to the constant resumption of pain, and provokes further progression of the pathological process in the structures of the spine, closing a vicious circle in spinal osteochondrosis. In this regard, the use of chondroprotectors in the complex treatment of spinal osteochondrosis seems logical. However, at present there are few studies that would confirm the effectiveness of chondroprotective drugs for spinal osteochondrosis [5]. Recent Russian studies of the effectiveness of one of the complex chondroprotectors, the drug Alflutop, have shown that in patients with chronic algic vertebrogenic syndromes, the drug helps to permanently reduce pain, increase spinal mobility and expand the functional capabilities of patients [9, 10]. The therapeutic effect of Alflutop was evident within the first 2 weeks of treatment and increased throughout the course of therapy.

The results of our study using the NPR technique showed that in patients with chronic pain, pain thresholds and nociceptive reflex were significantly reduced with a normal Pb/Pr ratio. This indicates an increase in peripheral nociceptive afferentation and a lack of antinociceptive control in these patients. After the end of treatment, a significant increase in both pain thresholds and reflex was obtained to the level of normative values. These results indicate normalization of the functional state of pain control systems, primarily due to the reduction of nociceptive afferentation. This analgesic effect, obtained in a fairly short period of treatment (3 weeks), allows us to discuss the role of nonspecific inflammation (peripheral sensitization) as one of the known significant mechanisms for maintaining chronic pain [1-3]. Alflutop probably has an analgesic effect in a fairly short time due to components with anti-inflammatory properties. Many studies emphasize that chondroprotective drugs containing glucosamine sulfate, chondroitin, etc., have anti-inflammatory properties and can reduce pain regardless of the structure-modifying effect [4, 5, 8, 11, 12]. However, the use of oral forms of chondroprotective drugs does not always have an analgesic effect [6]. Perhaps, due to the injection form and the content of a complex of components with chondroprotective and anti-inflammatory properties, Alflutop reduces the intensity of pain much faster than oral chondroprotectors. Good tolerability of the drug and its safety are also important, which is its significant advantage over NSAIDs.

One of the results of the study was a significant decrease in the degree of impairment of the patient’s functional abilities during treatment, assessed on the Roland-Morris scale. From our point of view, this result is extremely important, since the fastest return of the patient to daily physical activity is the main factor in the prevention of relapses and prevents the chronification of pain [1-3]. It is known that in case of chronic back pain, prolonged bed rest (“lying down”) and refusal of any physical activity are associated with a poor prognosis in terms of recovery and reduction in pain intensity. Often, patients, most often because of pain and fear of its intensification, choose such tactics (passive coping strategy), which further shapes their “pain behavior,” leading to poor recovery and maladjustment [3]. In our work, we showed that a gradual decrease in pain intensity, starting from the 2nd week of treatment with Alflutop, allowed patients in the study group to quickly restore their motor functional abilities. In general, the treatment led to a significant improvement in the quality of life indicator according to the SF36 questionnaire. Conclusion A course of treatment with Alflutop for 3 weeks (1 intramuscular injection daily) led to a significant decrease in the intensity of pain in the study group of patients with chronic back pain. A decrease in pain was noted from the 2nd week of injections, reaching a maximum at the end of the course. The analgesic effect persisted for 1 month after the end of treatment. As a result of therapy, a significant improvement in the motor functions of patients was noted, which is an important factor in the prevention of relapses and chronic pain. Data from NFR studies indicate the role of peripheral nociceptive afferentation (peripheral sensitization) in the mechanisms of chronic pain maintenance. It can be assumed that the analgesic effect of the drug is associated with a reduction in peripheral nociceptive mechanisms due to the anti-inflammatory properties of this drug. We also cannot exclude the possible analgesic properties of other components of the Alflutop drug. Thus, the results of our study allow us to consider Alflutop as an effective and safe drug for the treatment of chronic back pain, both as monotherapy and in complex treatment. Literature 1. Voznesenskaya T.G. Pain in the back and limbs. Pain syndromes in neurological practice. Ed. A.M.Veina. M.: Medpress, 1999; With. 217-83. 2. Danilov A.B. Pain syndromes. In the book: Neurology. National leadership. 2009; With. 423-41. 3. Podchufarova E.V. Chronic back pain: pathogenesis, diagnosis, treatment. RMJ. 2003; 11 (25): 32-7. 4. Badokin V.V. The importance of inflammation in the development and course of osteoarthritis. Cons. Med. 2009; 11 (9): 91-5. 5. Gorislavets V.A. Structure-modifying therapy of neurological manifestations of spinal osteochondrosis. Cons. Med. 2010; 12 (9): 62-7. 6. Walsh AJ, O'neill CW, Lotz JC. Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro. Spine J 2007; 7 (5): 601-8. 7. Groppa L.G., Mynzatu I. Karasawa M. et al. Efficacy of alflutop in patients with deforming arthrosis. Wedge. rheumatol. 1995; 3:20-2. 8. Korshunov N.I., Marasaev V.V., Baranova E.Ya. and others. The role of inflammation and assessment of the chondroprotective effect of Alflutop in patients with osteoarthritis according to magnetic resonance imaging of the knee joint. RMJ. 2003; 11 (23): 1320. 9. Levin O.S. and others. Efficacy of Alflutop in vertebrogenic cervicobrachialgia (Open multicenter study). Pharmateka. 2008; 6: 48-54. 10. Levin O.S. The effectiveness of Alflutop in chronic vertebrogenic lumbar ischialgia according to a double-blind, placebo-controlled study. Scientific-practical rheumatol. 2004; 4:80-4. 11. Lukina G.V., Sigidin Ya.A. Experience with the use of the drug alflutop in the treatment of osteoarthritis. Wedge. rheumatol. 1996; 4:40-3. 12. Svetlova M.S. Ignatiev V.K. The use of alflutop in the treatment of patients with osteoarthritis. Wedge. honey. 2004; 82 (6): 52-5. 13. Khodyrev V.N., Golikov L.G. Clinical effectiveness of alflutop for spinal osteochondrosis (12-month study). Scientific-practical neurol. 2003; 3: 104. 14. Bouhassira D et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114 (1-2): 29-36. 15. Raigorodsky D.Ya. Practical psychodiagnostics. Samara: Bakhrakh-M, 2004. 16. Roland M, Morris R. A study of the natural history of back pain: part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983; 8: 141-4. 17. Danilov A.B., Danilov A.B., Vein A.M. Nociceptive flexor reflex: a method for studying brain mechanisms of pain control. Journal neuropathol. and a psychiatrist. them. S.S. Korsakov. 1996; 1: 101-7. 18. Sandrini G, Serrao M, Rossi P et al. The lower limb flexion reflex in humans. Prog Neurobiol 2005; 77: 353-95. 19. Wilkens P et al. Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis JAMA 2010; 304(1):45-52. SOURCE CONSILIUM-MEDICUM NEUROLOGY No. 2/2010

Instructions from the manufacturer and interaction features

The instructions indicate the following nuances:

• therapeutic procedures with Rumalon are stopped when signs of an allergic reaction appear;
• the medication is prohibited for use by minors, pregnant and lactating women;
• Before using the medicine, a diagnostic examination and confirmation of the presumptive diagnosis is necessary.

Improvement in joint mobility, suppression of pain and other therapeutic effects are recorded 14-21 days from the start of treatment. The results obtained last for several months after completion of the procedures.

Rumalon improves the effect of individual drugs during joint therapy, the list includes:

• indirect anticoagulants;
• antiplatelet agents;
• fibrinolytics.

The combination with them requires regular checking of blood clotting speed. Combining Rumalon with NSAIDs allows you to reduce the dosage of the latter medications.

Patient reviews

Irina, 45 years old, Yekaterinburg: “I suffered from back pain for a year, which is why I went to the doctor. During the examination, osteochondrosis of the lumbar spine was discovered. Intra-articular injection of Alflutop was prescribed. During treatment, the back pain intensified. The doctor decided to replace the drug with Rumalon, which is administered intramuscularly. The discomfort disappeared. She was treated for 20 days, osteochondrosis went into remission. The pain has not appeared for six months.”

Sergey, 38 years old, St. Petersburg: “I read reviews about Rumalon, the majority were negative. I myself used these drugs during the recovery period after an injury. The injections helped restore joint mobility and relieve pain. I undergo treatment every six months. This helps you work normally and even go to the gym. The drugs differ in their duration of action. The effect of Alflutop lasts longer.”

Analogs

The occurrence of intolerance to the drug or side effects requires its replacement. The list of popular analogues is presented:

• Alflutop;
• Arthroi;
• Bishofite;
• Gialganom Phidias;
• Glucosamine-Chondroitin;
• Incenoy;
• KONDROnova;
• Movex Comfort;
• Piaskledin 300;
• Traumemel S;
• Chondroitin Complex;
• The goal of T.

The product has no complete structural analogues.

Why does ankylosing spondylitis develop?

No one knows the exact cause, but it is assumed that the disease develops due to malfunctions of the immune system, especially in the presence of provoking factors:

• too low birth weight;
• infectious disease at the age of 5-12 years (infections of the genitourinary system and intestines are of particular danger);
• hypothermia;
• spinal and pelvic injuries;
• the presence in the body of enterobacteria that cause arthritis, etc.

The HLA-B27 gene is present in almost everyone who has been diagnosed with ankylosing spondylitis

Forms of ankylosing spondylitis

Depending on the location, the disease has the following forms:

• central – only the spine is affected (accounts for about half of all cases);
• rhizomelic - the shoulders and hip joints are also affected;
• peripheral – affects, in addition to the spine, the knee, elbow and ankle joints (diagnosed mainly at the age of 10-16 years);
• Scandinavian - similar in symptoms to rheumatoid arthritis, affects all joints, including small ones;
• visceral - inflammation also extends to blood vessels, kidneys, eyes and other organs.

The earlier ankylosing spondylitis is detected, the better it is treated