What are Bekhterev's disease symptoms. Ankylosing spondylitis - prognosis for life. Description of characteristic symptoms

Often, chronic pain in the spine is a consequence of osteochondrosis or osteoarthrosis and is caused by the destruction of connective tissue and intervertebral cartilage and the inflammatory process. But sometimes such symptoms are a sign of a very dangerous and difficult to treat pathology - ankylosing spondylitis (or spondyloarthritis), which is called ankylosing spondylitis.

Many videos on the Internet and scientific publications are devoted to this pathology, but despite the achievements of modern medicine, the causes of the pathology are still not known for certain.

The disease is systemic in nature and affects not only the spine, but also large and peripheral joints, coronary vessels, heart valves and myocardium, organs of the bronchopulmonary, nervous, urinary systems, and eyes. It is the polymorphism of clinical signs that characterize ankylosing spondylitis that makes diagnosis difficult. And even treatment started in the early stages does not help in all cases, and in many patients the pathology ends in disability.

Only ankylosing spondylitis causes total damage to the spine, since the entire spine from the neck to the sacrum is involved in the pathological process, and the ribs, pelvis and joints of the torso become ankylosed (in other words, become immobile).

Ankylosing spondylitis has been known since ancient times. Characteristic changes in the skeleton were discovered during archaeological excavations in Egyptian mummies. In the middle of the 16th century, several cases of ankylosing spondylitis were first described in Realdo Colombo’s famous book “Anatomy” in medical circles. Much later, at the end of the 17th century, physician B. Connor described and demonstrated a human skeleton in which the ribs, sacrum, lumbar vertebrae and pelvis were fused and formed a single bone.

However, a real breakthrough in the study of this disease was the work of the Russian neurologist V.M. Bekhterev, observations of the German doctor A. Strumpel and his French colleague P. Marie. It was their work that formed the basis of modern ideas about ankylosing spondylitis, therefore a more correct formulation of its name is Bechterew-Strumpel-Marie disease.

The prevalence of the pathology is about 1.5%. It begins at a young age (from 15 to 30 years), with the peak appearance of clinical symptoms occurring at 24 years of age. In people over 40 years of age, such a diagnosis is made only in isolated cases. Men suffer from spondylitis 5 to 9 times more often than women.

Until recently, the exact cause of ankylosing spondylitis was not established. Experts were only sure that the development of such a pathology was genetically determined. Now doctors believe that the leading mechanism is the autoimmune mechanism, which begins under the influence of the HLA B27 antigen. At the same time, the risk of symptoms of spondyloarthrosis in a child whose one or both parents suffered from this disease is about 30%. Risk factors for the development of pathology are previous infections (in particular, the genitourinary system and digestive tract), especially those provoked by bacteria of the genus Klebsiella (sown in 75% of patients with spondyloarthrosis), Yersinia.

The pathogenesis is also not fully understood. But in the last decade, the role of tumor necrosis factor type α (TNF α), discovered by oncologists, in the development of inflammatory and other disorders in connective tissue has been actively studied. When affected by spondyloarthrosis, a high concentration of this biologically active compound is found in the sacroiliac joint. In addition, experts have found that TNF α stimulates the release of other inflammatory mediators and their destructive effect on cartilage tissue.

Diagnosing ankylosing spondylitis is difficult at an early stage, even with the use of MRI and other modern technologies. Treatment of the pathology includes a complex of non-steroidal anti-inflammatory drugs, pulse therapy with corticosteroid hormones and cytostatics. Recently, gene therapy has become widespread, but its widespread use is limited by the high cost of drugs in this group. For patients diagnosed with ankylosing spondylitis, daily gymnastics is required, consisting of a set of specially designed exercises. Only if you follow all the doctor’s recommendations can you stop the progression of the pathology and prevent disability.

Ankylosing spondylitis: principles of classification

The classification of ankylosing spondylitis is based on the location of the lesions and, accordingly, the intensity of clinical symptoms.

Bechterew's syndrome is of the following types:

Central. Occurs in half of the cases of the disease, mainly the ridge structures are affected.
Peripheral. The second most common form. In addition to the spine, large joints of the legs are included in the process. Most often diagnosed at 10-15 years of age.
Root(another name is rhizomelic). The spine and adjacent large joints—the hip and shoulder—are affected.
Scandinavian. This type of ankylosing spondylitis is rarely observed. The pathological process in the ridge is combined with inflammation of the peripheral joints of the hands and phalanges of the toes. This type of disease is often confused with rheumatoid arthritis.

In addition, ankylosing spondylitis is classified depending on the speed of spread of symptoms. Thus, there is a slowly progressing form of pathology, a slowly progressing form with periodic changes of exacerbation and remission, a rapidly progressing form, which in a fairly short time ends with the fusion of the structures of the bone and cartilaginous tissue of the spine and adjacent joints and ribs. The most dangerous form is considered to be septic ankylosing spondylitis, which, along with the “traditional” symptoms of the musculoskeletal system, causes damage to internal organs.

Ankylosing spondylitis: clinical picture and diagnostic methods

The pathology develops gradually, with the first sign being mild pain in the lumbar region, which becomes more intense as the disease progresses and spreads to other structures of the spinal column. Unlike other lesions of the musculoskeletal system, the pain becomes more intense during rest, especially after 2-3 am or in the morning, and after waking up, light exercises and a shower, it noticeably weakens or completely disappears.

Then ankylosing spondylitis manifests itself in the form of stiffness of the spine, which in some cases occurs unnoticed by a person and is detected only during a special examination.

Sometimes there is no pain syndrome, and the pathology manifests itself as a decrease in the functional activity of the spinal column.

Also a characteristic symptom is the gradual smoothing of physiological lordosis and kyphosis of the ridge. The lower back becomes flat, the chin gradually presses towards the chest. The pathological changes that accompany ankylosing spondylitis usually develop from bottom to top, so stiffness of movements in the cervical spine appears in the later stages.

Along with a decrease in the flexibility of the spinal column, ankylosis affects the joints connecting the ribs to the thoracic vertebrae. This leads to limited respiratory movements and decreased ventilation of the lungs, which contributes to the development of chronic lesions of the respiratory tract. Some patients additionally experience pain and stiffness in the shoulder, hip, and temporomandibular joints; in rare cases, discomfort and swelling of the joints of the arms and legs, pain impulses in the sternum.

Pathology often causes disruptions in the functioning of other organs. Almost a third of patients experience eye lesions, in particular iridocyclitis and uveitis. Moreover, these diseases are characterized by an acute onset with discomfort or severe pain and burning in the eye, redness, swelling, and lacrimation. After some time, photophobia develops and blurred vision appears. Usually the damage to the organs of vision is unilateral, but is recurrent.

Secondary pathologies of the cardiovascular system are in second place in terms of prevalence. As a rule, ankylosing spondylitis causes aortic valve insufficiency, disturbances in heart rhythm and myocardial conductivity with the formation of scar changes. Clinically, this manifests itself in the form of shortness of breath, weakness, and fluctuations in blood pressure.

Sometimes ankylosing spondylitis also affects the genitourinary system with severe renal dysfunction, impotence, and nephropathy. Symptoms of this condition are swelling, urination problems, and pallor. Damage to the nervous system is also possible (pinching of large nerve fibers is often diagnosed).

In general, the clinical picture that characterizes ankylosing spondylitis can be described as follows:

pain of varying intensity in the lumbosacral region at the initial stage of the pathology, and at the level of the thoracic and cervical region in the later stages;
stiffness of movements;
a feeling of chest compression and symptoms of hypoxia (weakness, constant feeling of fatigue and lack of air);
shortness of breath, arrhythmia, interruptions in cardiac activity;
swelling, pain in the kidney area, decreased daily urine volume;
symptoms of damage to the organs of vision;
neurological pain localized in the lumbar region, thoracic region or radiating to the limbs, buttocks, perineum, loss of sensitivity, numbness;
symptoms of cerebral circulation disorders - headache, dizziness, drowsiness, mental disorders, slow reaction, hearing impairment.

In the later stages of a patient diagnosed with ankylosing spondylitis, posture takes on a stable, specific form: in the area of the spine and shoulder blades, the back becomes almost flat, but the cervical spine protrudes forward, the chin is pressed to the chest.

Presumably, a diagnosis of ankylosing spondylitis can be made by a combination of several clinical manifestations. This:

gradual onset;
age of onset of pathology up to 40 years;
duration of back pain for more than 3 months;
impaired motor activity in the morning;
reduction of stiffness and pain after gymnastics and exercise.

The presence of four of the listed diagnostic criteria suggests ankylosing spondylitis with a probability of 75%. A family history of spondylitis also speaks in favor of spondylitis. However, more complete information will be provided by instrumental examination data. First of all, an x-ray is taken.

In pathology, the following changes are visible:

at the initial stage of the disease - an inflammatory process in the sacroiliac joint;
at stages I - II - the presence of erosions of the subchondral (located under the cartilage) bone;
at stage III - the appearance of sclerosis and partial ankylosis;
at stage IV - complete fusion of the sacroiliac joints.

Compared with standard radiography, CT is more sensitive in detecting bone erosions, subchondral sclerosis, and ankylosis. However, this study does not allow us to detect inflammatory changes in the early stages of the disease, when there are no structural changes in the cartilage tissue.

The most sensitive diagnostic method is MRI, since it can detect not only chronic disorders, but also acute inflammation.

The value of bone tissue scintigraphy using contrast isotopes is currently small. According to various sources, the sensitivity of such a study ranges from 0 to 82%, and the diagnostic value of MRI reaches 78%. Therefore, all doctors prefer magnetic resonance imaging as a safer and more accessible method.

A relatively new way to confirm pathology is Doppler ultrasound examination of the sacroiliac joints with contrast enhancement. Compared to MRI, the sensitivity of this method is 94%, and the specificity reaches 94%.

There are currently no laboratory tests for specific markers of ankylosing spondylitis. However, in almost 95% of patients diagnosed with ankylosing spondylitis, the presence of the HLA B27 antigen is detected (it is detected only in 5 - 14% of healthy people). Indicators such as C-reactive protein and ESR play a lesser role, since in almost half of patients their level does not exceed the norm.

In general, the diagnosis of pathology occurs as follows:

Identification of diagnostic criteria for spondyloarthrosis during the initial examination.
Blood test for HLA B27.
X-ray of the sacroiliac joint.

If the results of these studies are positive, the diagnosis of ankylosing spondylitis is beyond doubt. However, the discrepancy between the clinical picture and test data requires the appointment of additional tests (MRI, identification of markers of arthritis) to find the cause of pain in the back.

Ankylosing spondylitis: treatment with medication, surgery, massage and manual therapy

Currently, the following groups of drugs are used for pharmacological therapy of spondylitis:

non-steroidal anti-inflammatory drugs (NSAIDs);
analgesics;
corticosteroids;
muscle relaxants;
basic anti-inflammatory drugs;
TNF α inhibitors.

Among all the medications that are prescribed for the diagnosis of ankylosing spondylitis, treatment with NSAIDs is the most commonly used.

Their history begins in 1949, when the effectiveness of phenylbutazone was first proven. Subsequently (since 1965), the second generation of NSAIDs, which was represented first by Intomethacin and then by Diclofenac, was introduced into clinical practice. And since the 80s of the twentieth century, an avalanche-like increase in the number of NSAIDs with great variability in pharmacological and pharmacokinetic properties has been observed.

When prescribing these medications, pay attention to the following aspects:

NSAIDs are first-line drugs for the treatment of spondylitis;
in patients with long-term symptoms of the pathology, treatment with NSAIDs should be long enough to slow down the progression of the disease;
when using NSAIDs, it is necessary to take into account the possibility of developing complications from the digestive tract, cardiovascular system and kidneys and monitor the patient’s condition accordingly;
NSAIDs should be prescribed from the moment the diagnosis is confirmed, regardless of the stage of the disease.

The main goal of NSAID therapy is to eliminate the inflammatory process and associated pain; for this, when diagnosed with ankylosing spondylitis, treatment with such medications should be carried out for at least 1 - 2 weeks. The effectiveness of NSAIDs is dose-dependent, that is, if the standard dosage of the drug does not produce sufficient results, it is necessary to increase it. If this does not bring relief, the drug is changed to another.

If the main clinical manifestation of the pathology is morning stiffness or night pain, long-acting forms of NSAIDs should be taken in the late evening. To further eliminate pain impulses, analgesics (Paracetamol or, in severe cases, Tramadol) are indicated. They are prescribed in short courses.

As for corticosteroids, their oral use is not recommended due to discrepancies in efficacy and effect. For inflammation of peripheral joints, ointments with steroid hormones can be used. Also, local treatment with such medications is effective in cases of damage to the visual organs. If ankylosing spondylitis is too active, it is recommended that treatment be carried out using the so-called “pulse therapy”. In high doses, corticosteroids are administered intravenously over 1 to 3 days.

There is still fierce debate among specialists regarding the use of hormonal drugs for spondylitis. On the one hand, in small doses they are not effective enough, and in large doses they have a pronounced anti-inflammatory effect, but their use is accompanied by severe side effects. According to clinical studies, with pulse therapy the main symptoms of the disease disappear, and the result can last from 2 weeks to a year.

The effect of basic anti-inflammatory drugs for spondylitis is controversial. Some doctors testify that the effectiveness of the use of Methotrexate, Sulfosalazine and Leflunomide was no different from the group of patients taking placebo. However, the undulating course of spondylitis and spontaneous remissions (especially in the first years of pathology) significantly affect the results of clinical studies. But currently, methotrexate in the form of subcutaneous injection is prescribed for the treatment of ankylosing spondylitis.

TNF-α tumor necrosis factor inhibitors include the following medications:

Etanercept;
Infliximab;
Adalimumab.

In terms of clinical effectiveness, these drugs practically do not differ from each other, however, if there is no result from the use of one TNF α inhibitor with a diagnosis of ankylosing spondylitis, treatment is continued with another medication of the same pharmacological group. Long-term use of such drugs is accompanied by a pronounced slowdown in the progression of pathology.

It has been proven that the effectiveness of these drugs is much higher in the initial stages of the disease, however, even in advanced cases, the use of these drugs brings good results. There is clinical evidence of some restoration of motor activity even against the background of complete ankylosis of the spine.

Indications that the diagnosis of ankylosing spondylitis should be treated surgically are:

severe spinal deformity, which has a significant impact on the patient’s quality of life;
pain syndrome that cannot be relieved with medications;
severe disruption of the functioning of the bronchopulmonary and cardiovascular systems;
pronounced restrictions on the motor activity of the joints.

To eliminate the main symptoms of spondylitis, surgical straightening of the spine or prosthetics of joints affected by ankylosis is indicated.

If ankylosing spondylitis is diagnosed, treatment with manual manipulation should be carried out in parallel with drug therapy. Massage is done in courses (every three months), 10 daily sessions lasting 20-40 minutes. Despite numerous advice, such an impact must be entrusted to a qualified specialist.

Diet for ankylosing spondylitis, folk remedies, possible complications and preventive measures

Regardless of how a patient feels, every morning of a patient with spondylitis should begin with a warm-up.

Gymnastics will help develop joints and stop the ossification process. Doctors recommend the following set of exercises:

Sit on the floor with a straight back, straighten your arms in front of your chest. Perform torso turns with arms extended to the sides, palms up, 4-8 times.
The starting position is the same, but you need to bend slightly. At the same time, squeeze and unclench your hands and feet 10-20 times.
The starting position is the same. Pull each bent leg with your hands to your chest (4-8 times each).
Continue to remain on the floor. Lean forward, trying to reach your feet with your hands.
Sit on the edge of a chair and rest your hands on the seat. Alternately lift and move the straight leg to the side (4 - 10 times each).
Sit on a chair with a straight back, take a gymnastic stick in your hands and lift them above your head. Lean forward, trying to reach your toes with a stick (4 - 8 times).
Stand next to a wall and lean against it. Alternately squat on one leg, straightening the other (2-4 times).
Lie on your back, arms above your head. Pull your arms to your shoulders and your feet to your buttocks (4 - 8 times).
Stay in the same position. Alternately raise the straightened leg up (4 to 8 times).
Sitting on your heels, place your hands in front of you. Perform the “Wave” exercise with deflection (8 times).
Lie on your stomach, hands in front of you. Alternately lift each leg and move it to the side, while simultaneously arching your back (2-6 times).
Stand up straight, hold a gymnastic stick in your hands. Raise your arms up while simultaneously placing your legs back on your toes (4-8 times).
Straighten up, put your hands on your sides and perform circular movements with your torso (4 - 8 times in each direction).
The starting position remains the same, but spread your arms to the sides, legs shoulder-width apart. Bend down, trying to touch the toe of your left hand with the fingers of your right hand and vice versa. The knees should be straightened (5-6 times).
Walking in place (100 - 200 steps).
Relaxation.

For ankylosing spondylitis, physiotherapy is also prescribed. The effect of such treatment is as follows:

activation of blood flow in the lesion;
stimulation of bone and cartilage tissue regeneration;
prevention of joint ankylosis;
improving drug delivery;
inhibition of the inflammatory process;
elimination of pain syndrome.

So, the diet for ankylosing spondylitis should be accompanied by:

paraffin therapy;
ozokerite applications;
phono- and electrophoresis;
exposure to ultrasonic radiation and electromagnetic waves;
mud therapy and balneotherapy sessions.

For spondylitis, treatment with folk remedies is possible, but such therapy should only be carried out in combination with medication.

elderberry flowers, nettle leaves, parsley roots and willow bark - in equal proportions;
birch leaves, nettles, violet grass - in equal proportions;
3 tbsp each lingonberry leaves, oriole grass, 2 tbsp. calendula flowers, chamomile, linden and nettle leaves, 1 tbsp. horsetail and elderflower herbs;
currant leaves, lingonberries, rose hips - equally.

The decoctions are prepared in the same way.

It is necessary to pour 10 g of the plant mixture into half a liter of cold drinking water, leave overnight, then bring to a boil, leave for 2 hours and squeeze.

Take half a glass twice a day on an empty stomach.

Proper nutrition for spondylitis plays no less a role than drug therapy.

The diet for ankylosing spondylitis must include the following products:

vegetable oils (olive, sesame, flaxseed), should be used daily for dressing salads;
baked or steamed fish (mackerel, salmon, trout, cod), consume 3 - 4 times a week;
antioxidant-rich citrus fruits, cabbage, herbs, vegetables - fresh daily;
low-fat dairy and fermented milk products containing calcium - 2 servings in the first half of the day;
legumes, buckwheat and barley porridge - in unlimited quantities as side dishes.

It is necessary to completely exclude alcohol and caffeine-containing drinks, refined fats, sweets, and starchy foods from the diet. Boiled lean meat can be consumed no more than 2 times a week. In addition, the diet for ankylosing spondylitis should be balanced in terms of calories. An obese patient needs to eat in such a way as to lose excess weight, and a too thin patient needs to eat in such a way as to lose excess weight.

Spondylitis is a serious chronic disease that cannot be completely cured. Complications of such a pathology can affect internal organs, especially the heart and blood vessels. The only option to avoid systemic damage is to start therapy in the early stages.

Considering the genetic mechanisms of spondylitis development, there is no specific prevention. If you have a hereditary condition, sufficient physical activity, regular examination by a doctor and relevant research are necessary. The diet for ankylosing spondylitis must also be strictly followed. The intake of vitamins and minerals in the required quantities can stop pathological changes in bone and cartilage tissue.

Ankylosing spondylitis (AS) or ankylosing spondylitis (BB).

BB is a chronic systemic disease characterized by inflammatory damage to the joints of the spine, paravertebral tissues and sacroiliac joints with ankylosis of the intervertebral joints and the development of calcification of the spinal ligaments.

The basis of the disease is inflammation of the joints, tendons and ligaments. Inflammatory changes also occur in the synovial membrane of the joints and changes in bone tissue. If not diagnosed and treated in time, then prolonged uncontrolled inflammation of the articulations and joints of the spine leads to calcification and the development of ankylosis - immobility of the spine.
Therefore, it is important 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.

BD predominantly affects young men. Symptoms often appear after 35-40 years, but the disease can begin earlier, at 15-30 years.
The ratio of men to women is 9:1.
The term “ankylosing spondylitis” was first proposed to refer to this disease in 1904.

Etiology.

The cause of the disease still remains unclear. In the origin of BD, great importance is attached to genetic factors.
The reason is a genetic predisposition in people who are carriers of a certain antigen (HLA-B 27), which occurs in 90-95% of patients, approximately 20-30% of their first-degree relatives, and only 7-8% in the general population.

The cause of ankylosing spondylitis is an aggressiveness of the immune system against the tissue of one’s own joints and ligaments (inadequate immune response). In this case, the immune system mistakenly perceives some body tissues as foreign, which is the cause of aggression And.

The role and infectious factors in the development of BD. There is information about the role of some strains of Klebsiella and other types of enterobacteria in the development of peripheral arthritis in patients with BD. Data were obtained on the presence of inflammatory changes in the intestines in this category of patients, as well as signs of dysbiosis of varying degrees.

BB classification.

With the flow:
1) Slowly progressive;
2) Slowly progressive with periods of exacerbation;
3) Rapidly progressive(in a short time leads to complete ankylosis);
4) Septic option, characterized by an acute onset, heavy sweats, chills, fever, rapid manifestation of viscerates, ESR = 50-60 mm/h and higher.

By stages:
I initial (or early)- moderate limitation of movements in the spine or affected joints; X-ray changes may be absent or may indicate vagueness or unevenness of the surface of the sacroiliac joints, widening of joint spaces, foci of osteosclerosis;

Stage II- moderate restriction of movements in the spine or peripheral joints, narrowing of the joint spaces or their partial ankylosis, narrowing of the intervertebral joint spaces or signs of ankylosis of the spine;

III late stage– significant limitation of movements in the spine or large joints as a result of their ankylosis, bone ankylosis of the sacroiliac joints, intervertebral and costovertebral joints with the presence of ossification of the ligamentous apparatus.

By degree of activity:
I minimum- slight stiffness and pain in the spine and joints of the limbs in the morning, ESR - up to 20 mm/h, CRP +;

II moderate– constant pain in the spine and joints, morning stiffness (several hours), ESR - up to 40 mm/h, CRP++;

III pronounced– severe constant pain, stiffness throughout the day, exudative changes in the joints, low-grade fever, visceral manifestations, ESR - more than 40 mm/h, CRP+++.

According to the degree of functional joint insufficiency:
I – changes in the physiological curves of the spine, limitation of mobility of the spine and joints;

II – significant limitation of mobility, as a result of which the patient is forced to change profession (third disability group);

III – ankylosis of all parts of the spine and hip joints, causing complete loss of ability to work (second disability group) or inability to self-care (first disability group).

Forms of the disease (clinical variants):

Central form – only the spine is affected.
Rhizomelic form– damage to the spine and root joints (shoulder and hip).
Peripheral form– damage to the spine and peripheral joints (knees, ankles, etc.).
Scandinavian form– damage to small joints of the hands, as in rheumatoid arthritis, and the spine.
Visceral form– the presence of one of the above forms and damage to visceral organs (heart, aorta, kidneys).

Clinical picture.

Ankylosing spondylitis or ankylosing spondylitis can be of different types:

Disease of the ligamentous apparatus of the spine.
Pain in the elbow, ankle, knee joints.
Disturbances in the functioning of the cardiovascular system, such as heart rate abnormalities, pericarditis, aortitis, deterioration of the aortic valves.
Amyloidosis of the kidneys.

BB usually begins gradually, in adolescence or young adulthood (15-30 years). The disease may be preceded by malaise, loss of appetite, weight loss, fever, weakness and fatigue.

Symptoms of joint damage.

Cardinal symptom is sacroiliitis–bilateral inflammation of the sacroiliac joints. It is characterized by complaints of inflammatory pain in the sacrum, buttocks, and along the back of the thighs, reminiscent of lumbosacral radiculitis.
Pain in the lumbosacral spine with BD is bilateral, is constant, intensifying in the second half of the night. Atrophy of the gluteal muscles and their tension are often noted.

The second most important early symptom of BD is pain and stiffness in the lower back. The pain intensifies in the morning, but decreases after exercise and a hot shower. Stiffness appears in the lumbar region. Smoothness or complete disappearance of lumbar lordosis is revealed.

Later The inflammatory process spreads up the spine.
Lesion of the thoracic region characterized by pain, often radiating along the ribs. Due to the formation of ankylosis of the sternocostal joints, the excursion of the chest sharply decreases.
When the cervical spine is affected The main complaint is a sharp limitation of movements up to complete immobility, as well as pain when moving the head. The patient cannot reach the sternum with his chin.
As the disease progresses, the physiological curves of the spine disappear, a characteristic"pose petitioner" – pronounced kyphosis of the thoracic spine and hyperlordosis of the cervical spine. When the vertebral arteries are compressed, vertebrobasilar insufficiency syndrome is revealed, characterized by headache, dizziness, nausea, and fluctuations in blood pressure.
As a reaction to the inflammatory process in the spine, a reflex tension of the rectus dorsi muscles occurs. This reveals a symptom"string" - lack of relaxation of the rectus dorsi muscles on the flexion side when bending the body in the frontal plane

Often in patients in the process Peripheral joints are involved .
The peculiarity of this form of BB is that peripheral arthritis may be a temporary manifestation of the disease and disappear as it progresses.
Characteristic isdamage to root joints– hip and shoulder . The damage to these joints is symmetrical, begins gradually, and often ends ankylosis. Involvement of other peripheral joints in the inflammatory process occurs less frequently (10-15%).

A striking clinical manifestation of BD is enthesopathies– places of attachment to the calcaneus of the calcaneal tendon and plantar aponeurosis.

With BD observedVisceral lesions. Thus, according to various authors, 10-30% of patients with BD have eye damage in the form anterior uveitis, iritis, iridocyclitis . Eye damage may be the first manifestation of the disease, preceding the symptoms of sacroiliitis and is often recurrent.

Damage to the cardiovascular system occurs in 20-22% of all cases of BD. Patients complain of shortness of breath, palpitations, pain in the heart area. The reasons for these complaints are aortitis, myocarditis, pericarditis andmyocardial dystrophy. Patients may exhibit rhythm disturbances, systolic murmur over the aorta or at the apex of the heart, and muffled heart sounds. Cases of severe pericarditis with progressive circulatory failure and complete atrioventricular block have been described.
With a long course of BD with high clinical and laboratory activity, failure aortic valve. This is a distinctive feature of cardiac damage in BD.

When examining the respiratory organs is revealedLimitation of respiratory excursion of the lungs. Gradually formed emphysema, developing as a result kyphosis and damage to the costovertebral joints.
A specific lesion of the lungs in BD is the development of apical pneumofibrosis, which occurs infrequently (3-4%) and requires differential diagnosis with tuberculous changes.

Kidney damage with BB develops in 5-31% of patients. Edema, hypertension, anemic syndrome and renal failure appear in the later stages of the disease against the background of renal amyloidosis , which is the most common type of renal pathology in BD. The causes of renal amyloidosis are high activity of the inflammatory process and a severe progressive course of the disease. Sometimes the causes of urinary syndrome, manifested by proteinuria and microhematuria, can be long-term use of NSAIDs with the development drug nephropathy.

In some patients, BD is detectedSigns of damage to the peripheral nervous system, conditional secondary cervicothoracic or lumbosacral radiculitis. Due to the expressed osteoporosis, after a minor injury, fractures of the cervical vertebrae may develop with the development of quadriplegia.
Under the influence of a minor injury during the destruction of the transverse ligament of the atlas, they develop atlantoaxillary subluxations ( 2-3%). A more rare complication is the development cauda equina syndrome due to chronic epiduritis with impotence and urinary incontinence.

Diagnostics.

In advanced forms, diagnosis does not cause difficulties. But the main problem with Bechterew's disease is the late diagnosis.
What are the first signals? What symptoms should you look out for?
- Stiffness, pain in the sacroiliac region, which can spread to the buttocks, lower extremities, and intensifies in the second half of the night.
- Persistent pain in the heel bones in young people.
- Pain and stiffness in the thoracic spine .
- Increased ESR in blood tests up to 30-40 mm per hour and higher.

If such symptoms persist for more than three months, immediate consultation with a rheumatologist is necessary!
The disease does not always begin with the spine; it can also begin with the joints of the arms and legs (reminiscent of rheumatoid arthritis), with an inflammatory eye disease, with damage to the aorta or heart. Sometimes there is a slow progression, when the pain is practically not expressed, the disease is detected by chance during an X-ray examination.
Over time, the limitation of the mobility of the spine increases, bending to the side, forward, backward, etc. becomes difficult and painful. noted shortening of the spine. Deep breathing, coughing, and sneezing can also cause pain. Movement and moderate physical activity reduce pain.

Differential diagnosis of Bechterew's disease.

First of all, it is necessary to distinguish from degenerative spine diseases (DSD) --OSTEOCHONDROSIS, SPONDYLOSIS .

PLEASE NOTE THE FOLLOWING:

1. Ankylosing spondylitis mainly develops in young men, and DZP, despite the trend to their “rejuvenation” in recent years, they still predominantly occur after 35-40 years.
2. When ankylosing spondylitis the pain intensifies at rest or with prolonged stay in one position, especially in the second half of the night. At DZP On the contrary, pain occurs or intensifies after physical activity at the end of the working day.
3. One of the early signs ankylosing spondylitis- tension of the back muscles, their gradual atrophy and stiffness of the spine. At DZP restriction of movement occurs at the height of pain and development of radiculitis; when the pain is relieved, the mobility of the spine is restored.
4. Early radiographic changes in the sacroiliac joints of the spine characteristic of ankylosing spondylitis do not occur in DZP.
5. When ankylosing spondylitis an increase in ESR in the blood test and other positive biochemical signs of process activity are often observed, which does not happen with DZP.

It is necessary to distinguish the initial articular form of ankylosing spondylitis also from (RA).

THINGS TO REMEMBER:

1. RA Women are more often affected (75% of cases).
2. When RA More often there is symmetrical damage to the joints (mainly the joints of the hand), and with ankylosing spondylitis it is observed very rarely.
3. Sacroiliitis (inflammation of the sacroiliac joints), damage to the sternoclavicular and sternocostal joints are extremely rare in RA, and for ankylosing spondylitis very characteristic.
4. Rheumatoid factor in the blood serum occurs in 80% of patients with RA and only in 3-15% of patients with ankylosing spondylitis.
5. Subcutaneous rheumatoid nodules, which occur in RA in 25% of cases, do not occur in ankylosing spondylitis.
6. HLA-27 (a specific antigen detected in blood tests) is characteristic only of ankylosing spondylitis.

TREATMENT OF BEKHTEREV'S DISEASE.

How to treat ankylosing spondylitis?
Treatment should be complex, long-term, staged (hospital - sanatorium - clinic).

PRESCRIBED:

Non-steroidal anti-inflammatory drugs (NSAIDs),
Glucocoricoids,
Immunosuppressants (in severe cases)
Physiotherapy,
Manual therapy,
Physiotherapy.

Physiotherapy should be done twice a day for 30 minutes, the exercises are selected by the doctor individually.
In addition, you need to learn muscle relaxation. In order to slow down the development of chest stiffness, it is recommended breathing exercises (deep breathing).
In the initial stage, it is important to prevent the development of vicious spinal postures (proud pose, supplicant pose).

Skiing and swimming are shown, strengthening the muscles of the back and buttocks.
The bed should be hard and the pillow should be removed.

The disease is progressive, but it can be resisted. The main task is to delay the development of the disease and prevent it from advancing. Therefore, it is necessary to undergo regular examinations by a rheumatologist, and in case of exacerbations, go to the hospital.

Ankylosing spondylitis is an inflammatory disease of the spinal column and joints. Ankylosing spondylitis is also called ankylosing spondylitis. It is predominantly localized in the sacroiliac region of the spine, in the joints of the spinal column, as well as paravertebral tissues. The disease develops approximately in people between the ages of 20 and 30; men are affected 9 times more often than women.

History of Bekhterev's disease

The causes of the disease are not fully understood; most experts tend to assume that it is an autoimmune disease. Hereditary conditions in its formation in humans have been established; 90-95% of patients with a history of ankylosing spondylitis or ankylosing spondylitis also have the HLA-B27 antigen. The following shocks can serve as probable reasons for the development of the disease:

fact of hypothermia;
injuries, bruises, blows to the spine and pelvis;
experiencing infectious diseases;
the presence of allergic diseases;
hormonal and metabolic disorders;
the presence of inflammatory processes in the gastrointestinal tract;
inflammatory diseases of the excretory and reproductive system.

Ankylosing spondylitis is characterized by a situation where immune cells begin to attack the discs between the vertebrae, as well as the ligaments of the joints and tendons. An inflammatory process develops in these tissues, resulting in the degeneration of elastic hard bone tissue. This disrupts the natural mobility of joints and spinal segments.

Today there is a species classification of ankylosing spondylitis. The main forms include the following types:

The central form - kyphosis - involves straightening the spine in the lower back, but creates an increase in bending in the thoracic region. With a rigid form, the lumbar as well as the thoracic curve of the spine is smoothed, resulting in an abnormal flattening of the back.
The peripheral form primarily affects the peripheral joints - ankles, knees, and elbows.
The rhizomalic form is characterized by damage to large joints, such as the shoulders and hips, and not just the spine.
The Scandinavian form is characterized by symptoms of rheumatoid arthritis. Small joints are affected, however, without further deformation and destruction.
Bechterew's disease with a visceral form affects not only the joints and spinal column, but also the eyes, heart, kidneys, and blood vessels.

Ankylosing spondylitis, ankylosing spondylitis, ankylosing spondylitis symptoms

The first symptom that may indicate the presence of ankylosing spondylitis is intense pain in the lumbar spine. The pain syndrome usually appears at night, continues for several hours after waking up, and may completely subside in the afternoon. Therefore, very often patients with such an anomaly are forced to walk around in pain, specially getting up and moving. Against the background of pain, stiffness and general mobility of the spinal segments are also felt. Mobility is completely impaired in all directions, that is, it is extremely difficult to bend to the sides, back and forward.

Then the disease progresses and spreads to the entire spine, and also affects the joints. First of all, the hip joints are affected, as well as the shoulder joints, and the sacrum is affected. Then the disease affects the small joints of the feet and hands, but this occurs much less frequently. The joints begin to noticeably swell and ache. In cases where the sacrum is affected, the patient may experience discomfort in the buttocks themselves. Very often, this pain symptom is confused with radiculitis or pinched sciatic nerve, which complicates the diagnosis of the true cause of the pain.

After some time, the clinical picture of the disease begins to include smoothing of the natural curves of the spine. The back takes on a flat appearance. But the thoracic region is affected by kyphosis, that is, a pronounced stoop is formed. Posture is formed according to the type of “petitioner” pose - a hunched back, a noticeably tilted head down, legs slightly bent at the knees. All this is accompanied by tension in the back muscles and noticeable pain.

In special forms of Bechterew's disease, damage may begin precisely from the joints, and not from the back spine itself. It is more typical for adolescence.

Children and adolescents begin to experience the following symptoms:

experiencing pain in small joints, such as hands and feet;
a small but stable rise in body temperature;
tachycardia, rapid heartbeat, increased pulse rate;
fever of the wrong type, which is characterized by temperature fluctuations of 1-2 degrees;
chills and increased sweating.

This disease can affect not only the joints and spinal column, but also internal organs and sensory systems. This is typical for some forms. For example, if the eyes are affected, then iritis and iridocyclitis develop, which are characterized by pain in the eyes, unmotivated tearing, and noticeable deterioration of vision. If the heart is affected, carditis may develop.

Diagnosis of the disease

Diagnosis of the disease sometimes occurs untimely, and diagnosis is often difficult, since the symptoms of ankylosing spondylitis correspond to some other diseases (radiculitis, osteochondrosis, etc.). Because of this, the disease takes advanced forms.

One of the most reliable diagnostic methods is radiography. The image can show the presence of the disease even in the earliest stages. But x-rays of small joints of the legs and arms in the early stages of development are not very informative. Therefore, magnetic resonance imaging (MRI) may be additionally prescribed. It is mandatory to examine the presence of HLA-B27 Antibodies if there is the slightest suspicion of the disease, and a general blood test is also taken.

How to live with ankylosing spondylitis? Forming the right lifestyle

Life expectancy of ankylosing spondylitis is the most worrying question that arises in a patient and which is usually sent to the website of patients with ankylosing spondylitis or asked to a specialist. Life expectancy depends on the lifestyle that the patient adopts. This includes nutrition for ankylosing spondylitis, special diets, non-traumatic sports, swimming is especially recommended, increasing immunity and much more.

The diet for ankylosing spondylitis is designed to control weight, as well as provide the body with special microelements and vitamins. Therefore, you need to include protein foods in your diet: fish, legumes, mushrooms, and also increase your consumption of fruits and vegetables. The most commonly prescribed diet is the Mediterranean diet.

It is important to increase immunity by taking vitamins, since any infectious disease provokes an exacerbation of ankylosing spondylitis. Swimming, gymnastics, and regular stretching are highly recommended.

Massage for ankylosing spondylitis is an effective method of combating the disease.

The patient should not overwork or endure physical activity. It is important to remember that the bed must be selected with a solid base, the mattress must be hard, and a pillow is not recommended.

Treatment of ankylosing spondylitis

Treatment is protracted and complex. Initially, the patient is treated as an inpatient in the trauma department, where treatment with medications is provided. Non-steroidal anti-inflammatory drugs, intra-articular injections of corticosteroids, as well as sulfasalazine for ankylosing spondylitis are recommended as drug treatment. Drug treatment is difficult when ankylosing spondylitis and pregnancy are present.

Physiotherapy is effective, the most often used is magnetic therapy, heat treatment, and warming up. Heat treatment involves the use of paraffin applications and heating pads.

Pain therapy - treatment with water procedures, involves exposure to hydrogen sulfide, cold sodium, bischofite, radon baths. Exercise therapy courses have also proven themselves very well, but it is important that the program is developed by a specialist. Gymnastics should be carried out in two approaches with breaks. The program should not exceed 30 minutes. The treatment as a whole should take on the character of a system; the patient must be patient and adjust his lifestyle.

Ankylosing spondylitis is a rheumatic chronic systemic inflammation of the joints, mainly the spine, with a sharp limitation of the patient’s mobility, the formation of marginal bone growths on the articular surfaces and ossification of the ligaments.

The inflammatory process sooner or later leads to the disappearance of the joint space. This is precisely the reason why the patient will no longer be able to move in this joint. This change is called ankylosis. Therefore, the second name for ankylosing spondylitis is ankylosing spondylitis.

Who suffers from ankylosing spondylitis?

Ankylosing spondylitis affects men 5 times more often than women. The peak incidence occurs between 15 and 30 years of age. Ankylosing spondylitis is also diagnosed in children of primary school age (up to 15% of all cases). It is possible that the disease develops even earlier, but due to the vagueness of the symptoms and the difficulties of diagnosis, it is not always possible to determine ankylosing spondylitis in children. People of retirement age no longer get sick, so we can say with confidence that ankylosing spondylitis is the lot of young people. Due to the severity of the disease itself, patients lose their ability to work and become disabled over time. The quality of life progressively decreases, which adds significant psychological discomfort to the patient’s physical suffering.

What is affected by ankylosing spondylitis?

The pathological process in this disease is localized in the joints of the spine and some others. Their mobility gradually deteriorates until complete immobility.

The pathological process extends to the sacroiliac joints, spine, intervertebral joints and discs, peripheral joints (interphalangeal), and spinal ligaments.

The classic onset is damage to the sacroiliac joints (sacroiliitis), then the intervertebral discs and joints. This leads to the formation of the “bamboo stick” symptom. Movements in the spine become absolutely impossible; literally a person can neither bend nor straighten.

Ankylosing spondylitis is a systemic disease. This means that not only joints and ligaments are involved in the process, but also other tissues and organs. A quarter of patients develop iritis and iridocyclitis (inflammation of the iris and ciliary body of the eye), which can lead to glaucoma. In 10% of patients, the conduction system of the heart is affected (partial or complete blockade may develop), (formation of acquired defects), and arteries. In some cases, ankylosing spondylitis can provoke the development of fibrosis of the apexes of the lungs, with the formation of cavities, which complicates diagnosis, since a similar process on x-ray is very similar.

Causes of ankylosing spondylitis

Heredity. Sometimes there are cases of “family disease”, when ankylosing spondylitis is diagnosed in 2-3 family members at once. Also, in 90% of patients the special gene HLA B27 is detected. In healthy people it occurs only in 7% of cases.
Infectious diseases. The role of this factor has not been definitively established. There has been some connection between ankylosing spondylitis and a history of genitourinary or streptococcal infection.
Immune disorders. It is believed that increased levels of certain immunoglobulins (IgG, IgM, IgA) and immune complexes may contribute to the development of ankylosing spondylitis.

Symptoms of ankylosing spondylitis

The difficulty of diagnosis at the initial stage is manifested by the fact that the onset of the disease is often subclinical, almost imperceptible, and the possible symptoms are very diverse and lead the rheumatologist to think about other systemic diseases.

Most often, ankylosing spondylitis begins with. In 70% of patients, one or 2-3 peripheral joints are affected (knees, hand joints). They become red, swollen and painful. This is more like isolated arthritis, but not ankylosing spondylitis. Only 15% report discomfort in the lower back (damage to the sacroiliac joints).

In 10% of patients, iritis or iridocyclitis develops several weeks or months before joint problems appear.

Pain syndrome. Ankylosing spondylitis is characterized by a gradual increase in the intensity of the pain syndrome and its spread. At first, patients may notice stiffness in the lower back, back, or neck in the morning, which goes away after the person “unwinds.” Some patients report heel pain. Over time, the pain becomes inflammatory in nature, peaking at 3-5 am.

Due to the fact that the onset of the disease can be very different, there are several variants of the onset:

By type or sciatica. In this case, the pain is typical and localized in the lumbar region. Gradually the pain intensifies and in some cases is combined with pain in other joints.
According to the type of subacute mono- or oligoarthritis. It occurs mainly in young people. The disease manifests itself as intermittent inflammation of one or more joints. Sacroiliitis occurs much later.
Polyarthritis with fever. Observed. It begins with inflammation of several joints (more than three), the appearance of flying pains. Due to the increase in body temperature, this onset is sometimes confused with (acute rheumatic fever).
Type . With this type of onset, the interphalangeal joints of the hands are affected, which is a typical sign of rheumatoid arthritis. And only later, after an indefinite period of time, typical lower back pain occurs.
Feverish type. The patient experiences temperature fluctuations throughout the day, heavy sweating, chills, and weight loss. A clinical blood test reveals a sharp increase in ESR. Patients complain of pain in muscles and joints, while the joints themselves become inflamed only after 3-4 weeks.
Like iridocyclitis. When the process is localized extra-articularly, the first symptoms are eye lesions. Patients can be treated by an ophthalmologist for 2-3 months before sacroiliitis appears.
According to the cardiological type. During the examination, conduction disturbances and signs may be detected in the patient. And just as in the case of iritis, damage to the sacroiliac joints will only appear after a few months.

Due to the fact that the manifestations of ankylosing spondylitis are so diverse and mimic other diseases, timely diagnosis is significantly difficult.

During the initial survey of the patient, disorders typical for ankylosing spondylitis may not be identified. But a detailed and thorough questioning will help you find out that the patient has stiffness in the back, lower back or neck in the morning, which goes away during the day. Upon examination, attention is drawn to reduced mobility of the chest during breathing and limited movements in the spine.

Clinical manifestations of ankylosing spondylitis

Sacroiliitis, often bilateral, manifests itself as pain in the buttocks, radiating along the back of the thighs.
Damage to the lumbar spine leads to a gradual smoothing of the natural curve (), the appearance of pain and stiffness in the lower back.
Damage to the thoracic spine initially simulates intercostal neuralgia. Due to the formation of ankylosis of the intervertebral joints, the amplitude of respiratory movements of the chest decreases. At the same time, shortness of breath in such patients is observed quite rarely, since the diaphragm begins to compensate for the lost function of the chest.
Damage to the cervical spine is especially difficult for patients. In addition to pain and stiffness, they note regular... This is due to compression of one or two vertebral arteries. The degree of compression is proportional to the severity of symptoms.
It is quite rare for the entire spine to be affected at the same time.
Cases of ankylosing spondylitis without pain are also considered rare.
Damage to joints such as coxarthrosis. The patient develops arthritis of the hip joint (coxitis) and gradually develops ankylosis. After this, the person can no longer walk independently.
Damage to joints according to the type of gonarthrosis. In patients, the knee joints are affected, and ankylosis also forms, which leads to disability.
And changes in the lungs and kidneys are very rarely observed.

Clinical forms of ankylosing spondylitis

Central form. Occurs in 50% of patients. In this case, the entire spine or some of its parts are affected. Over time, the curves of the spine change, and a typical posture is formed - the “supplicant pose”.
Rhizomelic form. Occurs in 20% of patients. Simultaneously with sacroiliitis, coxarthrosis forms. In rare cases, damage to the hip joints appears before sacroiliitis. Such patients are sometimes mistakenly diagnosed with osteoarthritis. The disease begins with pain in the hip joint, spreading to the knee. Muscle contractures form very quickly, which leads to a sharp limitation of mobility. The shoulder joints are rarely involved in the process.
Peripheral form. In addition to the typical damage to the sacroiliac joints, patients have arthritis of the joints of the extremities (elbows, knees), and they appear before the symptoms of sacroiliitis.
Scandinavian form. A type of peripheral form in which arthritis of the small joints of the hands and feet is primarily noted, which makes this form very similar to rheumatoid arthritis and osteoarthritis. A more favorable course of arthritis and the appearance of sacroiliitis helps to make a correct diagnosis.
Ankylosing spondylitis in women is characterized by a very slow course. Symptoms may take 5-10 years to develop. Sometimes the only symptom is lower back stiffness. The main difference in the course of ankylosing spondylitis in women is the long-term preservation of the spine and its functions.

Diagnosis of ankylosing spondylitis

Functional tests

To detect sacroiliitis.

Kushelevsky's symptom I. The patient lies on his back, on the couch. The doctor places his hands on the iliac crests and applies sharp pressure. If there is inflammation in the sacroiliac joints, the patient will feel pain.
Kushelevsky's sign II. The patient lies on his side, the doctor presses on the area of the ilium. The appearance of pain indicates the presence of sacroiliitis.
Makarov's symptom. The patient experiences pain when tapping the area of the iliac and knee joints with a hammer.

Tests to determine mobility limitation.

Pain when pressing with fingers along the spinous processes of the vertebrae.
Forestier's sign. The patient stands against the wall and tries to touch it with his heels, torso and head. With ankylosing spondylitis, one part of the body does not touch the wall.
To determine mobility in the cervical spine, the patient is asked to touch his chin to his chest. As the disease progresses, the distance between the chin and sternum increases.
Thomayer's test. Allows you to assess the overall mobility of the spine. To do this, the patient is asked to lean forward and touch the floor with his fingertips. Normally, a person should touch the floor.

Instrumental diagnostics

X-ray examination

X-rays of the spine will help diagnose the disease.

The patient takes a picture of the pelvis, which can reveal signs of sacroiliitis. Depending on the severity of the manifestations, the stage of the disease is set.
X-ray of the spine in direct and lateral projections allows us to identify signs of the formation of ankylosis of the intervertebral joints, ossification of the spinal ligaments, and the formation of bone marginal growths.

Magnetic resonance imaging and computed tomography

CT makes it possible to see changes in the sacroiliac and intervertebral joints in the early stages.
MRI allows you to identify the first signs of disease in the joints: synovitis, destruction of the femoral head, erosion of the cartilage lining the articular surface, etc.

Laboratory research

A clinical blood test shows a sharp increase in ESR (up to 60 mm/h), signs of anemia.
A biochemical blood test reveals signs of inflammation: increased levels of C-reactive protein, fibrinogen, and some globulins.
Genetic analysis demonstrates the presence of HLA B27.
When assessing the immunological status, an increase in the level of immune complexes circulating in the blood and an increase in the content of IgM and IgG are noted.

Treatment of ankylosing spondylitis

The goals of treatment for patients with ankylosing spondylitis are to reduce pain and inflammation, prevent and reduce spinal stiffness, and maintain the patient’s activity.

Treatment should be constant and appropriate to the severity of the process. It is best for the patient to be regularly observed by a rheumatologist in the clinic, and during an exacerbation to be hospitalized in a specialized hospital.

Main drugs:

They are divided into non-selective (inhibiting cyclooxygenase-1 and cyclooxygenase-2) and non-selective (inhibiting only COX-2). Patients are prescribed drugs from both groups.

Non-selective NSAIDs

Diclofenac. Gold standard in rheumatology. Effective in the treatment of most rheumatic diseases. Usually prescribed in tablets of 50 mg 3 times a day. The dose may vary according to the needs of the patient. Unfortunately, due to its non-selectivity, diclofenac has several unpleasant side effects: irritation of the mucous membrane of the gastrointestinal tract (up to the formation of both the stomach and duodenum), liver damage, nausea and vomiting, inhibition of hematopoietic processes. If for gastric manifestations the patient can be prescribed omez 30 mg 2 times a day, and for nausea cerucal, then there are no special measures for liver damage and inhibition of hematopoietic processes.
Sometimes, instead of diclofenac, patients are prescribed ketoprofen, ibuprofen, and indomethacin. But the side effects of all non-selective drugs are the same.

Selective NSAIDs

The very first and most popular drug to appear on the pharmacological market is nimesulide (Nimesil, Nise). The maximum dose for an adult is 400 mg per day, in several doses. Just like other NSAIDs, it has side effects. The main side effect is an increased risk of liver damage (especially if the patient already had problems with it). There may also be headaches, nausea, vomiting, and ulcerations of the mucous membrane of the stomach and intestines. But the benefits of using the drug are much higher than the possible risks.
In addition to nimesulide, the patient may be prescribed Celebrex or meloxicam.

Glucocorticosteroids

In case of severe manifestations of the disease and the ineffectiveness of NSAIDs, the patient is prescribed hormones. The main drug is methylprednisolone. It is characterized by a strong anti-inflammatory effect. Patients taking hormones note a significant reduction in pain, a decrease in the intensity of inflammation, up to complete remission.

Sulfonamides

The most popular drug in this group is sulfasalazine. It is prescribed in a dose of up to 3 mg per day and has a pronounced anti-inflammatory effect.

Antimetabolites

Rheumatologists have been prescribing methotrexate to their patients for more than 50 years. Despite the potential carcinogenic effect, this drug is considered one of the most powerful anti-inflammatory drugs.

Immunosuppressants

If treatment is ineffective, drugs that suppress the immune response are sometimes prescribed: azathioprine, cyclophosphamide.

Biological agents

These drugs were initially synthesized for the treatment of cancer patients, but then they were found to have an interesting “side” effect in addition to their immunosuppressive effects. These medications block substances in the body that are involved in inflammatory cycles (such as tumor necrosis factor). Biological agents include: Infliximab (Remicade), Rituximab, Etanercept, Adalimumab.

A significant disadvantage of these drugs is their high cost.

Physiotherapy

During the period of remission of spondyloarthritis, it is very useful for the patient to go swimming.

The main method of treating functional joint insufficiency is regular physical activity. The physical therapy doctor selects a set of exercises for each patient in accordance with the form and stage of his disease. Therapeutic gymnastics should be done 1-2 times a day, for 20-30 minutes. During the period of remission, swimming and skiing have a positive effect.

Physiotherapy

Physiotherapy has a good analgesic and anti-inflammatory effect. Patients with ankylosing spondylitis are prescribed:

Ultrasound.
Currents Bernard.
Paraffin therapy.
Reflexology.
Balneotherapy.

Ankylosing spondylitis, like any other rheumatic disease, cannot be cured. The main goal of both the rheumatologist and the patient is long periods of remission. To do this, you need to carefully monitor yourself, carefully follow all medical appointments, and not skip regular examinations and hospitalizations.

With a competent approach, patients with ankylosing spondylitis live a full life for many years, maintain their ability to work, and do not feel limited or special.

Which doctor should I contact?

If you experience pain in the joints or spine, or mobility problems, you should consult a rheumatologist. Early diagnosis helps prevent progression of the disease. Additionally, the patient is examined by an ophthalmologist (for eye damage) and a cardiologist (for heart rhythm disturbances or manifestations of heart failure). When the cervical spine is affected, neurological symptoms predominate in the clinic, so consultation with a neurologist is necessary. A physical therapy doctor, a physiotherapist, and a massage therapist help overcome the disease.

Pain in the joints - shoulder, knee, hip, and smaller ones can occur for a variety of reasons. These are injuries and diseases of the joints themselves, associated with pathological processes in the ligaments, joint capsules, nerves, cartilage tissue, as well as diseases affecting the spine and joints. The inflammatory disease ankylosing spondylitis, better known as ankylosing spondylitis, is systemic in nature.

It affects mainly cartilaginous joints, often starting from the joints of the sacrum and iliac bones, over time spreading to the entire spinal column and can affect any joints, large and small. Over time, inflammation leads to fusion of individual joints and a significant limitation of their mobility.

Symptoms of the disease

In the early stages, the disease's symptoms are similar to osteochondrosis. The pain can cover the lower back and radiate to the legs, but if the development of the disease began in the cervical region, pain such as a lumbago radiates from the neck to one or both arms.

ATTENTION! Painful sensations in ankylosing spondylitis have a pronounced rhythmicity: they worsen after midnight, at 3-5 am they peak, before lunch the stiffness in the affected areas is stronger, and by noon it goes away, the pain also weakens. This is the main difference between ankylosing spondylitis and osteochondrosis.

In the early stages, the following symptoms may indicate ankylosing spondylitis:

pain in the lower back, sacroiliac region, radiating to the buttocks and legs, or in the neck radiating to the arms, intensifying in the morning;
stiffness at rest, decreasing with movement and load;
stiffness of the spine, tension in the back muscles, leading to their gradual atrophy;
chest stiffness, pain, difficulty breathing;
pain in the heel bones;
upon examination, you can notice a tendency towards flattening of the lower back and disappearance of the curvature of the spine;
in about half of the cases - fatigue, weight loss, increased body temperature, burning sensation in the eyes.

In the early stages, some forms of ankylosing spondylitis can develop virtually asymptomatically, which greatly complicates its diagnosis. Laboratory tests (blood tests) and hardware diagnostics - x-rays, MRIs - can help make a diagnosis. Ankylosing spondylitis has a number of characteristic symptoms.

ESR increased to 30-40 mm/hour;
In 90% of patients, a blood test reveals the specific element W-27;
At the first stage, x-rays sometimes show changes in the sacroiliac joints, expressed in the blurring of their contours and widening of the gap between the joints, at the second stage signs of erosion appear, and ankylosis, that is, fusion of the joints, is noticeable at 3-4 stages, first partial, then complete;
On MRI, signs of the disease are more noticeable at an early stage, and x-rays do not always reveal them.

In subsequent stages, the symptoms are more pronounced, numerous and specific.

The pain syndrome spreads to the entire spine, depending on the form of the disease, it can be limited to the spine (central form) or involve the hip and shoulder (rhizomyelic), middle joints of the extremities - knees, ankles (peripheral) and small joints of the feet, hands, fingers (Scandinavian).
The stiffness of the spine increases, bending and turning to the sides is difficult.
A “supplicant pose” is formed - the torso leans forward, the head is bowed, the knees are slightly bent.

Ankylosing spondylitis quite often affects young people, mainly men, while degenerative diseases of the spine with similar symptoms develop at a more mature age. Ankylosing spondylitis, which affects peripheral joints, is similar to rheumatoid arthritis, but joint damage is rarely symmetrical.

IMPORTANT! Constant pain in the lower back that does not stop for 3 months is a reason for a visit to a rheumatologist and an x-ray examination. In combination with other symptoms, this is a sign of the development of ankylosing spondylitis.

Causes

The reasons why ankylosing spondylitis develops have not been fully established; it is considered autoimmune, that is, caused by a malfunction of the immune system. The genetic factor plays a major role in the development of this failure - there is a hereditary predisposition. Carriers of the HLA-B27 antigen are much more likely to develop ankylosing spondylitis than people who do not have this antigen in their immune system. It causes increased susceptibility of joint tissue to infections.

There is a theory that under the influence of this antigen, the joint tissue “in the eyes” of the immune system becomes similar to certain microbes or viruses. When such infections enter the body, the immune system first destroys them, and then switches to the joint tissue, which it perceives as foreign, hostile to the body, and directs its efforts to its destruction. To compensate for the destruction of articular cartilage, which cannot be restored, the body begins to actively produce bone tissue, ossification of the spine occurs, the joints, the layers between which have collapsed, grow together. The development of the disease can be triggered by both external factors - infections and injuries, as well as a number of character traits and the state of the nervous system. Provoking factors are:

colds;
genitourinary system infections;
severe stress;
long-term suppressed anger;
chronic dissatisfaction with life circumstances.

Features of the disease in women

Statistics show that ankylosing spondylitis is a predominantly male disease; it affects women approximately 5-10 times less often. In addition, in women, this disease occurs in a milder form, which makes it difficult to diagnose. The development of ankylosing spondylitis in women has a number of characteristic features.

Women suffer exclusively from the rhizomyelic form of the disease, affecting the shoulder and hip joints.
The spinal deformity is less pronounced; the ossification process affects only the lumbosacral region. Therefore, even in the last stages of the disease, women manage to maintain mobility to a much greater extent than men.
Women tend to develop the disease slowly; it can take 10-15 years from the onset of development to the appearance of pronounced deformities visible on an x-ray. Periods when the disease progresses are followed by fairly long periods of remission.
The pain is paroxysmal, and the duration of attacks varies from several hours to several months.
Internal organs are rarely involved in the disease.

Symptoms may include inflammation of the sacroiliac joints, pain in the hip joints radiating to the groin and knees, and difficulty breathing due to limited mobility of the ribs and sternum. Pain in the heel bones and Achilles tendons is quite rare.

Treatment options

In the treatment of ankylosing spondylitis, timely diagnosis and a combination of factors such as an integrated approach, sufficient duration and alternation of stages of treatment in a hospital, sanatorium and clinic are very important. Complex treatment is carried out in three areas:

suppression of the immune system;
relieving inflammation with the help of non-steroidal and hormonal drugs;
restoration of joint mobility using physiotherapeutic procedures, therapeutic exercises and medications.

Since ankylosing spondylitis is an autoimmune disease, its treatment requires correcting the malfunction of the immune system. This is done with the help of drugs from the group “TNF-a blockers” (a membrane protein, the increased concentration of which is associated with joint damage). Infliximab (Remicade) has proven itself well, blocking the destruction of joint tissue by the immune system, but without affecting other protective mechanisms. Artificially synthesized hormones - corticosteroids - and non-steroidal anti-inflammatory drugs are also used to treat inflammation. Hormonal drugs are prescribed with caution because they have a number of undesirable side effects. The safest is a one-time local infusion of such drugs into the area of the affected joint.

Physiotherapeutic procedures during exacerbations are contraindicated, and during remissions they contribute to their prolongation. They are recommended to be combined with spa treatment. The main methods of physiotherapy used in the treatment of ankylosing spondylitis:

magnetic therapy;
heat therapy;
cryotherapy.

If the first method brings unconditional relief, then treatment with heat or cold at first can lead to an increase in inflammation and a general deterioration of the condition, and only then a therapeutic effect is noted. During the remission stage, you can also use light massage, manual therapy methods, sodium chloride and bischofite baths.

ATTENTION! There is no consensus regarding physiotherapy and massage in the treatment of ankylosing spondylitis; a number of traditional healers successfully use hard massage for these purposes, and official medicine considers intense massage unacceptable.

Physical activity is very important in case of ankylosing spondylitis, regular performance of a set of exercises selected by a doctor (daily for half an hour, 2 times a day). The patient must also learn to relax the muscles, breathe deeply, and maintain the correct posture, like a healthy person. You need to sleep on a fairly hard bed, strengthen your muscles - swimming and skiing are good for this. Treating the disease requires persistence and self-discipline.

In the early stages of the disease, stem cell treatment may also be used to counteract ligament ossification and joint fusion. According to available data, it gave the desired effect only in half of the cases. In severe cases, it is necessary to resort to surgical operations, replacing the affected joints with prostheses.

Forecast for life

Cases of complete recovery from ankylosing spondylitis are unknown to official statistics. The most favorable prognosis is an increase in the duration of periods of remission associated with significant relief, as well as stopping the progression of the disease.

If the disease was stopped at stages 1-2 and has not progressed in development for 30 years, its transition to stages 3-4 is extremely unlikely. With ankylosing spondylitis, pregnancy and childbirth are not prohibited, but the prognosis for each woman is individual. In 90% of cases, patients retain the ability for self-care even in adulthood and can engage in intellectual work. Heavy physical work with bending and squatting is contraindicated for patients, but disability is registered quite rarely when functional impairments are pronounced or complications are quite serious.

Ankylosing spondylitis can lead to serious complications and the development of diseases of internal organs, including:

heart valve insufficiency and other cardiac diseases - develop in 20% of cases;
renal failure caused by kidney degeneration – 30%;
iritis – inflammation of the iris, in advanced cases leading to cataracts and blindness – 40%;
osteoporosis, fraught with compression fractures of the vertebrae, is typical for older people;
lung diseases, including tuberculosis;
nervous system disorders;
disturbances in the functioning of the intestines and urinary organs.

Patients with ankylosing spondylitis can live to a very old age; deaths are associated not with the disease itself, but with severe complications.

Ankylosing spondylitis is a serious disease that affects the spine, joints, and sometimes internal organs. It develops in men aged 15-30 years, much less frequently and in a less pronounced form in women. The causes of this disease and the mechanism of its development are not fully understood; it is associated with disorders of the immune system.

Diagnosis of the disease at the first stage is difficult, since its symptoms are not specific enough, similar to osteochondrosis, rheumatoid arthritis. At the same time, early diagnosis of ankylosing spondylitis is very important, since competent therapy can stop the development of the disease and prevent complete ossification of the spine and the development of serious complications.