Ankylosing spondylitis: symptoms and treatment
Ankylosing spondylitis is a chronic disease that causes inflammation of the spinal column. It is also called ankylosing spondylitis and spondyloarthritis.
Pathology is constantly progressing, and its etiological factors remain unknown up to the present moment. The disease belongs to the group of spondyloarthritis and becomes the cause of the fusion of the intervertebral joints with further limitation of the mobility of the spine.
Content:
- What is ankylosing spondylitis?
- Symptoms of ankylosing spondylitis
- Symptoms of damage to other organs
- Causes of ankylosing spondylitis
- Diagnostics
- Treatment of ankylosing spondylitis
- Surgical treatment for illness
- Complications and consequences
- Preventive measures
What is ankylosing spondylitis?
Ankylosing spondylitis is a systemic disease characterized by inflammation of the connective tissue with damage to the joints and ligaments of the spinal column. In addition to the listed structural elements, internal organs and peripheral joints may suffer. Pathology has a chronic course and progresses all the time. The result of the disease is the limitation of the mobility of the spine and its deformation. As a result, the person becomes disabled.
VM Bekhterev was the first to describe this disease. It happened in 1892. In those years, ankylosing spondylitis was called "stiffness of the spine with curvature."
Symptoms of ankylosing spondylitis
The symptoms of the disease directly depend on the stage of development of the pathology. Ankylosing spondylitis is characterized by a chronic course, therefore, changes in the joints and tissues occur constantly.
Stages of development of ankylosing spondylitis:
- Initial stage. During this period, the first symptoms of pathology appear.
- Expanded stage. The symptoms of the disease are pronounced.
- Late stage. The joints are undergoing drastic changes.
Early stage symptoms
In about 10-20% of people, pathology has a latent course and does not manifest itself in anything at an early stage of development.
In other cases, the disease is characterized by the following set of symptoms:
- Pain in the sacrum. It is the painful sensations of this localization that become the first signal of a developing pathology. Most often, the pain is concentrated on one side of the sacrum, but it can radiate to the thigh and lower back.
- Spine stiffness. It is especially noticeable in the morning hours, after sleep, or after spending a long time in one position. During the day, the stiffness disappears, and it is also possible to get rid of it thanks to a warm-up. A distinctive characteristic of pain and stiffness that occurs with ankylosing spondylitis is that these sensations intensify at rest, and disappear after physical activity.
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Chest pain. It occurs due to the fact that the costal-vertebral joints are affected. Pain increases when trying to take a deep breath, as well as when coughing. Sometimes people confuse such painful sensations with heart pains and intercostal neuralgia. Doctors recommend that patients do not cut back on the depth of inspiration, do not switch to shallow breathing.
- Deterioration of mood. Not all patients with ankylosing spondylitis suffer from fatigue and depression. Apathy develops only in some patients.
- The appearance of a pressing feeling in the chest. It appears due to the deterioration of the mobility of the ribs. People with ankylosing spondylitis switch to abdominal breathing.
- Lowering the head. This symptom occurs due to the fact that the joints are affected, and the spinal column itself is deformed.
- Restricted mobility.
Late stage symptoms
At a late stage of the development of the disease, a person experiences the following symptoms:
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Signs of sciatica. They are characterized by severe pain in the spine, muscle numbness, and tingling. In the affected area, tactile sensitivity decreases, the muscles lose their tone, become weak and atrophy. Any physical activity leads to increased pain.
- Violation of the blood supply to the brain. A person has headaches, they are dull, pulsating, most often concentrated in the occipital region. The patient suffers from dizziness and tinnitus, and visual disturbances may occur. Deterioration of brain nutrition can be manifested by an increased heart rate, hot flashes, sweating, irritability, weakness, and increased fatigue.
- Suffocation. Attacks occur due to the fact that the mobility of the chest deteriorates, the pressure on the lungs increases, and the blood vessels become pinched.
- Increased blood pressure. This symptom develops due to the fact that the blood supply to the brain suffers, the load on the vessels and the heart increases.
- Deformation of the spinal column. His joints become ossified, which leads to a deterioration in their mobility. The cervical region is strongly bent forward, and the thoracic region is backward.
Symptoms of damage to other organs
Depending on the form of the disease, the symptoms of ankylosing spondylitis will differ.
With the rhizomelic form, the hip joints suffer, therefore, the symptoms of pathology can be distinguished as follows:
- Ossification of the spinal column.
- Slow growth of pathological signs.
- Pain in the hip joints. On the one hand, they will hurt more.
- Irradiation of pain in the thigh, groin, knees.
In the peripheral form of the disease, the knee joints and the joints of the foot suffer.
The main signs of violation:
- For a long time, a person is concerned only with those symptoms that relate to the spinal column.
- Mostly adolescents suffer from the peripheral form of the disease. The later the pathology develops in a person, the lower the risks of joint damage.
- The pains are concentrated in the knees and in the ankle joints.
- The joints are deformed, they cease to perform their function normally.
The Scandinavian form of the disease is manifested by symptoms such as:
- Lesions of the small joints of the feet and hands.
- Over time, the joints become deformed, and their mobility deteriorates.
- The clinic of the Scandinavian form of the disease resembles rheumatoid arthritis.
Causes of ankylosing spondylitis
Despite the advances in modern medicine, the exact causes of ankylosing spondylitis remain unknown.
Doctors only make assumptions about what pathology can develop because of:
- Hereditary predisposition to the development of pathology. As observations show, ankylosing spondylitis is transmitted from father to son in 89% of cases.
- Postponed urogenital infections. The likelihood of developing ankylosing spondylitis increases if the urogenital infection is chronic, and the person does not receive adequate therapy.
- Decreased immunity. The reasons for the weakening of the body's defenses can be very diverse. The weaker the immune system, the higher the likelihood of ankylosing spondylitis.
First, with ankylosing spondylitis, the sacrum and iliac region are affected, and then the pathology spreads to other joints.
Diagnostics
To make the correct diagnosis, the patient will need to undergo a series of studies. Without a comprehensive diagnosis, it will not be possible to determine ankylosing spondylitis.
Which doctor should I go to?
If a person develops symptoms that may indicate ankylosing spondylitis, he needs to contact specialists such as:
- Therapist. The doctor may suspect a disease and make a preliminary diagnosis. To clarify it, you will need to pass additional tests and visit doctors of a narrower specialization.
- Vertebrologist. This doctor deals with diseases of the spine.
- Rheumatologist. This doctor treats rheumatism and other joint pathologies.
- Orthopedist. The doctor of this specialty is engaged in the identification and treatment of diseases of the musculoskeletal system.
Instrumental and laboratory examination
To begin with, the doctor examines the patient's history, examines it, palpates the spine and other joints, evaluates their mobility.
Research that must be completed to clarify the diagnosis:
- X-ray of the spine.
- MRI of the spine.
- Blood donation for general analysis. The patient will have an increased ESR level and a positive DPA reaction, which indicates an inflammatory process in the body. In this case, the rheumatoid factor will be absent.
- Blood test for HLA-B27 antigen. This study is carried out in controversial cases.
The most informative diagnostic methods are MRI and radiography.
Treatment of ankylosing spondylitis
It will not be possible to completely cure ankylosing spondylitis. However, if treatment was started on time, then it becomes possible to stop its progression, to prevent the development of complications and immobilization of the patient. The patient is prescribed lifelong therapy, which should not be interrupted. The doctor will need to visit systematically. Otherwise, the pathology will progress.
Drug treatment
Drugs that are used to treat ankylosing spondylitis:
- Non-steroidal anti-inflammatory drugs: Ketoprofen, Diclofenac, Nimesulide, Movalis, Ortofen, Ketoprofen, Sulfasalazine, Aertal. These drugs are the main ones in the treatment of Bechterew's disease. Their use can improve the patient's well-being, reduce pain, and eliminate inflammation.
- Steroid anti-inflammatory drugs: Prednisolone, Diprospan, Kenalog. These drugs can quickly eliminate inflammation. They are prescribed only when NSAIDs do not allow for pain management.
- Immunosuppressants: Methotrexate, Azathioprine, Chlorbutin. Their use contributes to the suppression of human immunity. Immunosuppressants are prescribed for autoimmune pathologies, which include ankylosing spondylitis.
- Immunomodulators: Wobenzym. The effect of the use of immunomodulators is reduced to the relief of inflammation in autoimmune pathologies.
- Muscle relaxants: Mydocalm, Sirdalud. Taking drugs helps to relax muscles, reduce pain, stimulate blood supply to the affected tissues, and generally improve well-being.
- Chondroprotectors: Teraflex, Rumalon, Glucose. These drugs help repair damaged tissue.
- Vascular drugs: Pentoxifylline, Trental. Their use allows you to normalize the nutrition of tissues affected by the disease.
- Remicade (Infliximab). This drug belongs to the latest generation of immunosuppressants, which was invented through genetic engineering. Its use allows you to stop inflammation in the joints and prevent ossification of their tissues.
- Stem cell therapy. Such therapy is highly effective if carried out in the early stages of the development of the disease and in combination with kinesitherapy. Stem cell treatment allows you to prevent ossification of the spine, restore joint mobility, and prevent the pathological process from spreading to internal organs. The treatment will be long and difficult; stable remission can be achieved in 50% of patients.
Non-drug treatment
By itself, non-drug treatment will not allow achieving a positive effect, but in combination with drug correction and kinesitherapy, the result will not be long in coming.
Methods that can be implemented with ankylosing spondylitis:
- Physiotherapy effect on the body. Patients can be shown magnetotherapy, ultrasound treatment, balneotherapy, bischofite, sodium chloride and hydrogen sulfide baths.
- X-ray therapy. Such treatment involves exposing the affected area to X-rays.
- Massage. It is indicated after reaching a stable remission. It is necessary to influence the spine correctly; only a professional is allowed to perform the procedure. Otherwise, you can harm a person.
- Exercise therapy. The patient must engage in adapted sports. The complex is made up individually. Daily exercise will help prevent tissue ossification and maintain the performance of the spinal column.
- Kinesitherapy is a treatment with breathing techniques and movement.
- Exercise in the pool. Before you start swimming, you need to consult a doctor.
- Performing gymnastic exercises on special suspensions.
Video: real life story:
If you recognize yourself in this video or feel similar symptoms at a young age, be sure to consult a rheumatologist for a consultation!
Surgical treatment for illness
Surgical intervention is resorted to in the last stages of the development of pathology, when the patient has developed ankylosis, that is, movements of the joint are impossible.
Spine straightening
In a patient with progressive ankylosing spondylitis, the spine is bent forward, movement in it is significantly limited. This is a serious complication that makes the patient helpless. Thanks to the development of medicine, ossification of the tissues of the spine is less and less common, since pathology is detected in the early stages of development. Nevertheless, such cases are not excluded and patients require surgery.
Patients who cannot raise their head due to curvature of the spine are prepared for surgery. They suffer from severe pain and cannot be controlled with medication. In addition, the patients are diagnosed with disorders in the work of the heart, lungs and other internal organs. The joints are involved in the pathological process.
During the operation, the doctor removes the vertebrae, which have wedge-shaped growths. This manipulation allows you to straighten the spine. Rehabilitation after the intervention is long and takes several months. During this period, the patient needs to wear a plaster corset. The patient must definitely engage in specially designed exercises.
Endoprosthetics of joints
If the vertebrae are severely damaged, then they must be removed and replaced with a prosthesis. Most often, such patients require arthroplasty of the knee and hip joints.
Complications and consequences
Complications of ankylosing spondylitis include:
- Damage to the heart and aorta. The person suffers from severe shortness of breath, chest pains and heart problems.
- Amyloidosis. The patient suffers from kidney damage, organ failure may develop.
- Pneumonia, tuberculosis. These pathologies develop due to the fact that the mobility of the chest is severely limited.
In order to prevent the development of complications, you need to start treatment on time.
Preventive measures
Recommendations for the prevention of ankylosing spondylitis given by doctors:
- Do sport.
- Strengthen the immune system.
- Take vitamins.
- Protect the spine from injury.
- Sleep on a hard surface.
- Monitor your posture.
- Visit your doctor regularly for routine check-ups.
Compliance with these simple rules will reduce the risks of developing pathology to a minimum.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
