Bechterew's disease in women and men
Ankylosing spondylitis is an inflammation of the intervertebral joints, leading to the formation of ankylosis. As a result, the spinal column is encased in a rigid bone corset, which greatly limits its mobility. Ankylosing spondylitis is also called ankylosing spondylitis because the term ankylosis means fusion.
If we turn to statistics, then the number of people with this disease in different countries varies from 0.5 to 2%. Women get sick less often, for example, there is only one woman for every nine male patients. In addition, the representatives of the fairer sex tolerate ankylosing spondylitis much easier. Mostly young people aged 15 to 30 are sick. After the age of 50, pathology is rarely diagnosed. Among all rheumatological diseases, ankylosing spondylitis takes the last position in frequency of occurrence. As for the Russian Federation, in the country this pathology was diagnosed in an average of 400 thousand people.
The disease is very often confused with osteochondrosis, which is also manifested by back pain. However, ankylosing spondylitis leads to complete immobility of the joints of the spinal column, which is its main danger.
The first pain in the spine is almost always regarded by general practitioners as osteochondrosis. The correct diagnosis is established much later, on average 4-5 years after the onset of pathology. During this time, the patient already has time to develop gross disorders in the joints of the spinal column, which significantly complicates the subsequent therapy and reduces its effectiveness.
- Causes of ankylosing spondylitis
- The first signs of ankylosing spondylitis
- Bechterew's disease symptoms
- Forms of ankylosing spondylitis
- Diagnosis of ankylosing spondylitis
- Treatment of ankylosing spondylitis
Causes of ankylosing spondylitis
Pathology refers to idiopathic diseases. This means that the causes of ankylosing spondylitis are still not precisely known to science. However, it has been found that 96% of people have damage to the inherited gene of the HLA system. It is these genes that are responsible for normal immune responses to various diseases, they regulate the severity of the immune response, etc.
Damage to the normal structure of the gene occurs due to the effect on the body of pathogenic factors, as a result, it is transformed into an antigen. This antigen is passed from parents to children and is called HLA-B27.
Interacting with healthy cells, this antigen forms certain complexes, to which the immune system reacts as foreign. He begins to attack them, thereby provoking an inflammatory reaction.
Factors that can provoke the disease:
- Diseases of the genitourinary system of an inflammatory nature.
- Inflammation of the intestines and other organs due to infection with streptococci and Klebsiella.
- Dysfunction of the endocrine glands.
- Fractures of the pelvic bones.
- Hypothermia of the body.
However, gene mutations are not the only reason for the development of the disease, as a thorough examination of healthy people reveals the HLA-B27 antigen in them. It is present in 9% of the population, while only 25% of them will have a latent course of the disease. The rest of the people who are carriers of the antigen do not suffer from this pathology at all, but injury or a severe cold can provoke it. In addition, in about 15% of people suffering from ankylosing spondylitis, this antigen is not detected at all, but they are able to transmit the disease to their descendants by inheritance.
There is still no scientifically confirmed data on the fact that pathogenic microorganisms influence the development of the disease. After all, ankylosing spondylitis does not respond to antibiotic therapy. However, disorders in the functioning of immune defenses occur at the genetic level.
Recent studies on mice, which were carried out in connection with the study of ankylosing spondylitis, showed that pathology develops in rodents in the presence of antigen, infection and T-lymphocytes circulating in the blood. That is, a combination of at least three pathogenic factors is required. The disease did not develop in those animals in which the thymus, which is responsible for the production of T-lymphocytes, was removed.
The first signs of ankylosing spondylitis
The first signs of ankylosing spondylitis are as follows:
- Stiffness and pain in lower back and sacrum. Possible irradiation of painful sensations in the lower extremities, in the buttocks. The pains tend to get worse in the morning.
- At a young age, painful sensations arise in the heel area.
- The stiffness extends to the thoracic spine.
- If a clinical blood test is performed on the patient, the ESR will be increased in the range from 30 to 60 mm / hour.
If such signs persist in a person for several months, then an appeal to a specialist should be immediate. In this case, you need to insist on consulting a rheumatologist.
Bechterew's disease symptoms
Symptoms of ankylosing spondylitis are primarily manifested in pain that occurs in the spinal column, then other clinical signs of pathology appear. It is important to be able to distinguish them not only for the doctor, but also for the patient himself, which will allow for a faster diagnosis.
Features of pain in ankylosing spondylitis
- Pain occurs in the region of the sacrum. They are especially intense in the morning hours. So, after waking up, a person cannot move his arms and legs for some time. This stiffness most often goes away within 30 minutes.
- A distinctive feature of the disease is that after the cessation of movement, the pain does not become less intense, but, on the contrary, intensifies. Exercise brings relief.
- The nature of painful sensations depends on the form of ankylosing spondylitis. So, with rhizomelic and central form of the disease, pain is localized in the spinal column, as the disease progresses, a stoop is formed. If the patient has a peripheral form of the disease, then the joints of the knees and legs will initially swell and hurt.
This pathology can be suspected by the time of onset of pain. They often begin to bother a person at night, and during the day they practically disappear.
Disorders from organs and organ systems
The first to begin to suffer are the small vertebral joints, as well as those joints that connect the ilium to the sacral vertebrae and the joints of the pubic articulation. As the disease progresses, the surface of the bones that form the joint begins to deteriorate, resulting in an acute and then chronic process of inflammation.
The cells that form the cartilage begin to grow, the articular surfaces fuse, and then bone tissue grows into them. The articular ligaments also ossify. As a result, the person becomes immobilized.
The entire spinal column undergoes the pathological process, starting with the first lumbar vertebra and ending with the seventh thoracic vertebra. When the bone tissue grows to the maximum, the spine in its appearance begins to resemble a bamboo stem.
As for other joints, in the early stages of the development of the disease, the process of inflammation in them takes place, with periodic relapses. As the pathology progresses, the inflammatory process is chronized with the replacement of connective tissue with fibrous tissue and with the growth of bone tissue. As a result, the joints of the legs and arms, as well as the joints of the chest, are exposed to ankylosis.
About 25% of patients suffer from inflammatory processes of the vascular and iris of the eyes. Later, they develop secondary glaucoma.
In a small part of patients, atrophic processes are observed inside the membrane of large vessels located in the upper body. The aorta also suffers. This leads to the appearance of intravascular fibrous fibers, which disrupts the valves of the main artery of the heart. As a result, a person experiences rhythm disturbances, and pericarditis develops. Such manifestations of the disease affect from 2 to 8% of patients.
The upper parts of the lungs are sometimes inflamed. In them, cavities are formed, similar to the cavities in cavernous tuberculosis. Liver and kidney damage leads to the gradual failure of these organs to function normally.
Other symptoms of ankylosing spondylitis
Diagnosing a disease solely by symptoms is often difficult, since they are very diverse. The onset of the pathological process can proceed in different ways. There are five options for the development of the clinical picture:
- The inflammatory process is localized in the lumbar region and sacrum, the intensity of pain is constantly increasing. In parallel, painful sensations appear in the joints of the limbs.
- Inflammation of one or more joints is possible, but it is not necessary that they will be located symmetrically. The inflammation is characterized by frequent exacerbations and remissions. The lumbosacral zone is involved in the process of inflammation a little later. Most often, this is the type of disease that develops in young people.
- In childhood and adolescence, the manifestation of the disease most often resembles a rheumatic attack. Large joints are inflamed, they swell, the skin over them turns red, and the body temperature rises. The sacroiliac joints become involved in the pathological process after some time.
The most rare variant of the course of the disease is accompanied by such signs as: an increase in body temperature to high levels, temperature instability with a tendency to increase by 1-2 degrees in the morning. The patient begins to lose weight, feels weak, sweating increases. Joint and muscle pain occurs after 14-21 days.
- Sometimes in patients the blood vessels and heart muscle are primarily affected. Signs of inflammation can be seen on a blood test. In parallel, symptoms of iritis and iridocyclitis are observed. Joint inflammation manifests itself only months later.
Differences in the course of ankylosing spondylitis in men and women
It has been established that the disease progresses differently in men and women.
Symptoms of the disease in men
How does the disease manifest
Symptoms are mild, acute inflammation is absent.
It develops sharply, the symptoms appear brightly.
Time from the manifestation of the disease to the appearance of the first symptoms.
10 to 20 years old.
4 to 5 years old.
The predominant site of localization of inflammation.
The spine and large joints.
The spine and small joints.
The defeat of the spinal column.
The sacral and lumbar region suffers, but no strong changes are observed.
All parts of the spine suffer, its pathological curvatures develop, mobility is severely limited.
Damage to blood vessels, lungs and other organs.
It is often observed.
Forms of ankylosing spondylitis
There are four forms of ankylosing spondylitis, including:
- Peripheral form. It is considered the most common. According to various sources, from 20 to 75% of people with ankylosing spondylitis suffer from it. The spinal column and small joints are inflamed.
- The central form of the disease is characterized by inflammation of the spinal column exclusively. This form of the disease occurs in 46.6% of cases.
- The root form, which is also called rhizomyelic. In addition to the spinal column, large joints are involved in the inflammation process. The prevalence of this form of the disease is 18%.
- Less often than others, the Scandinavian form of the disease is diagnosed in which the spinal column and small joints of the upper and lower extremities suffer. By the nature of the course, this form of the disease is very similar to rheumatoid arthritis.
Diagnosis of ankylosing spondylitis
Diagnosis of ankylosing spondylitis is rather difficult, since it is often confused with other pathologies. RAMS recommends focusing on the following symptoms for diagnosis:
- For three months or more, a person experiences pain in the lumbar region. The pains tend to subside with movement, but get worse at rest.
- The mobility of the spine is difficult in all directions.
- A person cannot fully inhale and exhale.
- There is an inflammation of the sacroiliac joint of 2-4 degrees (sacroiliitis). The inflammatory process is bilateral.
If a person has sacroiliitis and there is at least one of the previous signs, then the doctor can make an appropriate diagnosis. These norms were adopted back in 1997 and are still valid. Nevertheless, one should not forget about the existing modern diagnostic methods, which make it possible to clarify the diagnosis and determine the extent of the disease.
If the therapist suspects ankylosing spondylitis in his patient, he must necessarily refer him to a consultation with an orthopedist, neurologist, rheumatologist. Additional instrumental examination methods are performed, such as radiography, MRI and CT of the spine. Blood sampling for a general analysis reveals an increase in ESR. When specialists have doubts, the patient is referred for a special analysis aimed at detecting the HLA-B27 antigen.
Equally important is the differential diagnosis of ankylosing spondylitis with other degenerative diseases of the spinal column, including osteochondrosis and spondylosis. Distinctive features are:
- All patients are predominantly young men;
- The nature of the pain. They occur in the morning and do not subside at rest, while with osteochondrosis, the pain intensifies in the late afternoon and after physical exertion;
- ESR in degenerative lesions of the spine does not increase.
Often the Scandinavian form of ankylosing spondylitis is confused with rheumatoid arthritis. However, doctors should remember that rheumatoid arthritis often affects women, and rheumatoid subcutaneous nodules are also characteristic of this disease. In 80% of cases with rheumatoid arthritis, rheumatoid factor is found in the blood of patients.
Treatment of ankylosing spondylitis
Treatment of ankylosing spondylitis involves the implementation of a whole range of therapeutic measures, which have the sole purpose of stopping the ankylosing process:
- When the acute period subsides, the patient is shown to perform exercise therapy, it is useful to go skiing, practice in the pool.
- The effect is provided by balneological procedures.
- Phonophoresis with hormonal drugs is carried out, paraffin therapy, ultrasound treatment is effective.
- It is important that the patient monitors his posture and sleeps on a firm, level surface.
- During the active stage of treatment, static loads on the spinal column, as well as running and performing other heavy physical exercises, are prohibited.
Perhaps the introduction of corticosteroid hormones into the articular cavity. Cryotherapy with liquid nitrogen in the spinal column helps relieve pain and relieve the patient's condition. Hirudotherapy and back massage can be used as auxiliary methods of treatment. However, these procedures can only be performed in remission.
In general, there are active disputes between doctors about physiotherapy. Many of them are of the opinion that exposure to heat on sore joints can only increase the inflammation process. This applies, first of all, to paraffin therapy. Patients indicate that a positive effect can be obtained from going to the bathhouse, but taking a bath with hot water only aggravates the course of the disease.
No less controversial is the question of the use of cryotherapy for the treatment of ankylosing spondylitis. So, almost every patient after the first session has a deterioration in general well-being. The patient should be aware that this effect is expected. Pain relief should only come after a week of cold treatment.
Prescribing selective immunosuppressants
Drugs that suppress the work of tumor necrosis factors are increasingly used to treat ankylosing spondylitis.
Selective immunosuppressants are prescribed only when basic therapy does not give the desired effect. These drugs are quite expensive, and taking them increases the risk of developing tuberculosis, sepsis and other severe infections against the background of suppressed immunity. These drugs include Etanercept (Enbrel), Adalimumab (Humira), and Infliximab (Remicade).
Experts recommend that all patients switch to protein foods. You should minimize flour products on the menu, give up potatoes, pasta, and fatty dishes. Useful products such as: fish, eggs, cottage cheese, boiled meat, cheeses, vegetables (cabbage, carrots, beets, herbs).
Exercise therapy and massage
The implementation of therapeutic exercises is a mandatory component of the complex therapy of ankylosing spondylitis. It is important that exercise therapy consists of vigorous exercises with amplitude work on the joints. You should diversify your activities with bends, turns, rotations. It is important that the joints are maximally involved during the performance of the gymnastic complex. Only regular physical activity for 30 minutes a day or more can have a positive effect.
Aqua aerobics is very effective in preventing the processes of ossification of the joints. An alternative are classes in a dry pool on a specialized apparatus "Ugul".
As for massage, it is performed only during remission. The impact on the joints should not be too intense. Only a massage therapist with a medical education can conduct sessions.
Organization of a sleeping place
The patient must properly organize his sleeping place. You should choose a flat and firm mattress. At the initial stages of the development of the disease, the pillow should be discarded. This will avoid the development of cervical lordosis. It is best to sleep on your stomach. As the disease progresses, you can place a roller or thin pillow under your head. Keep your legs straight.
Non-steroidal anti-inflammatory drugs are the leading drugs for the treatment of Bechterew's disease. Most often they are recommended to be taken for a year or more. The maximum course of treatment is 5 years. During the acute stage of the disease, the maximum dosage is prescribed, and as the acute process subsides, the dose is reduced.
More often than other drugs, the patient is recommended to take Ketoprofen (Flexen, Flamax, Ketonal), Meloxicam (Artrozan, Movalis, Amelotex) or Diclofenac (Altrofen, Voltaren). Perhaps the appointment of Butodion and indole derivatives, including Indomethacin and Metindol.
If NSAID treatment is ineffective, then this is a reason to revise the diagnosis.
Other drug therapy
- To reduce inflammation in the joints and to provide a bactericidal effect, the drug Sulfasalazine (Salazosulfapyridine) can be prescribed. However, the therapeutic effect may occur 3-7 months after the start of treatment.
- To reduce muscle tension, Tolperisone or Mydocalm are prescribed.
- Glucocorticoids quickly and effectively relieve inflammation, but their prolonged use can cause a number of complications from the digestive system. Probably the development of osteoporosis and diabetes mellitus.
- If a person has a severe course of the disease, then he is shown taking cytostatics and corticosteroids.
- Such drugs as Plavenil, Delagil, Cuprenil do not have a pronounced effect on the course of the disease.
Stem cell therapy
One of the modern methods of treatment of ankylosing spondylitis is stem cell therapy. It should be started in the early stages, when ossification of the spinal column and diseased joints has not yet occurred.
Stem cells are able to stop the progression of the disease and prevent the growth of bone tissue. At the same time, pain decreases, the range of motion increases, the person begins to feel much better. If you combine stem cell therapy with gymnastic exercises, the effect will come even faster.
As for the prognosis, with timely treatment started, it is quite favorable. Of course, it will not be possible to completely get rid of the disease, but every patient is quite capable of slowing down its development. The main thing is to regularly visit the doctor's office, and with an exacerbation of the pathology, carefully follow all the doctor's recommendations.
Which doctor should I go to?
A vertebrologist is a specialist in spinal diseases.
Author of the article: Alekseeva Maria Yurievna | Therapist
Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.