Ankylosing spondylitis: causes, symptoms and treatment (2023)

Spondylitis ankylosansIt is a chronic inflammatory disease of the spine and joints with progressive restriction of movement. The first manifestations in the form of pain and stiffness appear first in the lumbar region, and then spread to the spine. Over time, pathological thoracic kyphosis typical of the disease is formed. The volume of movement in the joints is gradually reduced, the spine becomes immobile.The pathology is diagnosed taking into account clinical symptoms, radiography, CT, MRI and laboratory tests. Treatment: pharmacotherapy, physiotherapy, physiotherapy.

CIE10

M45 Spondylitis ankylosans

Causes of ankylosing spondylitis

The causes of Bechterew's disease have not been fully elucidated. According to many researchers, the main reason for the development of the disease is the increased aggression of immune cells against the tissues of their own ligaments and joints. The disease develops in people with a hereditary predisposition. People with ankylosing spondylitis carry a specific antigen (HLA-B27) that causes an alteration in the immune system.

The starting point for the development of the disease can be a change in the immune system as a result of hypothermia, an acute or chronic infectious disease. Ankylosing spondylitis can be triggered by a spinal or pelvic injury. Risk factors for the development of the disease are hormonal disorders, infectious and allergic diseases, chronic inflammation of the intestine and urogenital organs.

pathogenesis

Between the vertebrae are elastic intervertebral discs that give the spine mobility. There are long, dense ligaments on the back, front, and side surfaces of the spine that make the spine more stable. Each vertebra has four processes: two superior and two inferior. The processes of adjacent vertebrae are connected to each other by movable joints.

In Bechterew's disease, the constant aggression of immune cells leads to a chronic inflammatory process in the tissue of the joints, ligaments and intervertebral discs. Gradually, the elastic structures of the connective tissue are replaced by solid bone tissue. The spine loses mobility. The immune cells in Bechterew's disease not only attack the spine. Large joints can suffer. Most often, the disease affects the joints of the lower extremities. In some cases, the inflammatory process develops in the heart, lungs, kidneys and urinary tract.

classification

Depending on the prevailing lesion of organs and systems in rheumatology, traumatology and orthopedics, the following forms of ankylosing spondylitis are distinguished:

• the central shape. Only the spine is affected. There are two types of the central form of the disease: kyphosis (accompanied by thoracic kyphosis and hyperlordosis of the cervical spine) and rigid (the curves of the thoracic and lumbar spine are smoothed, the back becomes straight like a board).
• rhizomelic form. Spinal cord injuries are associated with changes in the so-called root joints (hip and shoulder).
• peripheral shape. The disease affects the spine and peripheral joints (ankles, knees, elbows).
• Scandinavian form. In clinical manifestations, it resembles the initial stages ofrheumatoide Arthritis. Deformation and destruction of the joints do not occur. The small joints of the hand are affected.

Some researchers further distinguish the visceral form, in which damage to the joints and spine is accompanied by changes in the internal organs (heart, kidneys, eyes, aorta, urinary tract, etc.).

Symptoms of ankylosing spondylitis

The disease begins gradually, gradually. Some patients find that they suffered from constant weakness, drowsiness, irritability, and mild fleeting pains in the joints and muscles for several months or even years before the onset of the disease. As a rule, the symptoms during this period are so poorly expressed that patients do not seek medical attention. Sometimes persistent and poorly treatable eye lesions (epiescleritis, iritis, iridocyclitis) become a harbinger of ankylosing spondylitis.

A characteristic early symptom of Bechterew's disease is pain and a feeling of stiffness in the lumbar spine. Symptoms appear at night, increase in the morning, and resolve after a hot shower and exercise. During the day, pain and stiffness are present at rest and disappear or decrease with movement.

Gradually, the pain spreads down the spine. The physiological curves of the spine are smoothed. A pathological kyphosis (pronounced stooping) of the thoracic region is formed. Inflammation in the intervertebral joints and ligaments of the spine leads to constant tension in the back muscles.

In the later stages of ankylosing spondylitis, the joints of the vertebrae fuse together and the discs ossify. Intervertebral bones “bridges” are formed, which are clearly visible on x-rays of the spine. Changes in the spine develop slowly over several years. Periods of exacerbations alternate with more or less prolonged remissions.

Sacroiliitis (inflammation of the sacral joints) often becomes one of the first clinically significant symptoms of ankylosing spondylitis. The patient is concerned about pain in the depths of the buttocks, sometimes spreading to the groin and thighs. This pain is often mistaken for a sign of sciatic nerve inflammation, a herniated disc, or sciatica. Pain in the large joints occurs in about half of the patients. The feeling of stiffness and pain in the joints is more pronounced in the morning and in the morning. Small joints are less often affected.

In about thirty percent of cases, Bechterew's disease is accompanied by changes in the eyes and internal organs. Possible lesions of the heart tissue (myocarditis, sometimes as a result of inflammation, heart valve disease is formed), aorta, lungs, kidneys and urinary tract. In ankylosing spondylitis, the ocular tissues are often affected,Iritis,IridocyclitisÖUveitisdeveloped

Diagnose

The diagnosis of ankylosing spondylitis is made on the basis of examination, medical history and other examination data. The patient must consult an orthopedist and a neurologist. X-ray examination, MRI etcTC of the columnare ready. According to the results of a general blood test, an increase in ESR is noted. In cases of doubt, a special analysis is performed to detect the HLA-B27 antigen.

Ankylosing spondylitis must be distinguished from degenerative spinal diseases (DSD): spondylosis and osteochondrosis. Ankylosing spondylitis more commonly affects young men, while DSD tends to develop later in life. The pain in Bechterew's disease increases in the morning and at rest. DSD is characterized by increased pain at night and after physical exertion. ESR does not increase with DSD, specific changes are not detected on the X-ray of the spine.

The Scandinavian form of ankylosing spondylitis (predominantly a small joint lesion) must be differentiated from rheumatoid arthritis. Unlike ankylosing spondylitis, rheumatoid arthritis usually affects women. In ankylosing spondylitis, symmetrical joint damage is practically absent. Patients do not have subcutaneous rheumatic nodes, when examining the blood, rheumatoid factor is detected in 3-15% of cases (in patients with rheumatoid arthritis - in 80% of cases).

Treatment of ankylosing spondylitis

Therapy is complex, long-lasting. It is necessary to observe continuity at all stages of treatment: hospital (accident department) - polyclinic - sanatorium. Glucocorticoids and nonsteroidal anti-inflammatory drugs, therapeutic blockades are used. With severe treatment, immunosuppressants are prescribed. Lifestyle and special physical exercises play an important role in the treatment of ankylosing spondylitis.

The remedial gymnastics program is put together individually. The exercises must be done daily. To prevent the emergence of vice postures (peace posture, pride posture), the patient is recommended to sleep on a hard bed without a pillow and regularly engage in sports that strengthen the back muscles (swimming, skiing). Breathing exercises must be performed to maintain chest mobility. Massage, magnetic therapy, reflex therapy are used in the treatment. Patients with ankylosing spondylitis are shown therapeutic radon, hydrogen sulfide and nitrogen baths.

prognosis and prevention

It is impossible to fully recover from ankylosing spondylitis, but if the recommendations are followed and the treatment is selected correctly, the development of the disease can be slowed down. Patients suffering from this disease should be constantly monitored by a doctor and treated in a hospital during the period of exacerbation.

literature

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