Ankylosing spondylitis, or ankylosing spondylitis, is a disease of a whole system of joints: sacroiliac, intervertebral, etc. Pathology is accompanied by their permanent inflammation and a sharp restriction of mobility.
The essence of pathology
The disease is progressive in nature and ends with ankylosing of the joints (immobility due to contamination of the joint cavity), syndesmosis (connection of bones with fibrous tissue) and loss of elasticity of the ligaments.
From ankylosing spondylitis, the spine suffers first. Then the inflammation passes to the joints of the legs, hands. The process goes from large to small - from large to small joints.
Ankylosing spondylitis code according to ICD-10:
- M08.1 - juvenile ankylosing spondylitis.
- M45 - ankylosing spondylitis.
- M48.1 - ankylosing hyperostosis.
Frequency of occurrence
Spondyloarthritis affects 2% of the world's people. Africans and Asians - the disease occurs much less frequently than Europeans. Mostly men are affected - almost 10 times more often than women. The age of patients is mainly up to 30 years, often the disease originates in puberty.
After 50 years, ankylosing spondylitis is a rarity. Pathology can occur in children due to poor heredity. The frequency of pathology in Russia is up to 9 patients per 10 thousand people. The first description of the pathology was made in 1892 by the neuropathologist Bekhterev.
Ankylosing spondylitis is largely the behavior of the body's immune system. The second name is due to the fact that this pathology is expressed in ossification of ligaments and growth on the edges of vertebrae of bone osteophytes. Marked arthralgia, a sharp restriction of the motor activity of the spine, and in the later stages, its complete immobility (ankylosis) are noted. This type of spine is called bamboo, it is cruel and unbending. Patients in the later stages develop 2 characteristic poses by which this disease is easily recognized:
- The petitioner's pose is with a bent back, bent knees and a bowed head.
- Rose of pride - the column of the spine is only vertical and the head is thrown back.
Regardless of the final posture, the patient’s quality of life is reduced so much that he simply cannot serve himself and needs care.
Etiology of the disease
The true causes of ankylosing spondylitis are not established today. There are only a few hypotheses.
The theory of psychosomatics is now popular. It was revealed that many patients often for various reasons had the habit of restraining negative emotions. This is aggression, and the prevailing unpleasant and even tragic circumstances, and a sense of guilt. Such a negative leads to bending of the spine.
Another group of scientists attaches great importance to genetic heredity. In most patients, an altered HLA B27 gene is detected (in 95% of cases). For an unclear reason, human immunity begins to perceive spinal cells as foreign and attacks them. This process has been known to medicine for a long time as an autoimmune disease. Therefore, the most plausible theory remains that Ankylosing spondylitis is an autoimmune disease.
Studies have shown that there is a situation where the immune system rejects its cells and begins to destroy them. The established mechanism for the development of pathology in this case: the disrupted HLAB27 gene is present in the cartilage of the vertebrae and their articular surfaces. The gene is immune to infection. When she appears, he meets her. And here, for some unknown reason, immunity suddenly becomes hostile to the cartilages of the native spine. Cells are actively attacked by leukocytes and macrophages, which the body directs to fight a stranger. An inflammatory reaction occurs. Disks and joints begin to collapse from the inside.
In order to maintain the shape of the spine, the body tries to compensate for the death of cartilage tissue by creating new tissue. Since cartilage cannot be regenerated, the replacement is with bone tissue. The whole process often starts after infection.
It follows that a person who carries the HLAB27 gene must protect himself as much as possible from colds, not be exposed to drafts, hypothermia, and not be in contact with influenza patients.
Risk groups
The risk of developing spondylitis in the presence of an altered gene named above is 20%. Although it is impossible to stop the pathology, it is possible to undergo a medical and genetic consultation in time and determine if there are prerequisites for the appearance of the disease. The risk group includes representatives of the stronger sex aged 20 to 40 years.
The mechanism of development of spondylitis
The vertebrae are interconnected by elastic cartilage discs. This gives the spinal column flexibility.
On all surfaces of the spine in a circle are long dense ligaments. This is necessary for the stability of the spine. Each vertebra is equipped with 2 upper and 2 lower processes. These processes of serially connected vertebrae are articulated movably. Attacks of macrophages cause inflammatory reactions in the tissues of not only the disks, but also the ligaments, as well as the vertebral bodies themselves.
Elasticity is lost as a result of this, collagen and elastin begin to be replaced not even with connective tissue, but immediately with bone. The vertebrae are fused together and the vertebral column becomes motionless. In addition, the legs are affected - hip joints, knees, ankles. In autoimmune processes, important internal organs - the heart, lungs, and kidneys - always suffer.
Pathology classification
At the site of inflammation, 4 forms of clinical options are distinguished:
- The central option is more common than others. The load of damage affects only the spine, especially its lower part.
- Rhizomelic (root) form - this option affects women. The upper shoulder girdle and TBS (hip joint) are affected.
- The peripheral form - inflammation goes downward - damage to the joints of the knees and feet.
- Scandinavian form - the smallest joints suffer - fingers and toes. Often this form is diagnosed as rheumatic fever.
Ankylosing spondylitis stage
There are three of them:
- In the initial stage, there are no changes on the X-ray, the mobility is practically not broken.
- The second stage (moderate) - the joint gap narrows and there begins a decrease in spinal mobility, the risk of ankylosis becomes real. Clinically increasing arthropathy.
- The third stage (late) - the bones are fused and the process is irreversible. Ligaments ossify, salts are deposited in them.
Symptomatic manifestations
Each stage of ankylosing spondylitis has its own clinic. Often the symptoms resemble in their signs the onset of sepsis: temperature (up to 40 degrees), the patient sweats profusely, myalgia, arthralgia are observed, the person weakens and loses weight.
The danger of spondylitis is that it disguises itself as other pathologies of the spine, so the final diagnosis may be delayed. In advanced cases of ankylosing spondylitis, therapy has practically no effect.
Early symptoms
First, inflammation of the sacrum begins. Then the signs of ankylosing spondylitis pass higher - capture the lower back, chest, cervical spine. With further inflammation, the joints of the limbs are also affected, which invalidates the patient.
Even the cartilage of the fingers can become numb. Inflammation is accompanied by edema and passes to the ligaments of the lower leg, knees and feet. It often happens that heel pain can be the first signal of an onset of the disease.
Features of early manifestations
In the area of the sacroiliac joints, regular pain occurs, at night they intensify, and in the morning they become sharp, in the morning the spine simply refuses to move. Then, during the day, a person makes many movements, which leads to a decrease in pain. But the process of inflammation continues and rises higher. The patient feels especially sharp pains in the heels. It is noteworthy that diabetics and hypothyroidism may not have pain. Well reduces the discomfort of a hot shower.
With the spread of inflammation up, pain in the sternum occurs. A person begins to breathe through the diaphragm. His pain intensifies at the slightest exertion - sneezing, coughing, taking a deep breath. This suggests the involvement of cost-vertebral joints in the inflammatory process. The rectus muscles of the back are also constrained due to soreness. There is a decrease in working capacity and fatigue. In a blood test, ESR these days can rise to 30-40 mm / hour.
Late stage symptoms
With the progression of the process, the changes increase and become irreversible: the spine is sharply limited in movement, even simple tilts in any direction for the patient become impossible. The pains resemble sciatica. Numbness appears in the legs and arms. The chest is also sharply limited in its movements.
The respiratory system is disturbed - suffocation appears, pneumonia and tuberculosis join. The heart muscle is compressed, the pressure rises. The spinal muscles are not just constrained, they atrophy. The brain suffers due to insufficient oxygen supply, cephalgia, dizziness, and nausea appear. The flexibility of the spine is reduced.
The physiological bends of the skeleton are smoothed, as a result, the above characteristic postures develop. Kyphosis of the thoracic spine is noted. The legs are bent at the knees because the body is trying to compensate for the forward movement of the body's center of gravity. The iris of the eyes, pericardium is inflamed.
To the listed symptoms of ankylosing spondylitis are added a sharp decrease in performance and constant increased fatigue. The patient becomes an invalid who needs outside care.
The course of the disease in women
Although pathology is less common in women than in men, it has its own characteristics that you need to know about. Many researchers believe that data on the incidence of women with spondylitis are greatly underestimated.
Features of the course of the disease in the fairer sex:
- Vertebral ossification refers only to the lumbosacral, therefore, even in the last stages of the disease, women remain mobile.
- In women, the defeat option is such that the shoulders and hip joints — the rhizomyelic form — are involved in the inflammation process.
- Attacks of pain last hours and months.
- The development of pathology is slower - 10-15 years. Remissions are long.
- Internal organs are practically not affected.
- Heel bones and tendons also suffer very rarely.
Although the symptoms of ankylosing spondylitis in women differ, treatment during exacerbations is similar to that in men.
Possible complications
Since patients do not have a strict scheme for the development of the disease, the complications are also different for everyone. The most common of them:
- The heart and aorta are affected.
- In 35% of cases, the kidneys suffer - amyloidosis (impaired protein metabolism) and glomerulonephritis. This results in the development of renal failure.
- Aortitis occurs in 6% of cases.
- Lesions of the aortic valve are found in 8% of patients, pericarditis in 11%. These pathologies lead to the appearance of heart failure (heart failure).
- Due to the limited mobility of the ribs and respiratory muscles, pneumonia joins, and even tuberculosis can develop.
- Pulmonary fibrosis is observed in 10% of cases.
- In many patients, the organs of vision are involved in inflammation - eyeballs become inflamed in 30% of patients. The process is characterized by an acute onset - pain in the eyes, impaired vision, its fuzziness, irritation in the light. Such an acute period can last 2 months. There is no cure, the process just becomes chronic. Often it is inflammation of the eyeball that allows early diagnosis of spondylitis.
- Intestinal inflammation.
- Osteoporosis.
Diagnostic measures
The diagnosis of ankylosing spondylitis is made to patients on the basis of an X-ray examination of the spine, CT and MRI. UAC - allows you to identify the acceleration of ESR. If the clinic is unclear, a laboratory test is performed for the presence of the HLA-B27 antigen in the blood.
Treatment of ankylosing spondylitis
Full recovery does not occur, but inflammation can be slowed down and long-term remissions can be achieved. With early diagnosis, you can avoid complications, maintain the flexibility of the vertebral joints of the back and work capacity until the end of life.
Treatment of ankylosing spondylitis will give a result only with its comprehensive implementation. Its purpose is to stop the process of ankylosing. When the inflammation subsides, the patient is sent to wellness procedures: physiotherapy, exercise therapy, balneotherapy. Very useful are skiing, swimming, water aerobics with the development of limbs in water, underwater traction of the spine.
Proper bedding is important: the mattress should be flat and firm. There is no pillow in the initial stages so that there is no cervical lordosis. At other times, a roll or orthopedic small pillow is used. Sleep preferably on the stomach with legs straight. With active treatment of ankylosing spondylitis, running and static loads are prohibited.
Medications
The selection of medicines is individual. Medications are taken for life. The main directions of treatment 3: medication, physiotherapy and surgery.
Of the medicines used:
NSAIDs (non-steroidal anti-inflammatory), GCS (Glucocorticoids) - Urbazon, Medrol capsules, anti-rheumatic drugs Azathioprine, immunosuppressants.
TNF inhibitors block the synthesis of inflammatory mediators. They are administered subcutaneously. They are first-line drugs. These include Adalimumab, Infliximab.
Exercise therapy
Helps the patient and therapeutic exercises. The program is individual for each patient. It must be performed daily.
Physiotherapeutic procedures
The physiotherapy shows phonophoresis with hormones, electrophoresis with calcium chloride and lithium, ultrasound, UHF, ozokerite, paraffin treatment, radon gas and radium isotopes.
The most effective procedures:
- Stay in a cold cell followed by exercise.
- Mud wraps and bathtubs.
- Warm bath before going to bed.
- Infrared irradiation.
- Back massage - relieves muscle tension and pain.
Massage is prescribed in courses every six months. Very effective underwater massage.
Preventive actions
Special prevention does not exist. To prevent ankylosing spondylitis, the recommendations are as follows:
- Remediation of carious teeth.
- Avoidance of colds.
- Prevention of back injuries.
- Clinical examination in the clinic.
- Exclusion of physical inactivity and moderate physical activity.
- When sitting for a long time, you should check your posture by leaning against the wall - the heels, back, buttock and shoulders should be in line.
- Maintaining immunity at the proper level.
It is useful to refer the patient annually to spa treatment with radon and sulfide waters. Disability with ankylosing spondylitis is mandatory - from 3 to 1 groups. ITU is engaged in this (medical and social expertise). Patients with this diagnosis are exempted from conscription into the army.