Ankylosing spondylitis (ICD-10: M45) is an inflammatory process that affects the intervertebral joint, which leads to the formation of ankylosis. As a result of the development of the disease, the patient's spine is enclosed in a rigid corset of bones, which significantly limits mobility. This disease is scientifically called ankylosing spondylitis and all because the term "ankylosis" means splicing.
According to statistics, this ailment is more common in the male half of humanity, in addition, women are much easier to tolerate the disease. The disease is diagnosed most often in the age group from 15 to 30 years. In older people, the disease is rare.
The first manifestations are very reminiscent of osteochondrosis, but ankylosing spondylitis is dangerous because it provokes complete immobilization of the joint in the spinal column, which is very dangerous. How to treat ankylosing spondylitis, prognosis and best diagnostic methods further.
Forms
Doctors divide the disease into several forms, which depend on which part of the spine was affected:
- central - the disease affected only one area - the spine;
- rhizomelic - not only the spine suffers, but also large joints;
- peripheral - the disease affected, in addition to the spine, also the knee, ankle and elbow;
- Scandinavian - strongly reminiscent of rheumatoid arthritis, but at the same time small joints do not suffer;
- visceral - not only the spine is affected, but also many other systems and organs of the human body.
All these forms are manifested by similar symptoms, so only a doctor can, after conducting an examination, make an accurate diagnosis and accurately answer the question of how to treat ankylosing spondylitis in a particular case.
Causes of the disease
This ailment is attributed to idiopathic pathologies, and this means that while science can not say exactly what are the causes of ankylosing spondylitis. Symptoms also may not always indicate precisely the development of this ailment. But after lengthy studies, it became known that more than 90% of people develop an ailment due to a damaged gene in the HLA system. It is he who is responsible for the normal reactions of the immune system to various ailments.
Genes are damaged due to the aggressive effect of pathogenic flora on the body, as a result of which it is transformed into an antigen. It is transmitted from parents to children.
Having come into contact with healthy cells, the antigen forms complexes that the immune system perceives as alien, it begins to attack them, resulting in inflammation.
There are a number of factors that can trigger the rapid development of ankylosing spondylitis:
- inflammatory processes in the genitourinary system;
- damage to the intestines and other organs, provoked by the presence of microorganisms - Klebsiella and streptococcus;
- endocrine dysfunction;
- pelvic fractures;
- hypothermia.
But not only gene mutation can cause the development of the disease. Today, scientists still cannot say exactly how microorganisms affect the development of the disease, because antibiotics are not used in therapy. But violations in immunity occur precisely at the genetic level.
Recent studies conducted on mice have given scientists to understand that the disease develops in the presence of infection, antibodies and T-lymphocytes that circulate in the patient’s blood. Based on this, we can say for sure that only the presence of these three factors can provoke the development of ankylosing spondylitis.
The first signs of illness
You can recognize the development of the disease by the following signs:
- pain and stiffness in the region of the lower back and sacrum, irradiation to the lower extremities and buttocks is possible, pain can intensify in the morning;
- at a young age, pain can occur in the heel;
- stiffness extends to the chest area;
- general blood test shows increased ESR.
If all these signs are observed in the patient for several months, then they should force the person to seek the advice of a rheumatologist.
Manifestations of the disease
Symptoms of ankylosing spondylitis are manifested in the form of pain, which is concentrated in the spine, and after that there are other signs. It is important to determine the symptoms in the early stages not only to the doctor, but also to the patient.
Features of the pain syndrome:
- the pain manifests itself in the sacral region, it is especially pronounced in the morning hours, after waking up for half an hour a person cannot move his limbs;
- a distinctive feature of the disease is that after the cessation of movement or physical exertion, the pain does not subside, but only intensifies;
- the nature of the pain depends on the form of ankylosing spondylitis, with rhizomelic and central pain localized in the spine, during the progression of the disease, stoop is observed, but in the peripheral form the swelling of the joints of the legs is considered the first symptom.
You can recognize the disease by the time of manifestation of the pain syndrome. At night they are intense, but during the day they are almost inaudible.
Violations of the internal organs
Initially, small joints of the spine begin to suffer, which connect the ilium with the vertebrae of the sacral region and the joints of the pubic joint. The bone tissue that forms the joint, as the disease progresses, begins to collapse, resulting in acute inflammation, and then chronic.
Cells for the formation of cartilage grow, the surfaces of the joints grow together, and then bone tissue grows in them. Ligaments are also ossified. As a result, a person can no longer naturally move, and with a neglected form he generally becomes immobilized.
In the first stages, other joints do not suffer so much, everything happens with periodic relapses. But with the development of ankylosing spondylitis, the symptoms become more pronounced. Chronitisation of inflammation occurs when the connective tissue is replaced by fibrous. As a result, the joints of the chest and limbs are ankylosed .
A fourth of patients suffer from inflammation of the membranes of the eyes, and secondary glaucoma is subsequently observed.
Inflammation can affect the upper part of the lungs. Cavities may form in them, as in cavernous tuberculosis. The kidneys and liver are affected, they gradually cease to function normally.
How is the disease in men?
Ankylosing spondylitis in men is much more common than in the fair half. Moreover, their course is much harder. The defeat in a short time spreads to the entire trunk of the spine and covers the joints.
In men, there is a strong swelling of the joints, accompanied by severe pain. Patients have to wake up in the middle of the night to get up and stretch themselves, the only way to relieve pain and stiffness. If the sacrum is affected, then the pain radiates deep into the buttocks.
Ankylosing spondylitis in young men does not affect the spine, but the joints. But if no measures are taken, then in the future the lesion extends to the spinal column, limiting its mobility. Aching pain in small joints is characteristic.
In men, damage to other internal organs is also often observed. With eye damage, iritis can develop, and if the heart is affected, aching pain appears in its area.
The causes of the development of the disease in men can be as follows:
- injury to the pelvic organs;
- hypothermia;
- inflammatory processes in the genitourinary system;
- hormonal disorders;
- diseases of the stomach and intestines.
After the diagnosis is accurately made and the foci of the spread of the pathology are identified, you can accurately answer the question of how to treat ankylosing spondylitis in men to alleviate pain and remove symptoms.
How is the disease in women?
In beautiful ladies, this ailment is 9 times less common than in the strong half. That is why diagnosing them can be much more difficult. And this is due to the fact that the form of ankylosing spondylitis in women is different. After the first symptoms of skeletal damage, the ailment may not remind yourself of itself for a long time.
The disease begins mainly with the thoracic spine, it can also initially affect the shoulder girdle. This is what confuses the specialist when he examines and tries to make an accurate diagnosis. Often mistakenly diagnosed with polyarthritis. Most often, an accurate diagnosis in women (ankylosing spondylitis) can be made no earlier than 10 days after the onset of the first symptoms. And this is due to the fact that changes in the spine occur much later and with not such intensity as the strong half.
In rare cases, ossification is observed, mobility in the joints persists for a long time. Damage to other organs happens in rare cases, especially for the liver, kidneys and heart.
Diagnostic methods
It is important to correctly diagnose, so as not to confuse the symptoms of ankylosing spondylitis in women and men with other pathologies. This is the only way to start timely treatment. Functional tests are recommended for identifying sacroiliitis:
- Symptom Kushelevsky I. The patient lies on his back. The specialist puts his hands on the crests of the ilium and presses on them. If there is inflammation, then this pressing will lead to pain.
- Symptom Kushelevsky II. The patient lies on his side, the specialist presses on the ilium, as a result, the body responds with pain.
- Symptom of Makarov. The pain appears at the moment when the doctor taps the knee and iliac joints with a hammer.
The doctor also conducts tests to determine mobility restrictions:
- Pain when pressing with fingers along the spinous processes of the vertebrae.
- Symptom Forestier. The patient becomes close to the wall, trying to squeeze the heels, head and torso to it. If a person has ankylosing spondylitis, then one of the parts will not touch the surface.
- To determine the mobility of the spine in the cervical spine, the patient is asked to reach the chest with his chin. If the disease progresses, the distance between the chin and sternum will increase.
- Sample Thomayer. Helps assess mobility of the entire spine. The patient needs to lean forward and try to get to the floor. The norm is when a person reaches the floor.
In addition, the patient is recommended to undergo instrumental diagnostics:
We must not forget about laboratory research:
- a clinical blood test may indicate an elevated ESR;
- biochemistry will show high C-reactive protein, globulin, fibrinogen;
- genetic analysis for the presence of the HLA B27 gene.
Only when the diagnosis is accurately made can therapy be started.
Treatment of ankylosing spondylitis
The main goal of therapy is to reduce pain and inflammation. It is also necessary to prevent and reduce stiffness of the spine, to maintain human activity.
Therapy should be constant and fully consistent with the severity of the process. It will be better for the patient if he regularly visits a rheumatologist who will monitor the development of the pathology, the first symptoms of which were described by our academician Bekhterev. The disease requires constant monitoring, and in the period of exacerbation - observation in a hospital.
Drug treatment involves the use of non-steroidal anti-inflammatory drugs. They are presented in two groups: non-selective and selective.
Non-selective:
- "Diclofenac" is prescribed mainly in tablets of 50 mg three times a day.
- “Ketoprofen”, “Ibuprofen” or “Indomethacin” can become a replacement for “Diclofenac”, because it has many contraindications and side effects.
Selective:
- The most popular drug from this group is Nimesulide. It is allowed to take no more than 400 mg per day.
- Other drugs may also be prescribed: Celebrex, Meloxicam.
Additionally, glucocorticosteroids are prescribed. They are recommended for the most severe manifestations of the disease and in those cases if non-steroidal anti-inflammatory drugs did not give the desired result. Taking hormones helps to relieve severe pain, reduces inflammation.
"Sulfasalazine" is considered another good drug from the sulfonamide group. It is recommended to take 3 mg per day if the inflammation is severe.
Also, a patient with ankylosing spondylitis is recommended to take antimetabolites. Methotrexate has been used by rheumatologists in the treatment of this disease for more than 50 years. The drug is a powerful anti-inflammatory drug.
As immunosuppressants, which are recommended for patients, if other drugs did not help, use "Azathioprine", "Cyclophosphamide".
In addition to drug therapy, specialists add physiotherapy exercises, but only during remission. It would be good for the patient to do swimming. The main basis of treatment is regular exercise. A set of exercises is selected for each specific patient, depending on its form and stage of the disease. Gymnastics must be done twice a day for 30 minutes.
It relieves pain and inflammation perfectly physiotherapy. Patients are recommended:
- ultrasound;
- Bernard currents;
- paraffin therapy;
- balneotherapy;
- reflexology.
Ankylosing spondylitis, reviews of doctors and patients confirm this fact, it can not be cured, like any other rheumatic disease, but you can achieve long-term remission. To do this, carefully follow all the recommendations of the doctor.
With the right approach, people with this ailment live a full life, few deny themselves anything.
Doctors Recommendations for Lifestyle
The basic rule that you must adhere to is regular exercise. Be sure to do exercises in the morning and evening, but not very exhausting. Physical activity will help maintain mobility in the joints.
You only need to sleep on a hard bed, no sagging mattress. A minimum of pillows.
To choose clothes by the principle - the most warm, but breathable. If the cervical region is particularly sensitive to cold, then sweaters and turtlenecks are the best choice. Shoes should be on thick elastic soles, cushioned while walking.
Nutrition must be healthy. Excess weight adversely affects the spine, additional burden is placed on it. Cut down on sugary and fatty foods.
When working at a computer, you need to sit on a chair with a hard back. The workplace must be properly organized so that you do not have to bend or crank your neck.
If there are pains that do not go away after rest, but only intensify, immediately go to the doctor to start therapy in time and prevent a serious relapse.
Forecast and Prevention
Patients with such an ailment can fully live their whole lives, the main thing is to follow the doctor's recommendations, but as for prevention, it does not exist. It will not work to protect yourself from the disease, because scientists say that it is a genetic pathology and is laid in the womb. Women in general may not even notice that they have this ailment if they have taught themselves to eat and exercise correctly when they are young.