Ankylosing spondylitis (ankylosing spondylitis) is a chronic systemic joint disease in which the process is localized mainly in the sacroiliac joints, as well as paravertebral soft tissues and joints of the spine. In Russia, it is detected in 0.3% of the population.
What are the causes of this pathology? What symptoms indicate its development? Is it possible to cure? This article is dedicated to the answers to these questions.
Causes
Unfortunately, today they are not fully understood. Most researchers believe that the key cause of this disease is the increased aggression of immune cells that they show in relation to their own joints and ligament tissues.
Ankylosing spondylitis (ankylosing spondylitis) develops in people who have a hereditary predisposition to it. They have identified a specific antigen - HLA-B27, because of which the notorious changes in the immune system occur.
What is the trigger in the development of this pathology? Usually this is a chronic or acute infectious disease or a decrease in the body's defenses resulting from hypothermia. Also, the development of the disease can provoke an injury to the pelvis or spine.
The risk factors for ankylosing spondylitis (ICD-10; M08.1, M45, M48.1) include hormonal disorders, chronic intestinal inflammation, infections of the genitourinary organs, as well as allergic reactions.
Pathogenesis
You should understand how this pathology develops. As everyone knows, spinal mobility is ensured by elastic intervertebral discs that are located between the vertebrae. The pillar itself makes stable dense ligaments located on its lateral, front and rear surfaces. Each vertebra has four processes - upper and lower. They are also connected by moving joints.
What happens with ankylosing spondylitis (ICD-10; M08.1, M45, M48.1)? Due to the aforementioned aggression of immune cells, a chronic inflammatory process begins to develop. It affects the intervertebral discs, ligaments and joints.
Because of this, connective tissue structures are slowly replaced by bone hard tissue. The result is a loss of spinal mobility.
It should be noted that this process also affects the joints of the lower extremities. In rare cases, it spreads to the urinary tract, kidneys, lungs, and heart.
Classification
Its consideration should also be given a little attention. Forms of ankylosing spondylitis (ankylosing spondylitis) are determined by the nature of the damage to systems and organs. The following are distinguished:
- Central form. In this case, only the spine is affected. The disease can be of two types: kyphoid (at the same time there is a curvature of the thoracic region and a neck defect) and rigid (smoothing of the lumbar and thoracic bends occurs, as a result of which the back becomes flat, like a board).
- Peripheral form. The disease affects not only the spine. Peripheral joints - elbow, knee and ankle joints are also affected.
- Rhizomelic form. Accompanied by changes in the root joints. Shoulders and hips are usually affected.
- Scandinavian form. The clinical picture is similar to that characteristic of rheumatoid arthritis. The joints are not deformed or destroyed. But defeats, however, are present. They affect the small joints of the hand.
Some doctors additionally isolated the visceral form of ankylosing spondylitis. Ankylosing spondylitis in this case is characterized not only by damage to the spine and joints, but also by changes in the internal organs. They affect the urinary tract, heart, aorta, kidneys, eyes, and more.
Symptoms
Before moving on to the treatment of ankylosing spondylitis in women and men, it is necessary to study the signs by which this pathology manifests itself.
Symptoms occur gradually. Some patients experience drowsiness, chronic weakness, irritability, and also pain in the muscles and joints of a volatile nature for months, even years. During this period, the clinical picture is so weakly expressed that people do not even have the thought to consult a doctor.
More alarming, but also a rare preliminary symptom are poorly treatable, persistent eye diseases. Typically, these are iridocyclitis, iritis, and episcleritis.
A more characteristic symptom is severe pain and a feeling of stiffness, localized in the lumbar region. These signs occur in the evening, closer to night, and intensify in the morning. They can be eliminated with the help of physical exercises and a hot shower.
In the afternoon, by the way, these sensations can also arise if a person is at rest for a long time. After active movements, they disappear.
Over time, pain begins to spread up the spine. A person notices that the bends of the back are smoothed out, a pronounced stooping of the thoracic section occurs. The muscles are in constant tension due to inflammation in the ligaments and joints.
In men and women after 40, ankylosing spondylitis in the later stages is manifested by ossification of the intervertebral discs. This is due to the fact that their joints are fused. A kind of "bridges" between the vertebrae, which are clearly visible on radiographs, begin to form.
All these changes are developing very slowly over the years. A person may be disturbed by periods of exacerbations, which are replaced by remissions.
Very often, an inflammation of the joints of the sacrum, known as sacroileitis, becomes an alarming signal. This condition is characterized by pain localized in the depths of the buttocks, which periodically spreads to the upper femoral part and inguinal region. Often this symptom is perceived as a sign of a hernia, inflammation of the sciatic nerve, or radiculitis.
The advanced stage is accompanied by changes in the internal organs and eyes. According to statistics, they occur in 30% of cases.
Cases of disease in women
This topic needs special attention. The fact is that women are more likely to encounter this pathology, but they can tolerate it more easily than men. There are six characteristic features that manifest the disease in patients:
- Ankylosing spondylitis often begins to develop during pregnancy - during an increased load on the body.
- It is accompanied by the occurrence of multiple polyarthritis, which is characterized by lesions of large joints.
- In women, remissions are very long - lasting from 5 to 10 years.
- The disease is extremely rarely accompanied by immobilization of the joints. But in men, the limitation of free movements is observed much more often.
- The sacrum becomes inflamed on one side only. In men, from both. As a result, the process involves the costal vertebral joints.
- In women, the pathology may be accompanied by the development of aortic valve insufficiency, which causes dizziness, rapid heartbeat, pulsations in the neck and head. In men, another consequence is observed - inflammation of the sacroiliac joints.
What is the forecast? Symptoms of ankylosing spondylitis in women are not as diverse and severe as in men. And therefore, they are much less likely to experience serious conditions. If pathology develops, then mobility is lost only to the elderly, even senile age - and then, rarely. Men can lose mobility by the age of fifty.
Diagnostics
It begins with a consultation by a neurologist and orthopedist. An X-ray ankylosing spondylitis, as well as CT and MRI of the spine, are required to be identified.
It is important to pass a general blood test, in which, in case of a disease, an increased erythrocyte sedimentation rate is detected. If the case is in doubt, then the patient may be referred for a procedure to identify the notorious HLA-B27 antigen.
In men and women after 40, ankylosing spondylitis may be similar in symptoms to other ailments, and therefore, as part of the diagnosis, it must be differentiated from pathologies of a degenerative nature. This refers to osteochondrosis and spondylosis.
After this, the form of the disease is determined, for which additional studies can be prescribed.
Disability
It is impossible to recover completely from this disease. But if a person seeks help in time, the doctor will prescribe him competent treatment, with which it will be possible to slow down the development of pathology.
A logical question arises: is disability formed with ankylosing spondylitis? Yes, but subject to the following conditions:
- The disease progresses rapidly.
- Relapses are fixed, remissions between them do not last long.
- Acute seizures occur regularly, and are characterized by an average duration. This affects other organs, which stimulates the development of other diseases.
- The functionality of the joints of the shoulders or the hip area is impaired.
Disability of the following categories can be issued:
- The third group. If the patient loses the opportunity to work in their profession. It is also formed if the disease develops in slow motion with short, rare relapses. In general, a violation of the functional skeleton of the initial stage is already an occasion for the third group. The patient receives more accurate information on an individual basis.
- The second group. It is made out if a person cannot fully and stably work in his profession. An exception is manual labor. The second group takes shape if the pathology progresses actively, and relapses last a long time. Skeletal abnormalities are assessed by a 2-3 degree, a negative effect on internal organs is revealed.
- The first group. It is issued to patients in whom disorders of the musculoskeletal system have already reached extremely severe or irreversible consequences. Such people are confined to their ailment either in a wheelchair or in bed.
The group is appointed by a panel of doctors performing a full assessment of the patient’s health status. It includes a therapist, neurologist, vertebrologist, traumatologist and other specialists whose knowledge can help diagnose all disorders observed in the human body.
Anti-inflammatory therapy
The causes and symptoms of ankylosing spondylitis have been described above. Treatment should also be mentioned. Of course, the therapy is complex and lengthy, it is prescribed by the doctor individually.
It is mandatory to carry out anti-inflammatory therapy, which is aimed at stopping the destructive processes running in the joints. Nonsteroidal drugs help to eliminate pain, ease the period of exacerbation and further prolong remission.
However, prolonged use of NSAIDs is fraught with serious consequences. Studies have shown that their harm in many ways exceeds the benefit. But because now tablets are not prescribed - they prescribe the use of suppositories and injections. Nonsteroidal drugs must be injected directly into the focus of inflammation. So injections are placed in the area of affected tissues of the joints. They are painful, but very effective.
"Methotrexate": instructions for use and price
As already noted earlier, the doctor always prescribes therapy individually. But there are especially common drugs, the action of which needs to be discussed separately. "Methotrexate" is one of those.
This is a folic acid antagonist, which, by stimulating the synthesis of adenosine, has an effect on immune and inflammatory reactions, destroying cells that provoke these processes. It is considered an effective antitumor drug and cytostatic, also having an immunosuppressive effect.
How much is the injection? From 350-360 rubles, its price starts. Instructions for use "Methotrexate" is not universal - the dosage varies from 6.5 to 26 mg, depending on the condition of the disease and the degree of neglect. They begin, as a rule, with a minimum dose, after a while (2-3 weeks) increasing it.
The doctor puts an injection once a week. In some cases, a fractional dose may be prescribed - one dose is divided into 2-3 times with an interval of 12 hours.
Relief of symptoms is observed 5-6 weeks after the start of therapy. The maximum effect manifests itself after six months.
Leflunomide
Instructions for use of this drug should also be studied. Because this tool is considered almost the only drug on the market, the safety and effectiveness of which is confirmed from the perspective of evidence-based medicine. However, it is available in tablet form.
The instructions for use of "Leflunomide" describes in detail the effect that this tool has on the human body. Using it, you can achieve anti-inflammatory, antiproliferative and immunomodulating effects.
It is forbidden to drink these tablets to people with immunodeficiency, liver pathologies, anemia, thrombocytopenia, hematopoiesis, leukopenia, renal failure, hypoproteinemia, as well as pregnant and lactating women. The prognosis of ankylosing spondylitis in such patients will be unpleasant if they neglect the instructions.
How is the drug taken? The tablets are swallowed with clean still water. Treatment begins with a dosage of 10 mg at a time. The next day, everything repeats - the doctor simultaneously monitors the patient's condition, can adjust the timing and dosage. Based on the reaction of the body, further long-term treatment with the drug is prescribed.
Prednisolone
The third drug that deserves attention. It is used to treat chronic infectious or inflammatory diseases characterized by severe course, severe pain and swelling.
How to take "Prednisone" with ankylosing spondylitis? Given that it is available not only in the form of tablets, but also in the form of a solution for injection, intraarticular injections are preferred.
Contraindications are pregnancy, infectious diseases, periarticular osteoporosis, arthroplasty, pathological bleeding and the presence of an inflammatory process of bacterial origin in the joint.
The drug is quickly absorbed, but because the effect comes quickly. "Prednisolone" has anti-toxic, anti-inflammatory, anti-allergic, anti-shock and anti-exudative effects.
Other recommendations
Well, the above was briefly described about a serious and, fortunately, rather rare disease. Finally, it is worth considering the clinical recommendations not mentioned earlier that help to cope with ankylosing spondylitis. You can select them in the following list:
- Therapy necessarily includes the use of antimicrobial agents. Most often this is Sulfasalazine.
- Corticosteroids are prescribed if NSAID injections are ineffective.
- As a prophylaxis, compresses with Dimexidum should be applied.
- Physiotherapy should not be neglected - this is massage, therapeutic baths, mud therapy and exposure to cold.
And, of course, moderate physical activity is welcome. It is best to make a choice in favor of physiotherapy exercises (the program is individually selected by the doctor) or the pool.
It must be remembered: timely treatment initiated by a specialist can slow down the development of the disease. And this means that the patient will be able to lead a full life to old age.