Ankylosing spondylitis

The international name for ankylosing spondylitis is ankylosing spondylitis. The disease is an inflammation of the intervertebral joints, which leads to their ankylosis (fusion), due to which the spine appears as if in a hard case that restricts movement. The number of patients is 0.5-2% in different countries. Young men are mainly subject, more often 15-30 years. The ratio of men and women is 9: 1. It occurs at a young age, more often in men, in women it proceeds much easier. Mainly affects the spine and sacroiliac joints, large joints of the lower extremities. May affect iris (Iritis). It is not necessary that in one patient all the listed localizations of inflammation take place, a very different combination of inflammatory symptoms occurs.

The causes of ankylosing spondylitis are genetically determined (a specific feature of the immune system is inherited). It is the presence of chronic infections (mainly intestines and urinary tract). Intestinal, genital infections, stresses and injuries of the musculoskeletal system usually act as a provoking factor.

Today it is believed that the disease occurs due to improper functioning of the immune system. In this regard, ankylosing spondylitis is called an autoimmune disease (autos - from the Greek root "self"). In the sacroiliac joints there is a particularly high concentration of TNF-a, which is located in the immediate epicenter of the disease and plays a central role. It can be largely considered the culprit of the fact that the spine, due to the chronic inflammatory process, becomes stiff and inoperable. As a result, there is no effective treatment for Bechterew's disease. It is impossible to completely cure it, but with the help of various medications, physiotherapy exercises and physiotherapeutic procedures, you can stop the development of the disease and significantly improve the quality of life of the patient.

Diagnosis of ankylosing spondylitis is often also associated with certain problems. Ankylosis of the joints, which indicates this disease, can be distinguished on radiographs only when the disease has reached the second stage. At the first stage, Bechterew's disease can be ascertained using magnetic resonance imaging, which, unfortunately, is rarely performed.

In advanced forms, the diagnosis does not cause difficulties. But the main problem of people suffering from ankylosing spondylitis, it is a late diagnosis. Therefore, we will focus on the manifestations of the disease and on distinguishing it from others in the early stages.

What is worth paying attention to?

• Stiffness, pain in the sacroiliac region, which may give to the buttocks, lower limbs, intensify in the second half of the night.
• Persistent pain in the heel bones in young people.
• Pain and stiffness in the thoracic spine.
• Elevated ESR in the blood test up to 30-40 mm per hour and above.

If these symptoms persist for longer than three months, an immediate rheumatologist consultation is necessary!

The disease does not always begin with the spinal column, it can also begin with the joints of the arms and legs (resembling rheumatoid arthritis), with inflammatory eye disease, with aortic or heart lesions. Sometimes there is a slow progression, when the pain is almost not expressed, the disease is detected by chance during X-ray examination.

Over time, the restriction of mobility of the spine increases, the inclinations to the side, forward, backward are difficult and painful, and the spine is shortened. Deep breathing, coughing, sneezing can also cause pain. Peace and stillness increase pain and stiffness, and movement and moderate physical activity reduce it. If untreated, the immobility of the spine can occur, the patient acquires the "suppliant" position (arms bent at the elbows, back splayed, head bent, legs slightly bent at the knees).

The insidiousness of ankylosing spondylitis is that without proper treatment and regular exercise therapy, the patient gradually fixes all the joints, and he is bedridden. In addition, ankylosing spondylitis has a number of associated diseases. Most often the eyes become inflamed, due to movement restrictions in the chest, pulmonary tuberculosis develops, frequent use of potent drugs leads to peptic ulcer. However, despite all this, patients with ankylosing spondylitis are, for the most part, strong-willed and cheerful people. They become so, even if they were not optimistic before the illness. Bechterew's disease causes a person to gather his will into a fist, to exercise regularly, to appreciate every day in which he can be a full-fledged member of society.

How and from what diseases should Bechterew's disease be distinguished?

First of all, it is necessary to distinguish from degenerative diseases of the spine (DZP) - OSTEOCHONDROSIS, SPONDYLOSIS. The knowledge of the following will help the diagnosis:

1. Bechterew's disease mainly develops in young men, and the DZP, despite the tendency to "rejuvenate" them lately, still predominantly occur after 35-40 years.
2. In ankylosing spondylitis, the pain is aggravated at rest or with a long stay in the same posture, especially in the second half of the night. When DGP, on the contrary, pain occurs or increases after exercise at the end of the working day.
3. One of the earliest signs of ankylosing spondylitis is tension in the back muscles, their gradual atrophy and stiffness of the spine. In DGD, movement restriction occurs at the height of pain and development of sciatica, when pain is relieved, spinal mobility is restored.
4. Early radiologic changes characteristic of ankylosing spondylitis in the sacroiliac joints of the spine are not found in case of DGP.
5. In ankylosing spondylitis, there is often an increase in ESR in the blood test, other positive biochemical signs of the activity of the process, which is not the case with DGP.

Often, lesions of peripheral joints appear before lesions of the spine, so it is necessary to distinguish the initial form of ankylosing spondylitis also from rheumatoid arthritis. Here you need to remember:

1. RA more often women suffer (75% of cases).
2. Symmetric damage to the joints (mainly the joints of the hand) is characteristic of RA, which is rarely seen in ankylosing spondylitis.
3. Sacroiliitis (inflammation of the sacroiliac joints), the defeat of the sternoclavicular and sterno-cerebral joints are extremely rare in RA, and for Bechterew's disease is very characteristic.
4. Rheumatoid factor in serum is found in 80% of patients with RA, and only in 3-15% of patients with Bechterew's disease.
5. Subcutaneous rheumatoid nodules occurring in RA in 25% of cases do not occur in ankylosing spondylitis.
6. HLA-27 (a specific antigen found in blood tests) is characteristic only for ankylosing spondylitis.

How to treat ankylosing spondylitis?

Modern medicine uses three main methods of treatment of ankylosing spondylitis. It is a suppression of the immune system, which presumably provokes the disease. This hormone therapy is the introduction of artificially synthesized hormones of corticosteroids that fight the inflammatory process in the joints. And physiotherapy, used in combination with drugs.

Treatment should be complex, long-term, staged (hospital - sanatorium - clinic). Non-steroidal anti-inflammatory drugs are used, glucocorticoids, in case of severe course of immunosuppressants. Physiotherapy, manual therapy, therapeutic gymnastics are widely used. Therapeutic exercises should be held twice a day for 30 minutes, the doctor selects the exercises individually. In addition, you need to learn muscle relaxation. In order to slow down the development of immobility of the chest, deep breathing is recommended. In the initial stage it is important to prevent the development of vicious postures of the spine (posture proud, posture of the applicant). Showing skiing and swimming, strengthening the muscles of the back and buttocks. The bed should be hard, the pillow should be removed.

The disease is progressive, but with proper therapy you can withstand it. The main task is to delay the development of the disease, to prevent it from progressing. Therefore, it is necessary to undergo regular examinations of a rheumatologist, and during exacerbations go to the hospital. The goal is pain relief and the development of stiffness of the spine.

Of course, ankylosing spondylitis is a very serious disease, and the purpose of the article is in no way a call for self-treatment. Knowledge should only be directed to the attention to their own health and help to avoid the terrible consequences of this disease.

Causes of ankylosing spondylitis

The causes of ankylosing spondylitis (ankylosing spondylitis) science has not yet been precisely determined. However, scientists have derived a relationship between this disease and the presence of human antigen HLA B27. This does not mean that the presence of this antigen sooner or later leads to the development of the disease, but indicates a genetic predisposition. There is a theory that the HLA B27 antigen imparts the similarity of the articular tissues of people who carry the gene to certain types of infections. When a gene carrier picks up any infection, the body's immune system produces antibodies to fight it. Antibodies destroy the infection brought from the outside, after which the joints are "attacked", taking them for an infection. However, this is one of the hypotheses.

It is only known for certain that the HLA B27 antigen is present in all those with Bechterew's disease. But not all carriers of this gene are sure to get Bechterew's disease. There is a specific mechanism that triggers a disease program. It can be an infectious disease, even a banal cold suffered on the feet. Accidental injury or constant stress can lead to the development of ankylosing spondylitis.

Oddly enough, practically no one is studying the disease of ankylosing spondylitis and its causes in the world. A few studies rarely provide new knowledge about the disease. From recent studies, we can recall only experiments conducted on mice, which showed that a disease similar to ankylosing spondylitis, these rodents occur when a combination of three factors: the presence of HLA B27 antigen, infection from the outside and the presence of T-lymphocytes in the blood. If the mouse was kept under sterile conditions, or the thymus was removed, then the organ responsible for the production of T-lymphocytes did not develop the disease.

Due to the fact that the mechanism of the development of ankylosing spondylitis has not been studied, it is difficult to talk about any kind of prevention. It is obvious that people who carry the HLA B27 antigen should take a closer look at their health, avoid traumatic situations, and treat infectious diseases in time. People who already have ankylosing spondylitis, can only prevent complications and inhibit the development of spondyloarthritis by continuous therapy, physical therapy, sanatorium-and-spa treatment.

Joint pain is a symptom of ankylosing spondylitis

Ankylosing spondylitis (ankylosing spondylitis) does not develop asymptomatically, but the first manifestations of this disease are often missed not only by doctors, but also by patients. The first and most common symptoms are pain in the sacrum, which is often mistaken for sciatica, a constant feeling of tiredness and pain in the joints. More specific is the so-called "morning" syndrome, when, after waking up after a night's sleep, a person cannot move his limbs for some time. Immobility in the joints usually goes away after half an hour.

Joint pains are characteristic of many diseases, but ankylosing spondyloarthritis is distinguished by the fact that in this case pain is not eliminated by rest for the joint. On the contrary, exercise can bring relief.

Ankylosing spondylitis can occur in three forms: central, rhizomelic and peripheral. In the first two forms of symptoms are pain in the spine, developing stoop, inability to straighten yourself. When the peripheral form of the disease begins with the defeat of the knee and ankle joints. Swollen knee joints - one of the reasons to suspect the disease.

Night pain is another symptom of the disease. Usually they are intensified closer to the morning. In the afternoon, in the afternoon, they can almost completely disappear.

About ankylosing spondylitis can indicate symptoms not only from the joints, but also other organs and body systems. A frequent concomitant symptom is inflammation in the organs of vision. In patients with ankylosing spondylitis, there are problems with the respiratory organs due to the violation of the shape of the chest.

As the disease develops, a change in the patient’s posture occurs due to the disappearance of the physiological curves of the spine. The loin becomes unnaturally straight, a person loses the ability to sag not only forward and backward, but also to the sides (this feature helps doctors distinguish patients with Bechterew's disease from patients with severe osteochondrosis). Further, the root joints are affected - the hip and shoulder joints. Usually the disease "goes" from the bottom up, so the vertebrae of the cervical spine are affected and lose their mobility.

Inflammatory processes in the joints are often accompanied by a slight increase in temperature and increased ESR in the blood.

Diagnosis of ankylosing spondylitis

Diagnostic signs of ankylosing spondylitis:

On the recommendation of the Institute of Rheumatology RAMS, 1997

• Pain in the lumbar region, not at rest, relieved by movement and lasting more than 3 months;
• Restriction of mobility in the lumbar spine in the sagittal and frontal planes;
• Restriction of the respiratory excursion of the chest relative to normal values ​​according to age and sex;
• Bilateral sacroiliitis II-IV stage. The diagnosis is considered reliable if the patient has a fourth symptom in combination with any other of the first three.

The diagnosis of ankylosing spondylitis (ankylosing spondylitis) is often made only when the disease has already turned into neglected or severe forms. This is partly due to the low level of knowledge of the disease, and partly to the generality of its first symptoms. Doctors often confuse ankylosing spondylitis with other diseases of the joints, early signs are often attributed to osteochondrosis.

If you suspect ankylosing spondylitis necessarily carried out X-ray examination. This method of diagnosis is still the most common and is considered the most reliable. The patient is taken a picture of the pelvic region. Changes in the sacroiliac joints for the doctor - a reason to suspect ankylosing spondylitis. At the first stage of the disease, the picture will show a widening of the joint space, lack of clarity of the contours of the joints. In the second stage, single erosions of the articular tissue will be visible in the picture. On the third - partial ankylosis (fixation) of the sacroiliac joints. The fourth stage is a pronounced complete ankylosis.

However, changes in the joints in the early stages of the disease are not always visible on radiographs. A more sensitive method in this regard is magnetic resonance imaging. Unfortunately, there are few such devices in the cities of Russia, and such studies are extremely rare.

If you suspect an ankylosing spondylitis, a study is conducted on the presence of human antigen HLA B27, since its presence indicates a hereditary susceptibility to ankylosing spondylitis. This antigen is usually detected in 80-90 percent of patients.

An additional sign of the presence of the disease may be increased ESR. But this diagnostic method can be used only in combination with others, since a high indicator of ESR says only that the body has an inflammatory process. Not necessarily, this process goes exactly in the joints, as in ankylosing spondylitis. For ankylosing spondylitis is characterized by an indicator of ESR 30-60 mm / h.

The doctor makes a diagnosis of ankylosing spondyloarthritis on the basis of X-ray data and clinical manifestations - persistent back pain that lasts at least three months, the presence of morning immobility syndrome, which disappears after exercise, restriction of mobility in the lower spine, age-related restriction of respiratory excursion.

Treatment of ankylosing spondylitis

Treatment: physiotherapy, sports, physiotherapy to avoid incorrect positions or stiffness of the spine and joints. You should maintain the correct posture - it will not allow the spine to lock in an undesirable position. It should sit straight, with a maximum extension in the lumbar spine. Sleep on a flat surface and not too soft bed, and in the early stages - without a pillow and a cushion under the head, so as not to strengthen the cervical lordosis, or on the stomach without a pillow. In more advanced stages, if you sleep on your back, use a thin pillow or put a cushion under your neck, trying to keep your legs straight in a dream. In the advanced stage of the disease, running, contact sports, static load on the spine are contraindicated, but swimming is useful.

New targeted medications neutralize negatively acting mediators, thus stopping the inflammatory chain reaction. These drugs are perceived by the patient as natural protein substances, and on their basis belong to a group of drugs called "biological agents". The emergence of these drugs is the result of intensive biotechnological research, that is, they have nothing to do with homeopathy or alternative treatment methods. Their second name is "TNF-a blocker", and one of them is infliximab or Remicade.

Infliximab (Remicade) has proven itself in treating patients suffering from ankylosing spondylitis. Therefore, since 1999/2000, this drug has been approved for use as a therapeutic agent. This drug blocks precisely those pathological mechanisms that cause the inflammatory process and contribute to its further development, without affecting other important protective processes in the body. Therefore, an effect is achieved that could not or rarely could be achieved with the help of the available drugs: effectively preventing the further development of inflammation and thereby preserving the mobility of the spine and joints.

According to experts, the effective suppression of the inflammatory process with the help of the drug infliximab (Remicade) can presumably prevent the fearful ankylosis of the spine, which occurs in ankylosing spondylitis.

In most cases, non-steroidal anti-inflammatory drugs have to be used: delagil, plaquenil, or sulfosalazine (the doctor selects the dosage).

In addition to drug therapy, the patient should be provided with: adequate sleep in the correct position, emotional comfort, optimal motor activity, the absence of foci of chronic infection, regular physical education classes, Annual spa treatment. Useful dosed tempering procedures. Manual therapy can be applied with extreme caution; therapeutic massage (it is better not to massage the sites of tendon attachment).

It is necessary to refrain from physiotherapy during exacerbation.

It should be clarified: Bechterew's disease will remain with the patients forever. But the quality of life and the phase of the disease (remission or exacerbation) depends on the correct treatment.

Physiotherapy

Physiotherapeutic procedures for patients with ankylosing spondylitis are usually used in conjunction with drug therapy, during sanatorium-resort treatment and to prolong periods of remission. The most common physiotherapeutic procedures are magnetic therapy, thermotherapy, and cryotherapy. Doctors disagree about the effectiveness of each of these funds, as, indeed, the patients themselves.

Magnetotherapy has the least complaints. Magnetic field treatment almost always brings at least short-term relief to patients with Bechterew's disease. Due to the fact that many patients find it difficult to go to the clinic for procedures, they often purchase devices for conducting magnetic therapy at home.

Heat treatment is also easy to carry out at home, however, practice shows that in some cases, heating pads or paraffin waxing on sore joints can cause even more inflammation. The bath gives a positive effect, but a hot bath can strengthen the swelling of the joints.

Most disputes are conducted around cryotherapy, that is, treatment with cold. Most likely, this is due to a sharp deterioration in the general condition of the patient, which is almost always observed after a cryotherapy session. Many doctors immediately warn patients that after the first session all joints may become inflamed. But this does not mean that cryotherapy brings only harm. In a number of patients, after a week of taking the procedures, a significant improvement occurred.

During the spa treatment of patients with ankylosing spondylitis, sodium chloride baths are prescribed, which have anti-inflammatory and analgesic effects, as well as bischofit baths.

Massage and manual therapy are also used to treat ankylosing spondylitis when the disease is in remission. Almost all doctors are inclined to believe that massage should not be intense, it can only provoke an inflammatory process. With this opinion argues folk medicine. There are cases when the condition of patients with ankylosing spondylitis significantly improved after a course of hard massage, conducted by traditional healers who are not recognized by official medicine.

From the foregoing it follows that there is no unequivocal opinion on any physiotherapeutic method of treating Bechterew's disease, and the patient has to rely on his own intuition and reactions of his own body when choosing.

Corticosteroids in the treatment of ankylosing spondylitis

Corticosteroid hormones are produced by the human adrenal glands as the body's response to an inflammatory process. For a long time, in 1949, scientists found a way to artificially synthesize these hormones and in high doses to inject the patient to relieve the inflammatory process. Such therapy is widely used for the treatment of patients with ankylosing spondylitis. However, soon it turned out that corticosteroids, removing inflammation in the joints, have a number of negative effects on the body. Like any hormonal means, artificially obtained corticosteroid hormones are addictive, physical and mental. With regular use of corticosteroids, the human body stops producing this hormone itself, the adrenal glands atrophy. Excess weight, the appearance of facial hair, stomach ulcer are not all the negative effects of prolonged use of corticosteroids. Very dangerous for patients with ankylosing spondylitis is osteoporosis, caused by taking corticosteroids. Increased bone fragility leads to fractures, and forced immobility due to gypsum can become fatal for ankylosing spondyloarthritis for patients.

However, despite all the risks, treatment with corticosteroid hormones can give a significant therapeutic effect and improve the patient's condition. Therefore, the question of the justification for the use of corticosteroids in each case should be decided individually. It is necessary to warn in time or at least minimize the harmful effects of the drugs used. For example, drugs in the form of tablets, for example, prednisone, are taken at the same time, drinking plenty of liquids, such as kissel or kefir, to envelop the stomach to reduce the harmful effects on the stomach. If hormones are administered by injection, the patient should focus on the prevention of osteoporosis, that is, spend more time on physical therapy. While moving, more calcium enters the bones, strengthening them.

If the inflammation is concentrated in a single joint, local infusions of drugs containing corticosteroids are often used. For example, depomedrol or kenaloga. These injections are usually one-off; they provide temporary but significant relief. In addition, a single injection of the drug does not cause side effects.

Forecast

Modern medicine offers ways if not cured, then at least delay the development of the disease with the help of various medications. Many of them have serious side effects, and some patients prefer to resort to traditional medicine: herbs, massages, a bath.

The course of the disease is accompanied by a change in the inflammatory and remission phases. During remission, the patient is greatly relieved, but official statistics do not know cases of complete recovery.

Treatment of ankylosing spondylitis with stem cells

Ankylosing spondylitis - a disease associated with inflammation of the joints of the axial skeleton (intervertebral, costal-vertebral, sacroiliac) and the involvement of internal organs (heart, aorta, kidney) in the process.

Ankylosing spondylitis has a tendency to a chronic progressive course. The classic case of neglected inflammation of the spine was Nikolay Ostrovsky: immobility and blindness. On average, about 3 out of a thousand people in Russia suffer from Bechterew's disease.

Ankylosing spondylitis develops as a result of hidden infections in people who have a hereditary predisposition and certain genetic characteristics. In ankylosing spondylitis, inflammation initially affects the junction of the sacrum and the iliac bones; then it spreads to the lumbar spine and "crawls" up the entire spine. In the future, the inflammatory process can capture any joints of the body - from hip to finger joints.

Inflammation of the joints in ankylosing spondylitis in many cases can be easily suppressed with the help of drugs. It is much worse that in case of ankylosing spondylitis, the "ossification" of the ligaments of the spine, its intervertebral joints and discs occurs. There is a gradual process of "fusion" of the vertebrae among themselves, the spine loses its flexibility and mobility.

Symptoms of ankylosing spondylitis, at first, can very much resemble the symptoms of osteochondrosis. The patient complains of pain in the lumbar region. Later, swelling and soreness of one or several joints are added to the lumbar pains, pronounced morning stiffness of the waist, which disappears before dinner.

Ankylosing spondylitis most often begins at a young patient age, in 20-30 years. Half of the patients already at the very beginning of the disease can detect inflammation of the eyes (their redness and feeling of "sand in the eyes"), increased body temperature and weight loss.

But the main symptom of ankylosing spondylitis is the increasing stiffness of the spine and restriction of the mobility of the chest during respiratory movements. A sick person moves as if a stick is inserted in place of his spinal column — the patient has to bend and turn with his whole body.

Ankylosing spondylitis is dangerous not only because it eventually immobilizes the entire spine and joints, but also by its complications. Of these complications, the greatest danger is damage to the heart and aorta, which occurs in 20% of patients and manifests as shortness of breath, pain behind the sternum and interruptions in the work of the heart. A third of patients develop amyloidosis, a renal degeneration leading to chronic renal failure. Decreased mobility of the chest contributes to lung disease.

The first and most important rule - treatment of ankylosing spondylitis with stem cells should be started at the onset of its first symptoms, while the "ossification" of the entire spine and inflamed joints has not yet occurred.

The effect of the introduced stem cells for the treatment of ankylosing spondylitis is aimed at stopping the "ossification" of the ligaments of the spine, its intervertebral joints and discs. And also to prevent the process of "fusion" of the vertebrae among themselves, restoring its flexibility and mobility.

After treatment of ankylosing spondylitis with stem cells, the range of movements in the joints and the spine significantly increases, pain decreases, and timely treatment with stem cells helps to avoid damage to the heart and aorta, kidneys and lungs.

It should be noted that in conjunction with the treatment of ankylosing spondylitis with stem cells, therapeutic gymnastics occupies an important place. In case of ankylosing spondylitis, various inclinations, body turns in all directions, rotation of joints, etc. are used in full. Such energetic and high-amplitude movements should prevent the fusion of the vertebrae and the "ossification" of the ligaments of the spine.

It is necessary to engage in daily for at least 30-40 minutes. And it is advisable not to miss a single day! The patient must understand that every lost day gives a disease irrevocably a particle of the joint or a tiny piece of the spine, which is ossifying and will never regain its mobility!

According to reviews of the treatment of ankylosing spondylitis with stem cells, improvement is observed only in half of the cases and only at the initial stage of the disease.