Ankylosing spondylitis (ankylosing spondylitis) is
rheumatic chronic systemic inflammation of the joints,
predominantly spinal, with a sharp restriction of mobility
patient, forming on the articular surfaces of the marginal bone
growths and ossification of ligaments. First symptoms of the disease
were described in detail in 1892 by the Russian academician V.M.
Bekhterev. By фамилии исследователя патология и получила
What is ankylosing spondylitis, what causes and symptoms, as well as
why it is important to start treatment on time to prevent irreversible
processes in the body, we will look further into the article.
Ankylosing spondylitis: what is it?
Ankylosing spondylitis — это системное хроническое
inflammatory disease of the joints and spine, referring to
a group of seronegative polyarthritis. This disease
predominantly exposed men ages fifteen to
thirty years, and their number exceeds the number of women
five to ten times.
The mechanics of ankylosing spondylitis is that the inflammatory
the process affects the spinal joints, large ones (and in some
cases and small joints of the limbs, joints of the sacrum with
ileal pelvic bone, which leads to complete immobility
the patient. Byмимо костно-суставной системы патология развивается во
internal organs – kidney, heart, iris. Combinations of these
lesions may be different.
- The disease causes moderate to moderately severe pain,
localized in the area of the femur and back, especially by
in the morning
- Movement during the day can reduce
- The first signs of ankylosing spondylitis appear in adolescence or
after 30 years.
- By мере прогрессирования заболевания симптомы нарастают. AT
more ankylosing spondylitis affects men.
In about 5% of cases, the disease begins to appear even in
childhood. In children, the disease begins to affect the knee and
hip joints, five, big toes. Byзже заболевание
already affects the spine.
|Forms of ankylosing spondylitis|
|Form name||What tissues are affected?|
||Byзвоночник, плечевые и тазобедренные суставы|
||Byзвоночник, коленные суставы, суставы стоп|
||Byзвоночник, мелкие суставы стоп и кистей.Эту форму часто
take for another disease – rheumatoid arthritis.
- Начальная стадия характеризуется незначительным нарушением
mobility of affected joints. With radiological
research signs of Bakhterev’s disease may be absent.
- Moderate stage, signs of which may be partial
ankylosing of the affected joint and narrowing of its gap. AT клинике
growing symptoms of arthropathy.
- Byздняя стадия — развитие необратимого анкилоза и
accumulation of mineral salts in the bundles, which manifests itself as complete
lack of movement in the joint.
The development of ankylosing spondylitis contribute to the violation of normal
работы иммунной системы организма, когда лейкоциты начинают
destroy cartilage tissue, taking it for a foreign one. Byгибая,
white blood cells cause inflammation. Macrophages
rush to the hearth inflammation activates protective resources
an organism that seeks to repair damaged cartilage
tissue, replacing it with bone.
AT результате наступает анкилоз – сращивание суставов с полной
loss of mobility.
Immune cells in ankylosing spondylitis attack not only
spine. Large joints may suffer. More common disease
affects the joints of the lower limbs. AT ряде случаев воспалительный
the process develops in the heart, lungs, kidneys and urinary
- Heredity. Sometimes there are cases of “family
diseases “, when ankylosing spondylitis is diagnosed immediately in 2-3
family members. Also, a special HLA gene is detected in 90% of patients.
AT27. In healthy people, it is found only in 7% of cases.
- Infectious diseases. The role of this factor is not definitively
installed. There is some connection between Bechterew’s disease and
наличием мочеполовой, кишечной или стрептококковой инфекции в
- Immune disorders. Byвышение уровня некоторых имуноглобулинов
(IgG, IgM, IgA) and immune complexes.
The main age of the diseased is 15 – 40 years, 8.5% are sick in 10 –
15 years of age, and among persons after 50 years the onset of the disease
extremely rare. Men with ankylosing spondylitis sick in 5 – 9
times more often, but some authors talk about 15% of women among all
Symptoms of ankylosing spondylitis in adults
Each stage of ankylosing spondylitis is accompanied by a characteristic
symptomatology. The danger of the disease lies in the difficulty
early diagnosis because similar symptoms
accompany other degenerative pathologies of the spine
(osteochondrosis, spondylosis), rheumatoid arthritis. Often the patient
learns about the terrible diagnosis already with the existing stiffness
The main symptoms of ankylosing spondylitis relate:
- increased fatigue;
- limited spinal mobility;
- stiffness in the place of articulation of the sacrum with the ileum
- sleep disturbances during morning hours caused by pain
- back pain and hip joint pain;
- difficulty breathing caused by damage to the sternoclavicular
- бурситы и артриты;
- spinal curvature and standing posture in
vertical position, characterized by the slope of the upper part
- complete immobility (in later stages
ATо время болезни Бехтерева отмечается тупая затяжная боль,
arising in the lumbosacral region. At the beginning
Stages in patients with crises, after a while
the duration increases and as a result they stretch
for a few days. Toward the morning the pains become sharper
the strength of their manifestation can be described as “inflammatory rhythm
Первая стадия заболевания характеризуется появлением
the following symptoms:
- Stiffness in the spinal column that develops after
Awakening and long stay in the same pose that passes
после выполнения гимнастических exercise;
- Pain and discomfort in the sacrum, thigh
- Pain in the thoracic region in a circle, aggravated by coughing,
- Lack of air, pressure in the chest;
- Rapid fatigue, decreased performance.
In the late stage of ankylosing spondylitis occur:
- Byявляются признаки, свойственные радикулиту. Byявляются
unbearable pain, tingling of the spine and numbness
- Blood supply to the brain decreases.
- Suffocation. Such attacks occur due to the reduction in the possibility
chest movement. This implies that the heart, lungs and
other large vessels are compressed;
- Byвышенное артериальное давление.
- Spine change. Due to the fact that the ligaments and joints
the spine become stiff, there is a decrease in its mobility.
The disease is manifested not only by problems
musculoskeletal system, but also symptoms of lesions of others
organs: quite often the iris of the eye is affected (develops
iridocyclitis), heart (pericarditis), breathing is impaired due to
The difference between osteochondrosis and ankylosing spondylitis
Signs on which the patient with ankylosing spondylitis can
Unmistakably distinguished from a person suffering from osteochondrosis:
|Without taking your feet off the floor and standing on straight legs, most
cases can be deep enough to bend sideways – to the left or
to the right.
|Without taking your feet off the floor, it will not be able to bend far sideways, so
as the lower back flexion in this disease is impaired in all
|The intake of nonsteroidal anti-inflammatory drugs gives
the required effect is very rare
|At the initial stage of the development of ankylosing spondylitis, the use of
nonsteroidal anti-inflammatory drugs in the required
adequate dosage, almost always immediately (in the first hours after
reception) gives albeit temporary, but powerful anesthetic
Signs of ankylosing spondylitis in women and men
Negative processes in muscles, vertebrae, cartilage worsen the external
kind of disturbing posture:
- the patient is constantly slouching;
- body tilted forward;
- the shoulder joint is slightly deployed, the legs and arms are half bent,
- a person cannot actively move, is disturbed
AT таблице, мы привели сравнительную характеристику болезни
Ankylosing spondylitis in women and men.
|Byказатели||in men||among women|
|nature of onset||often acute forms with severe symptoms||start gradual with minimal amount and weak
severity of symptoms
|duration between relapses||
|time from onset to typical
|main localization option||
|preferential localization of processes in the spine||all departments, which leads to ankylosis of the entire spine, loss
physiological and the appearance of pathological curvature
|mainly sacral and lumbar; arise late (after
50 – 60 years), do not lead to pronounced changes
|damage to the vessels, aorta, lungs, heart, kidneys and liver
the development of liver and kidney failure
There is no strict scheme for the development of the disease. Byявление различного
sort of complications individually. However, in most patients
The following associated disease phenomena are observed:
- lesions of the heart and aorta. By статистике такие сопутствующие
diseases that are characterized by shortness of breath, pain for
sternum, interruptions in cardiac activity.
- About a third of patients suffer from amyloidosis. For this
заболевания is characteristic перерождение почек, следствием которого
is renal failure.
- ATвиду низкой подвижности грудной клетки часто у больных может
develop pneumonia and tuberculosis.
To avoid the mentioned complications, you should be on time
diagnose the disease and take action on it cure.
Diagnosis and treatment of ankylosing spondyloarthritis
Specialists are engaged in:
- Vertebrologist – a doctor specializing in diseases
The main activities that are provided in the framework of the diagnosis
болезни Бехтерева, включают предварительный осмотр в
combination with the study of the patient’s medical history and results
- Patients are often prescribed x-ray examination.
spine, CT and MRI.
- Often requires a complete blood count to identify
increase in ESR.
- If the clinical picture is unclear, the specialist may refer
patient to undergo additional analysis to detect
the presence of antigen HLA-B27.
Treatment of ankylosing spondylitis
Ankylosing spondylitis is a chronic disease that
lasts for a long time. In fact it
incurably. The process can not be stopped, but it can be significantly
to slow down If treatment is started early, the patient is clearly
fulfills the recommendations of the doctor – it is possible to avoid complications, save
well-being, normal activity and performance in
Treatment of ankylosing spondylitis подразумевает выполнение целого
complex therapeutic measures that are unique
The goal is to stop the ankylosing process:
- When the acute period subsides, the patient is shown to perform physical therapy,
useful to ski, engage in the pool.
- Balneological procedures have an effect.
- Phonophoresis is performed with hormonal drugs, effective
paraffin therapy, ultrasound treatment.
- It is important that the patient looks after his posture, sleeps on a flat and
- Static loads are prohibited during the active stage of treatment.
on the spine, as well as running and performing other heavy
Non-steroid medications are used as drug therapy.
anti-inflammatory drugs and corticosteroids to combat
inflammatory process and immunosuppressants for immunocorrection
(suppress aggressive immune response).
The list of drugs that must be taken is selected
individually, but the general quandary is usually this:
- Common drugs against nonsteroid-type inflammation (aspirin,
- Disease-modifying antirheumatic drugs
- Corticosteroid (various hormone capsules – Urbazone,
- TNF inhibitors – drugs that help eliminate
inflammation in the body of the patient.
Organization of a berth
The patient must properly organize your bed.
You should choose a flat and hard mattress. In the initial stages
development of the disease from the pillow should be abandoned. This will allow
avoid the development of cervical lordosis. It is best to sleep on the stomach. By
as the disease progresses, you can put it under your head
roller or thin pillow. Legs should be kept straight.
A large role in the treatment of ankylosing spondylitis plays a way of life and
special exercise. Therapeutic Gymnastics Program
compiled individually. Exercises should be performed.
To prevent the development of vicious poses (posture of the petitioner, posture
proud) patient is recommended to sleep on a hard bed without a pillow
and regularly engage in sports that strengthen the back muscles
(swimming, skiing). To preserve the mobility of the chest
cells need to perform breathing exercises.
Heat, cold, currents, radon and radium are indispensable for ankylosing
spondyloarthritis. Methods of physiotherapy effects
Bechterew’s disease will be selected by a rheumatologist.
- stay in a cold chamber with the subsequent performance
- thermal and mud baths;
- infrared irradiation;
- warm baths before bedtime;
- mud wraps;
- the use of radium isotopes;
- radioactive gas radon.
In ankylosing spondylitis, a back massage is performed, which helps
relieve pain, reduce muscle tension. The patient must undergo
massage courses at least once every six months.
Forecast относительно продолжительности жизни больного и ее
quality depends on several things:
- How early the spine began to stiffen;
- From which articular joint inflammatory has spread
- Whether the joints of the extremities are stiff or stiff;
- Do Bechterew’s disease accompany other pathologies;
- Are there any complications of the work of the pelvic organs?
- Is it difficult for the patient to breathe;
- Does the pain in the individual case of the patient
nonsteroidal anti-inflammatory drugs.
The patient will survive if the result of ankylosing spondylitis is not
disruptions in the functioning of the kidneys or the heart have occurred.
A disappointing prognosis is made in cases where ossify
begin all the joints of the body.
Specific prophylaxis is not developed. For warning
ankylosing spondylitis must adhere to the following
- undergo an annual routine examination at the clinic;
- sanitize foci of chronic infection;
- to avoid traumatic spinal injury;
- normalize physical activity by focusing on
общеукрепляющих видах exercise;
- to correct the condition of the intestinal microflora.