Update: December 2018
When pain occurs in the lumbar region, as a rule,
the reason they assume the presence of osteochondrosis. In most
cases this is confirmed by further surveys. But from any
rules are exceptions.
Symptoms of the disease are very similar to osteochondrosis.
Bechtereva, or, as it is otherwise called, idiopathic
ankylosing spondyloarthritis, that is, resulting in complete
stiffness in the joints of the spine (first).
Most people know little or nothing at all about
this disease. Low public awareness and complexity
diagnostics are the cause of late treatment of patients with
medical care, as well as the cause of low levels of detection
disease at the onset of the first symptoms. it во многом усложняет
What is ankylosing spondylitis
It is a chronic inflammatory disease.
spine and joints. In the large list of prevalence of all
known rheumatic ankylosing diseases
спондилоартрит занимает одно из последних мест. AT
according to data from different sources, its prevalence
ranges from 0.1 to 2% of the total world population. AT России болезнью
Бехтерева страдают около 400 000 человек.
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
When the first pains in the lumbar region appear, the main diagnosis
in medical institutions it is osteochondrosis. Usually takes place in
an average of 4 to 5 years from the onset of the disease to the establishment of the correct
diagnosis. Unfortunately, this is a very long time during which
rough irreversible sclerotic changes have time to form
in the affected areas, resulting in the treatment of ankylosing spondylitis
much more difficult.
Causes and mechanism of the disease
The term “idiopathic” means that the developmental mechanism and the exact
causes of ankylosing spondylitis are not fully established. 96% of persons with this
the disease has detected the presence of an injured gene for the HLA system,
inherited. Intact gene of this system
controls positive and negative reactions in the body
immune system in certain diseases, the degree of immune
answer and so on.
AT силу определенных причин (алкоголизм, наркомания и др.) этот
the gene is damaged and itself becomes an antigen, that is, foreign to
body element. Antigen involved in the development mechanism
disease, named HLA B27. Being on the surface of cells
connective tissue it makes them highly sensitive to
causative agents of infections. HLA B27 is passed to children from parents and
provides a predisposition to ankylosing
For reasons unknown so far, under the influence of some provoking
factors, it forms complexes with healthy cells that
the immune system begins to be perceived as alien and directs
lymphocytes to destroy them. AT результате этого возникает
inflammatory reaction in the affected parts of the body.
The provoking factors are:
- ATоспалительные заболевания мочеполовой системы
- ATозбудители воспалительных процессов в кишечнике и других
organs, in particular – Klebsiella, streptococci
- Pelvic bone fracture
- Various endocrine dysfunction
That is not the only mechanism for
diseases, according to some statistics. For example,
HLA B27 antigen is found in 9% of healthy people, but with careful
examination, 25% of them reveal the hidden course of the disease,
almost not clinically manifest. AT тоже время у 10 – 15%
persons already infected, the antigen is not detected, but they are able to transmit
descendants predisposition to the disease.
Direct evidence of participation in the process of occurrence
diseases of infectious pathogens also not because
The use of antibiotics does not affect its course. However fail
The body’s defense system occurs at the genetic level.
Symptoms of ankylosing spondyloarthritis
Pathological processes occurring in systems and organs during
ankylosing spondylitis, are the cause of the corresponding symptoms.
Major pathological changes in organs and
They arise primarily primarily in small joints.
spine, pubic joint, and also in the joints connecting
sacral vertebrae with ileal bones. Articular surfaces
bones gradually collapse, develop spicy, and then
chronic course of the inflammatory process of the synovial membrane,
продуцирующей внутрисуставную жидкость, снижается
elasticity of the articular capsule. ATпоследствии функциональные ткани
replaced by fibrous, proliferate cartilage cells, which leads to
fusion of articular surfaces with their subsequent germination
bone tissue. The ossification process is exposed and articular
bundles. So there is ankylosis and stiffness of the joints.
The entire spine undergoes similar changes, starting with
disc lesions and joints between the XII thoracic vertebra and I
lumbar. The formation of the edges of the bodies of the vertebral bone
growths, ossification of the ligaments and the fibrous ring of the intervertebral
discs are the cause of complete immobility of the spine, which
acquires a characteristic “bamboo stick”.
AT остальных суставах, особенно в суставах нижних конечностей, на
In the early stages of the disease, intermittent
recurrent inflammatory changes in the synovial membrane. AT
the inflammation further progresses and becomes chronic.
Normal connective tissue is replaced by fibrous, expands
bone tissue that leads to the subsequent development of ankylosis
joints of the limbs and chest.
To extraarticular pathological changes in ankylosing spondylitis
include inflammation of the iris and choroid (in 25%
patients) with the subsequent formation of rough scars and the formation
At 2 – 8% of patients develop atrophy of the inner shell of large
vessels of the upper half of the body and aorta, inflammation
connective tissue of their middle shell with its subsequent replacement
fibrous fibers and the development of aortic valve insufficiency.
These same changes affect the heart, causing disruptions
conducting system with the development of blockades at different levels and
heart rhythm disturbance, flushing or adhesive occurs
pericarditis (formation of effusion fluid and adhesions between the sheets)
ATозможно вовлечение в процесс верхушек легких с образованием
cavities by the type of cavernous tuberculosis, spinal membranes, that
leads to unexpressed arachnoiditis, as well as liver and kidneys with
development of hepatic or renal failure.
The disease in most cases begins unnoticed, and
symptoms are very diverse. It is believed that the onset of the disease in
75% are accompanied by pain in the lumbosacral region, in the joints – in
20%, damage to the eyes – in 5%. But these data differ from different
Различают 5 вариантов начала diseases:
- inflammation occurs in the lumbosacral region and
accompanied by gradually increasing pain, often
combined with pain in the joints;
- predominantly affects one or more asymmetric
joints; inflammation is unstable subacute; phenomena
inflammations in the joints of the lumbosacral region join
later; This option is mainly found in boys;
- in adolescents and children, the onset of the disease is more likely to
rheumatism attack – “volatile” inflammatory processes in individual
large joints in combination with their swelling and redness,
increased body temperature and ESR, an increase in heart rate
contraction; arthritis with symptoms similar to rheumatoid
артритом могут протекать с поражением мелких joints; sacroiliitis
(inflammation of the sacroiliac joints) joins
- the beginning of the type of acute fever: temperature
high, irregular (rises in the morning and decreases in the evening), in
the current of the day fluctuates in 1–2 degrees, accompanied by
increased ESR (see elevated ESR: causes), chills, and abundant
pouring sweat, weight loss; in 2 – 3 weeks appear
pain in many joints and muscle groups; this option is found
- the beginning is extra-articular in nature with significant changes
inflammatory in blood tests; it flows as
endocarditis, pericarditis, myocarditis, inflammation of the internal
оболочки аорты, что может сопровождаться симптомами сердечной
insufficiency or attacks of stenocardia, iritis and iridocyclitis;
симптомы sacroiliitisа или поражения суставов возникают только через
The course of ankylosing spondylitis in women differs from that in
men. The main comparative characteristic is given in
|indicators||symptoms in men||symptoms in women|
|nature of onset||often acute forms with severe symptoms||start gradual with minimal amount and weak
severity of symptoms
|duration between relapses||without treatment – short||is a few years|
|время от начала заболевания до проphenomena типичной
|45 years||10 – 20 years|
|main localization option||peripheral||rhizomyelic|
|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
|is characteristic||rarely and less pronounced|
Forms of the disease
AT зависимости от преимущественной
the localization of the lesion distinguish the following forms of the disease
- Root, or rhizomiellicheskaya (17 – 18%), at which
mainly affects the spine and the largest joints –
shoulder and hip
- Peripheral (20 – 75%) – localization also in the spine,
but in combination with smaller joints (knee, ankle
and small foot joints).
- Central (46.6%) – only the spine (all or some of its
- Scandinavian – a rare form in which they are affected
spine and small joints of the arms and legs. This form is very similar to
The first symptoms suggest the initial stages
- Stiffness and pain in the lumbosacral region
the spine, which gives to the legs and buttocks and increases to
- Pain in young people in the heels.
- Sensation of inactivity and stiffness in the thoracic region
- In the study of clinical blood analysis – ESR up to 30 – 60
mm / hour
Preservation of these clinical symptoms for 3 months
should be a reason for the immediate treatment of the patient to
In order to make a diagnosis by the Institute of Rheumatology of the Russian
Academy of Medical Sciences recommended (1997) to consider
The main signs are:
- Soreness for more than 3 months in the lumbar region,
which does not pass in a calm state, but its intensity
decreases with movement.
- Limited spinal mobility in the anterior, posterior and
- Decreased inhalation and exhalation compared with age and
- Bilateral (II – IV stages) sacroiliitis.
A reliable diagnosis of ankylosing spondylitis is considered to be
if the last symptom is combined with at least one of the three
previous. For greater credibility and refinement of the stage and
disease activity is performed by clinical blood and urine tests,
biochemical analyzes, X-rays, and
magnetic resonance imaging (MRI) and computed tomography (CT) tomography
spine and joints (allow already in the first months to identify
заболевание), исследование, направленное на определение
the presence of the antigen HLA B27, etc.
Treatment of ankylosing spondylitis
The main treatment of ankylosing spondylitis is aimed at reducing and
slowing the ankylosing of the joints. Recommended:
- complexes of physical therapy and gymnastics outside periods
- swimming, skiing
- balneological procedures
- physiotherapy (phonophoresis with hormonal
drugs, ultrasound, paraffin on the joint area)
- maintaining correct posture and body position in bed –
the bed should be flat, firm with a small pillow
- during the extended course of the disease loads are contraindicated
on the spine of a static nature, running, some sports and
heavy gymnastic exercises
Nonsteroidal anti-inflammatory drugs
These drugs are a major component of treating a disease.
Bekhtereva, they are prescribed long courses of one year
continuous reception up to 5 years. When exacerbation is carried out in
maximum dosage, then the patient is transferred to the supporting
regimen (1/4 or 1/3 of the maximum dose).
Of all the NSAIDs are considered the most preferred Ketoprofen.
(Ketonal, Flamaks, Flexen), Diclofenac (Voltaren, Altrofen),
Butodione, indole derivatives (Metindol, indomethacin), and
meloxicam (Movalis, Artrozan, Amelotex); see the full list of NSAIDs in
article shots from back pain, back.
The effect of these drugs for the treatment of ankylosing spondylitis
so great that if the effect of their reception does not occur, then
it makes you doubt the correctness
diagnosis. If the patient has ankylosing spondylitis, then
prolonged use of NSAIDs can significantly slow down
- Salazosulfapyridine (Sulfasalazine) as basic therapy
Used as with rheumatoid arthritis, it has
bactericidal and anti-inflammatory action. Therapeutic effect
it does not occur immediately, but after 2-3 months, 60-70% helps
- With a marked increase in muscle tone are assigned
relaxers central action (Mydocalm, Tolperisone).
- Hormones have anti-inflammatory effects.
glucocorticosteroid series, long-term use of which has its
disadvantages in the form of hormonal dependence,
the formation of steroid ulcers of the digestive tract, development
diabetes and osteoporosis.
- У пациентов с лихорадкой, висцеритами при тяжелым течении
diseases use cytostatics (anticancer drugs,
immunosuppressants – azathioprine, leukeran), corticosteroids
- Basic preparations – Delagil, Plaquenil, Immard, salts of gold,
Kuprenil in ankylosing spondylitis most often little effective and
- Injections are prescribed for the local treatment of the inflamed joint.
corticosteroids in the joint cavity, as well as compresses with
- Cryotherapy with liquid nitrogen has a good effect.
spine, which in 90% of cases leads to relief
the patient. It is also possible to use radiotherapy, which
has a direct anti-inflammatory effect on affected tissue
- Hirudotherapy is an ancient way treat all diseases and in
as an adjuvant therapy for ankylosing spondyloarthritis
It is possible to use medical leeches, they increase immunity and
оказывают противовоспалительное act.
- Back massage is useful for treating the spinal column in case of illness.
Bekhtereva, and for the whole body. But remember that any
massage, warming, therapeutic mud can be used only when
relative remission of the disease when blood tests are normal, no
inflammatory processes in the body, otherwise the effect will be
opposite with involvement in inflammation of new joints.
From drug drugs recently effective
means of stopping the inflammatory process, are considered
drugs that block tumor necrosis factor that stimulates
the formation of substances (cytokines) leading to inflammatory
processes in the joints.
There are three drugs on the global pharmaceutical market.
Groups: Adalimumab (Humira), Infliximab (Remicade), Etanercept
(Enbrel). They have a positive effect even in cases where
conventional therapy is ineffective. However, they are very expensive.
and their use is associated with a high risk of activation
tuberculosis, the development of septic conditions and severe infections,
since the immunity is significantly reduced.
Therapeutic gymnastics is essential in combating
ossification and progressive stiffness of the joints and
spine. A distinctive feature of gymnastics with the disease
Ankylosing spondylitis is that in contrast to exercises with arthrosis
(gentle joint development), here the exercises should be
energetic, amplitude, gymnastics should be performed actively. it
due to the fact that such movements with a wide amplitude (rotation
joints, bends, turns) prevent ossification and fusion
связок spine. It is very important to make physiotherapy exercises.
every day without a pass for at least half an hour per day (outside
In a good way that combines gymnastics with promotes
muscle relaxation is exercise in the pool. And also in “dry
the pool “on the device” ugol “- when the patient performs gymnastics
in a sitting or lying position, in suspense on
special suspensions. The uniqueness and effectiveness of such gymnastics
that movements are made with complete relaxation of the muscles. it
significantly increases joint activity and reduces pain
Protein diets are recommended by rheumatologists for all patients.
ankylosing spondyloarthritis – that is, a decrease in diet
bakery, pasta, potatoes, flour confectionery
products and other products with high starch content.
Increase fish consumption (not fried, but steam or baked),
eggs, cottage cheese, cheese, boiled meat, among vegetables – to enter into the diet
more carrots, beets, peppers, cabbage, greens, onions, and all
fruits and berries.
Undoubtedly rest and treatment in the resort area is always beneficial
affects the overall health, mood. Patients with
ankylosing spondylitis during periods of remission shows sanatorium
treatment in Evpatoria, Sochi, Pyatigorsk, Tskhaltubo, Odessa, etc.
resorts. Especially good effects are sulfide,
radon baths, physiotherapy – ultrasound, ultraviolet irradiation, DDT currents,
phonophoresis with hydrocortisone, ozokerite and mud therapy as it was
said above can lead to aggravation, therefore they are prescribed
only in the quiet period of the disease.
A complete cure of ankylosing spondylitis is impossible. In advanced stages
Ankylosis diseases of the hip joints
prosthetics However, early diagnosis and proper treatment.
can significantly slow down the development of pathological processes,
reduce the frequency and severity of exacerbations and keep active for a long time
full lifestyle. Patients who struggle every day
ailments, doing therapeutic gymnastics, retain sufficient
mobility of joints and spine, suspending development