Bechterew's disease( ankylosing spondylitis) - Causes, symptoms and treatment. MF.

International name of Bechterew's disease - ankylosing spondylitis .The disease is an inflammation of the intervertebral joints, which leads to their ankylosis( adhesion), because of which the spine turns out to be in a rigid case limiting movement. The number of patients is 0.5-2% in different countries. Predominantly exposed young men, 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 is much easier. Primarily affects the spine and sacroiliac joints, large joints of the lower extremities. May damage the iris of the eye( Iritis).It is not necessary that one patient will have all of the listed inflammation localizations, there is a very different combination of inflammatory symptoms.

The causes of Bechterew's disease are genetically determined( a specific feature of the immune system is inherited).The presence of chronic infections( mainly the intestines and urinary tracts) is important. The provoking factor is usually intestinal, sexual infections, stress and trauma of the musculoskeletal system.

To date, it is believed that this disease occurs due to the malfunction of the immune system. In this regard, ankylosing spondylitis is called an autoimmune disease( autos - from the Greek root "itself").In the sacroiliac joints there is an especially high concentration of TNF-a, which is in the immediate epicenter of the disease and plays a central role. It can be considered more responsible for the fact that the spine becomes stiff and inefficient due to a chronic inflammatory process. As a consequence, there are no effective ways to treat Bechterew's disease. Completely cure it is impossible, but with the help of various medications, physiotherapy exercises and physiotherapeutic procedures, it is possible to stop the development of the disease and significantly improve the quality of life of the patient.

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

In far-reaching forms, the diagnosis of difficulties does not cause. But the main problem of people suffering from Bekhterev's disease is a late diagnosis. Therefore, we will focus on the manifestations of the disease and its difference from others precisely in the early stages.

What is worth paying attention to?

- Stiffness, pain in the sacroiliac region, which can give to the buttocks, lower limbs, intensify in the second half of the night.
- Persistent pain in the calcaneus in young people.
- Pain and stiffness in the thoracic spine.
- Increased ESR in blood analysis up to 30-40 mm per hour and above.

If these symptoms persist for more than three months, an immediate consultation with a rheumatologist is needed!

Not always the disease begins with the spine, it can begin with the joints of the hands and feet( recalling rheumatoid arthritis), with inflammatory eye disease, with lesions of the aorta or heart. Sometimes there is a slow progression, when the soreness is practically not expressed, the disease is detected accidentally by X-ray examination.

Over time, the limitation of the mobility of the spine increases, the slopes to the side, forward, backward are hindered and painful, and the spine is shortened. Deep breathing, coughing, sneezing can also cause pain. Peace and immobility increase pain and stiffness, and movement and moderate physical activity - reduce. In the absence of treatment, the full immobility of the spine may come, the patient acquires the "supplicant" pose( arms bent at the elbows, back stooped, the head bent, legs slightly bent at the knees).

The insidiousness of Bekhterev's disease lies in the fact that without proper treatment and regular training in physiotherapy, the patient gradually fixes all the joints and he is confined to the bed. In addition, Bekhterev's disease has a number of concomitant diseases. Often the eyes become inflamed, due to the restrictions of movement in the chest, pulmonary tuberculosis develops, frequent intake of potent drugs leads to peptic ulcer. However, despite all this, patients with Bekhterev's illness are, for the most part, strong-willed and cheerful people. They become so, even if they were not optimistic before the illness. Bekhterev's disease forces a person to collect will into a fist, regularly engage in physical education, appreciate every day in which he can be a full member of society.

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

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

1. Bechterew's disease mainly develops in young men, and DZP, despite the tendency to "rejuvenate" them recently still mostly arise after 35-40 years.
2. With Bechterew's disease, the pain intensifies at rest or during prolonged stays in one position, especially in the second half of the night. With DZP, on the contrary, pains arise or increase after physical exertion at the end of the working day.
3. One of the early signs of Bechterew's disease is the tension of the back muscles, their gradual atrophy and stiffness of the spine. With ZAP, movement limitation occurs at the height of pain and development of radiculitis, and when the pain is removed, the mobility of the spine is restored.
4. Early X-ray changes in the sacroiliac joints of the spine, which are characteristic for Bekhterev's disease, do not occur in case of ZAP.
5. With Bechterew's disease, an increase in ESR in the blood test is often observed, and other positive biochemical signs of the activity of the process, which is not the case with DZP.

Often the lesions of the peripheral joints manifest before the spinal injury, therefore it is necessary to distinguish the initial form of Bechterew's disease from rheumatoid arthritis. Here it is necessary to remember:

1. RA is more often affected by women( 75% of cases).
2. RA is characterized by a symmetrical lesion of the joints( mainly the joints of the hand), which is rare in Bekhterev's disease.
3. Sacroiliitis( inflammation of the sacroiliac joints), lesion of the sternoclavicular and sternocostal joints is extremely rare in RA, and for Bekhterev's disease is very characteristic.
4. Rheumatoid factor in serum is found in 80% of RA patients and only in 3-15% of patients with Bekhterev's disease.
5. Subcutaneous rheumatoid nodules occurring in RA in 25% of cases do not occur with Bechterew's disease.
6. HLA-27( a specific antigen found in a blood test) is characteristic only of Bechterew's disease.

How to treat Bechterew's disease?

Modern medicine uses three main methods of treating Bechterew's disease. This is the suppression of the immune system, which, presumably, provokes the disease. This hormone therapy is the introduction of artificially synthesized hormones of corticosteroids fighting with the inflammatory process in the joints. And physiotherapy, used in combination with drugs.

Treatment should be comprehensive, lengthy, stage( hospital - sanatorium - polyclinic).Non-steroidal anti-inflammatory drugs, glucocorticoids are used, with severe immunosuppressant flow. Physiotherapy, manual therapy, therapeutic gymnastics are widely used. Therapeutic exercises should be held twice a day for 30 minutes, the exercises are selected by the doctor individually. In addition, you need to learn muscle relaxation. In order to inhibit the development of immobility of the chest, deep breathing is recommended. In the initial stage it is important not to allow the development of vicious spinal positions( the pose of the proud, the pose of the petitioner).Showing skiing and swimming, strengthening the muscles of the back and buttocks. The bed should be stiff, the pillow should be removed.

The disease is progressive, but with competent therapy it can be resisted. The main task is to delay the development of the disease, to prevent it from advancing. Therefore, it is necessary to regularly undergo rheumatologist examinations, and when exacerbations go to the hospital. The goal is to relieve pain and develop the stiffness of the spine.

Of course, Bekhterev's disease is a very serious disease, and the purpose of the article is by no means an appeal to self-treatment. Knowledge only needs to be directed towards attentive attitude to one's own health and to help avoid the terrible consequences of this disease.

Causes of occurrence of Bechterew's disease

The causes of the occurrence of Bechterew's disease( ankylosing spondylitis) by science have not been precisely established so far. However, the scientists deduced the relationship between this disease and the presence of the 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 according to which the HLA antigen B27 gives similarity to the joint tissues of human carriers of a gene with certain types of infections. When the gene carrier picks up any infection, the body's immune system produces antibodies to fight it. Antibodies destroy the infection, introduced from the outside, after which they "attack" the joints, taking them for an infection. However, this is one of the hypotheses.

It is for certain only known that the antigen HLA B27 is present in all who have become ill with Bekhterev's disease. But not all carriers of this gene necessarily fall ill with Bekhterev's disease. There is a definite mechanism that triggers a disease program. It can be an infectious disease, even a common cold, transferred on legs. To the development of Bechterew's disease may result in accidental trauma or constant stress.

Strange as it may seem, almost nobody studies Bekhterev's disease and its causes in the world. A few studies rarely give new knowledge about this disease. Of the latest studies, we can recall only conducted experiments in mice that showed that a disease similar to Bekhterev's disease in these rodents occurs when a combination of three factors is present: the presence of HLA antigen B27, infection from the outside and the presence of T-lymphocytes in the blood. If the mouse was kept in sterile conditions, or it was removed thymus - the body responsible for the production of T-lymphocytes, the disease did not develop.

Due to the fact that the mechanism of development of Bekhterev's disease has not been studied, it is difficult to talk about any prevention. It is obvious that people who carry antigen HLA B27 should carefully monitor their health, avoid traumatic situations, and treat infectious diseases in time. People who already have Bechterew's disease can only prevent complications and inhibit the development of spondyloarthritis through constant therapy, physical therapy, sanatorium treatment.

Joint pain - smpttom disease Bechterew

Bechterew's disease( 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 are often mistaken for radiculitis, a constant sense of fatigue and joint pain. More specific is the so-called "morning" syndrome, when, after waking up after a night's sleep, a person can not move limbs for some time. Immobility in the joints usually goes through half an hour.

Pain in the joints is typical for many diseases, but ankylosing spondylitis is distinguished by the fact that in this case the pain is not eliminated by rest for the joint. On the contrary, physical exercises can bring relief.

Bechterew's disease can occur in three forms: central, rhizome and peripheral. In the first two forms, the symptoms are pain in the spine, developing stoop, inability to straighten yourself. With peripheral form of the disease begins with the defeat of knee and ankle joints. Swollen knee joints are one reason to suspect a disease.

Night pain is another symptom of the disease. Usually they intensify closer to the morning. In the afternoon, after noon, they can almost completely disappear.

About Bechterew's disease symptoms can not only show on the part of the joints, but also on other organs and systems of the body. A frequent accompanying symptom is the inflammatory process in the organs of vision. Patients with ankylosing spondylitis have problems with respiratory organs due to a violation of the shape of the thorax.

As the disease develops, the posture of the patient changes due to the disappearance of physiological curves of the spine. The waist becomes unnaturally straight, the person loses the ability to cave in not only forward-backward, but also to the sides( this sign helps doctors to distinguish patients with Bekhterev's disease from patients with severe form of osteochondrosis).Then the root joints - hip and shoulder joints are affected. Usually the disease "goes" from the bottom up, so the latter are affected and lose mobility of the vertebrae of the cervical department.

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

Diagnostics of Bechterew's disease

Diagnostic signs of ankylosing spondylitis:
On the recommendation of the Institute of Rheumatology RAMS, 1997

1. Pain in the lumbar region, not passing at rest, facilitated by movement and lasting more than 3 months;
2. Limitation of mobility in the lumbar spine in the sagittal and frontal planes;
3. Restriction of respiratory chest excursion relative to normal values ​​according to age and sex;
4. Bilateral sakroileitis II-IV stage.

A diagnosis is considered reliable if the patient has a fourth symptom in combination with any of the other three.

The diagnosis of ankylosing spondylitis( Bechterew's disease) is often made only when the disease has already passed into neglected or severe forms. This is due in part to the poor knowledge of the disease, in part to the generality of its first symptoms. Often doctors confuse Bekhterev's disease with other joint diseases, early signs are often written off for osteochondrosis.

An X-ray examination is mandatory for suspected Bechterew's disease. This method of diagnosis is still the most common and is considered the most reliable. The patient gets a picture of the pelvic area. Changes in the sacroiliac joints for the doctor - an occasion to suspect Bechterew's disease. At the first stage of the disease, the enlargement of the joint gap, the fuzziness of the contours of the joints will be noticeable on the picture. At the second stage, single erosions of the articular tissue will be seen in the picture. The third - partial ankylosis( fixation) sacroiliac joints. The fourth stage is a pronounced complete ankylosis.

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

When suspected of Ankylosing spondylitis, a human antigen HLA B27 is tested, since its presence suggests a genetic predisposition to Bekhterev's disease. 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 method of diagnosis can be used only in conjunction with others, since a high index of ESR only indicates that the body has an inflammatory process. It is not necessarily this process is exactly in the joints, as with Bekhterev's disease. Bekhterev's disease is characterized by an ESR index of 30-60 mm / h.

The diagnosis of ankylosing spondylitis is based on the data of X-ray examination and clinical manifestations - permanent low back pain lasting not less than three months, the presence of morning sickness syndrome, disappearing after physical exercises, limitation of mobility in the lower parts of the spine, age-restricted restriction of the respiratory excursion.

Treatment of Bechterew's disease

Treatment: medical gymnastics, exercise, physical therapy to avoid incorrect positions or stiffness of the spine and joints. It is necessary to maintain a correct posture - this will not allow the spine to fix in an undesirable position. Sitting should be exactly, with the 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 platen 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 roller under your neck, trying to keep your legs straight in the dream. In the advanced stage of the disease, running, contact sports, static loading on the spine are contra-indicated, but swimming is useful.

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

Infliximab( Remicade) has proven itself in the treatment of patients with Bechterew's disease. Therefore, from 1999/2000, this drug is 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 has not been achieved or was rarely achieved with the help of available medicines: an effective impediment to further development of inflammation and thereby preserving the mobility of the spine and joints.

According to experts, effective suppression of the inflammatory process with the drug infliximab( Remicade) can presumably prevent the awful ankylosing of the spine, which occurs with Bekhterev's disease.

In most cases it is necessary to use non-steroidal anti-inflammatory drugs: doegyl, plakvenil or sulphosalazine( dosages are chosen by the doctor).

In addition to drug therapy, the patient should be provided with: adequate sleep in the right position, emotional comfort, optimal locomotor activity, absence of foci of chronic infection, permanent physical education, annual spa treatment. Dosage hardening procedures are useful. Extremely cautious can be applied manual therapy, therapeutic massage( it is better not to massage the tendon attachment points).

It is worth to refrain from physiotherapy during an exacerbation.

It should be clear: Bekhterev's disease will remain with the sick forever. But the quality of life and the phase of the disease( remission or exacerbation) depends on proper treatment.

Physiotherapy

Physiotherapy procedures for patients with Ankylosing spondylitis are usually used in conjunction with drug therapy, during spa treatment and to prolong the periods of remission. The most common physiotherapeutic procedures are magnetotherapy, heat treatment and cryotherapy. Doctors disagree about the effectiveness of each of these tools, as, indeed, the patients themselves.

The least censure is magnetotherapy. Treatment with a magnetic field almost always brings sick people with Bekhterev's disease at least a short-term relief. Due to the fact that it is difficult for many patients to go to the clinic for procedures, they often purchase devices for carrying out magnetotherapy at home.

Heat treatment is also easy to conduct at home, however, practice shows that in some cases, warmers or paraffin wax applications on the affected joints can cause even more inflammation. The bath gives a positive effect, but a hot bath can strengthen the swelling of the joints.

The most disputes are 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 can become inflamed. But this does not mean that cryotherapy brings only harm. In a number of patients, after a week of receiving the procedures, there was a significant improvement.

During spa treatment of patients with Bechterew disease prescribed sodium chloride baths that have anti-inflammatory and analgesic effect, as well as bischofite baths.

Massage and manual therapy are also used to treat ankylosing spondylitis when the disease is in remission. Almost all doctors tend to believe that massage should not be intense, it can only provoke an inflammatory process. Traditional medicine is arguing with this opinion. There are cases when the condition of patients with Bechterew's disease improved significantly after the courses of hard massage performed by folk healers who are not recognized by official medicine.

From all the above it follows that for no one physiotherapeutic method of treatment of Bekhterev's disease there is no unequivocal opinion, and the patient has to rely on his own intuition and the reactions of his own organism when choosing.

Corticosteroids in the treatment of Bechterew's disease

Corticosteroid hormones are produced by the adrenal glands of a person as an organism's response to an inflammatory process. Long enough, in 1949, scientists found a way to artificially synthesize these hormones and injected into the patient in increased doses to relieve the inflammatory process. This therapy was widely used to treat patients with Bekhterev's disease. However, in a short time it turned out that corticosteroids, removing inflammation in the joints, have a number of negative effects on the body. Like any hormone, artificially obtained corticosteroid hormones are addictive, physical and mental. With regular intake of corticosteroids, the human body stops producing this hormone itself, the adrenal glands are atrophied. Excess weight, the appearance of facial hair, stomach ulcer is not all the negative consequences of prolonged intake of corticosteroids. Very dangerous for patients with Bechterew's disease is osteoporosis, caused by the intake of corticosteroids. The increased brittleness of bones leads to fractures, and forced immobility due to gypsum can become fatal for patients with ankylosing spondylitis.

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 of the use of corticosteroids in each case should be addressed individually. It is necessary to warn in time or at least minimize the harmful effects of the drugs used. Thus, preparations in the form of tablets, for example, prednisolone, are taken at the same time, with plenty of liquids that are enveloping the stomach - acid or kefir, to reduce the harmful effects on the stomach. If hormones are injected, the patient should focus on preventing osteoporosis, that is, to devote more time to exercise therapy. During the movement in the bone receives more calcium, which strengthens them.

If inflammation is concentrated in a single joint, local injections of preparations containing corticosteroids are often used. For example, depomedrola or kenalog. These injections, as a rule, are single, they bring temporary, but significant relief. In addition, a single injection does not cause side effects.

Forecast

Modern medicine offers methods if not cured, then at least to 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 folk medicine: herbs, massages, baths.

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

Treatment of Bechterew's disease with stem cells

Bechterew's disease is a disease associated with inflammation of the joints of the axial skeleton( intervertebral, costal-vertebral, sacroiliac) and involvement of internal organs( heart, aorta, and kidneys) in the process.

Bechterew's disease tends to develop progressively. The classic case of neglected spinal inflammation was in Nikolai Ostrovsky: immobility and blindness. On average, about 3 people out of a thousand are sick with Bekhterev's disease in Russia.

Bechterew's disease develops as a result of latent infections in people who have hereditary predisposition and certain genetic characteristics. With Bechterew's disease, the inflammation initially affects the joint of the sacrum and ileal bones;then 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 the hip to the joints of the fingers.

Inflammation of joints with ankylosing spondylitis in many cases can be easily suppressed with drugs. Much worse, that with Bekhterev's disease, there is an "ossification" of the ligaments of the spine, its intervertebral joints and discs. There is a gradual process of "fusion" of vertebrae with each other, the spine loses its flexibility and mobility.

Symptoms of Bechterew's disease, at first can be very reminiscent of the symptoms of osteochondrosis. The patient complains of pain in the lumbar region. Later, to lumbar pain, swelling and soreness of one or more joints is added, pronounced morning stiffness of the waist, disappearing for dinner.

Bechterew's disease usually begins at a young age of the patient, in 20 to 30 years. At half of patients already at the very beginning of the disease it is possible to detect inflammation of the eyes( their reddening and feeling of "sand in the eyes"), increased body temperature and weight loss.

But the main sign of Bekhterev's disease is the increasing stiffness of the spine and the restriction of the mobility of the chest during respiratory movements. The sick person moves as if a stick is inserted in his place instead of a spine - the entire body should bend over and turn around.

Bekhterev's disease is dangerous not only because it eventually immobilizes the entire spine and joints, but also with its complications. Of these complications, the greatest risk is the damage to the heart and the aorta that occurs in 20% of patients and manifested by shortness of breath, chest pain and irregular heartbeat. A third of patients develop amyloidosis - renal degeneration leading to chronic kidney failure. Reducing the mobility of the chest contributes to lung disease.

The first and most important rule - the treatment of Bechterew's disease with stem cells must begin when the first symptoms appear, until the "ossification" of the entire spine and inflamed joints has occurred.

The action of injected stem cells for the treatment of Bechterew's disease is aimed at suspending the "ossification" of the ligaments of the spine, its intervertebral joints and discs. And also to prevent the process of "fusion" of the vertebrae with each other, restore its flexibility and mobility.

After treatment of Bechterew's disease with stem cells, the volume of movements in the joints and spine considerably increases, pains decrease, and timely treatment with stem cells will avoid heart and aorta, kidney and lung lesions.

It should be noted that in conjunction with the treatment of Bechterew's disease with stem cells, especially important is the therapeutic gymnastics. With Bekhterev's disease, various inclinations, body rotations in all directions, rotations 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 be engaged every day for at least 30-40 minutes. And it is desirable not to miss a single day! The patient must understand that every lost day gives the disease irretrievably to the particle of the joint or a tiny piece of the spine that knocks and will never regain mobility!

According to reviews on the treatment of Bechterew's disease with stem cells, improvement is observed only in half of the cases and only at the initial stage of the disease.