At what age can ankylosing spondylitis appear? Ankylosing spondylitis

The onset of ankylosing spondylitis is gradual and inconspicuous. There are no specific signs of the disease, so at the first stage when visiting a doctor, an incorrect diagnosis is often made. This is the great insidiousness of the disease, since in advanced cases it is difficult to help the patient. Therefore, you need to be very attentive to your health and if signs of discomfort in the spinal column and its stiffness appear (especially if you have close relatives with damage to the skeletal system), if there is a persistently high ESR, look for good specialist to conduct a quality survey.

Forms of ankylosing spondylitis

During the disease, not only the spinal column is affected; the joints of the legs and arms, and the tissues of some organs are involved in the process. Due to the different localization of the process, the following types of ankylosing spondylitis are distinguished.

1. Central (slow development) - only the joints of the spinal column are affected:

• kyphosis - changes in the cervical and thoracic spine lead to the body leaning forward more and more, a “supplicant pose” is formed
• rigid - smoothing out all the curves of the spine, the back becomes flat, the head leans back slightly - “proud pose”;

1. Rhizomyelic - large joints of the limbs are affected, in addition to the spinal column itself, the course is gradual.
2. Peripheral - in addition to damage to the spinal column, changes are detected in small joints.
3. Scandinavian - small joints of the hand are involved in the process
4. Visceral - in addition to damage to the spinal column and joints, internal organs are involved in the process.

With any type of pathology, the quality of life decreases, a person loses the ability to self-care and becomes dependent on other people.

The first manifestations of ankylosing spondylitis

The disease creeps up unnoticed. But there are several warning signs, the appearance of which should alert a person.

1. Precursors of ankylosing spondylitis.

• stiffness of the spinal column in the morning, which soon goes away (especially after taking a hot shower);
• weakness, drowsiness and fatigue;
• persistent eye damage in the form of inflammation;
• flying unexpressed pain in the lumbar region;
• pain in the sacral area may appear at rest or in the morning;
• when coughing, active breathing or sneezing, the pain becomes stronger (if the costovertebral joints are involved);
• sometimes a person notices discomfort while sitting on a hard surface.
• the amplitude of head movement decreases;
• gait may change, persistent pain appears in the heel area;
• there is a feeling of squeezing chest;
• increasing pain in the hip joint;

But at first, these phenomena do not particularly bother the patient, since they are weakly expressed. During this period, he rarely consults a doctor himself, since the symptoms quickly disappear after basic physical exercise or taking an analgesic tablet. In the future, the disease progresses and the previous methods of dealing with discomfort and pain (pills, hot showers, heat) no longer help, stiffness and stiffness of the joints increases.

1. Manifestations of ankylosing spondylitis on late stages:

• it is difficult to bend and turn the torso and head;
• atrophy of the spinal muscles;
• chest growth slows down;
• pronounced stoop appears;
• legs do not bend at the knees;
• appear regularly headache, nausea, dizziness;
• the mucous membrane of the eyes is affected, but vision does not change;
• breathing problems occur;
• inflammation and hyperemia of articular surfaces

Disability occurs primarily due to the fusion of the joints of the spinal column, therefore, as the disease progresses, its bends change and a stoop is formed. In an advanced stage, the curvature can be so severe that the patient cannot look straight ahead (“supplicant pose”). Along with the spine, other joints can be affected, including the small phalanges of the hand. In addition to joints, inflammation can also affect the epithelium of the intestines, blood vessels, kidneys, and eyes. However, ability to work sometimes remains for a long time. Periods of exacerbation alternate with periods of remission. It is important to see a doctor in time.

Complications of ankylosing spondylitis

Complications of the disease are dangerous and serious. The most common:

• amyloidosis of the kidneys with subsequent development of renal failure;
• pneumonia due to decreased mobility of the chest;
• inflammation of the iris of the eye, leading to loss of vision;
• vascular damage, risk of heart attack and stroke;
• bone osteoporosis;
• “Cauda equina syndrome” - compression of the bundle of nerve roots of the lower parts of the spinal cord, resulting in urinary and fecal incontinence, paralysis of the legs;
• smoothing the curves of the spine (proud pose);
• immobility

Diagnosis of ankylosing spondylitis

Before prescribing treatment, the patient is carefully examined. In addition to the examination and history taking, the patient is prescribed laboratory tests. He must undergo genetic and immunological research. Instrumental methods, as a rule, include studies such as MRI, CT, and radiography. Depending on the manifestation of the disease, the patient consults with relevant specialists (nephrologist, cardiologist, ophthalmologist, neurologist, rheumatologist).

Ankylosing spondylitis has a scientific name: ankylosing spondylitis. In its essence, pathology is a certain fusion of articular joints. Consequently, movements are limited as much as possible, which leads to complete immobility of the human spine.

If we consider ankylosing spondylitis, the main causes of its occurrence can be very different. The first manifestations are caused by the appearance of pain and a certain stiffness in the lumbar region. Gradually, the symptoms begin to increase, and the stiffness moves up the vertebra.

Ankylosing spondylitis may also have secondary symptoms. How to treat pathology in men and women? In this case there are some characteristic differences. Consequently, there is a need in this article to consider the main signs of ankylosing spondylitis, the stages of its development, as well as what needs to be done to completely eliminate the pathology or eliminate its negative manifestations as much as possible.

The main causes of the disease

Ankylosing spondylitis: causes and symptoms of the disease.

If we talk about the most common causes of back disease, it is worth noting that this factor has not yet been fully studied. The most common version of the occurrence of pathology is an increase in the aggressiveness of immune cells towards the ligaments and joints of one’s own body. Very often, the development of the disease is observed in those people who have a genetic predisposition.

List of the most common reasons

Most often, the beginning of the development of pathological changes can be banal hypothermia or a viral disease. In addition, it is possible that after receiving any injury, the doctor does not diagnose ankylosing spondylitis after some time. Most often these are injuries to the spinal or pelvic region.

In addition, ankylosing spondylitis can develop due to hormonal instability, allergic reactions, as well as pathologies gastrointestinal tract or urinary system.

As you can see, there can be quite a few reasons for the appearance of the disease. Therefore, if you identify any alarming symptoms, it is very important to consult a specialist. Only a highly qualified doctor will be able to timely determine the development of the disease and take all necessary measures to ensure that the disease does not begin to actively progress.

How does ankylosing spondylitis develop?

To allow the spine to move, elastic discs are placed between its vertebrae. So that, during movement, the vertebral structure can create resistance and be more stable, it is fastened with the help of strong fibrous ligaments. It is also worth noting that each individual vertebra is connected by strong articular joints.

Diagnosis of ankylosing spondylitis shows that due to the constant aggressiveness of immune cells, a practically permanent inflammatory process in the connective tissues of the spine. Thus, elasticity is almost completely lost and soft connective structures are replaced by bone tissue. As a result, the vertebrae stop moving, which leads to complete or partial restriction motor activity person.

In addition, it is worth noting that the immune cells attack not only the spinal region. In addition, in most cases, large articular formations are affected.

Bekhterev's disease, as the photos show, actively affects the lower limbs of a person. But it is possible that in the most advanced cases, the inflammatory process can migrate to organs such as the heart, lungs, urinary organs and others.

Ankylosing spondylitis (ankylosing spondylitis) is a disease of the joints, mainly intervertebral, accompanied by inflammation. Due to the disease, the mobility of the spine becomes less pronounced or absent altogether, the joints of the vertebrae fuse together (ankylose).

In addition, ankylosing spondylitis often affects the sacroiliac joints of large joints.

Ankylosing spondylitis is an autoimmune disease that can affect both adults and children.

This disease affects 2 people out of 1000. In Russia, ankylosing spondylitis affects 400 thousand people. It is noted that Very young people (up to 40 years old) are affected. Children and teenagers can also experience this disease. Ankylosing spondylitis is usually observed in men: symptoms of the disease appear in them up to 10 times more often than in females.

Scientists have not yet found a clear answer to the question of why this disease occurs. However, it is known that ankylosing spondylitis is inherited.

More than 90% of patients and about 25% of their blood relatives are carriers of the genetic marker of ankylosing spondylitis HLA B27, which can lead to the development of this disease.

However, it happens that ankylosing spondylitis develops without the presence of the HLA B27 gene.
Factors in the development of ankylosing spondylitis can also be:

• intestinal infection;
• respiratory infectious diseases;
• genitourinary system infections;
• hypothermia;
• stress;
• physical injuries;
• dyshormonal disorders in the body, etc.

The onset of the disease can be considered the moment when the immune system attacks the tissues of its own body, confusing them with foreign ones. It first affects the sacroiliac joints, and then other joints. The disease can also affect the smallest joints.
For more information about the causes of ankylosing spondylitis, watch the video:

Symptoms of the disease

The manifestation of ankylosing spondylitis in women and men is slightly different. The symptoms are generally the same, but the difference is that women are less susceptible to this disease, and if they get sick, the disease has a very mild form.

In this case, ankylosing spondylitis usually affects the female body only in the sacral and lumbar spine, while symptoms in men appear throughout the entire spinal column, moving to the peripheral joints.

The consequences of ankylosing spondylitis for males are much more serious than for the female half of humanity.

Ankylosing spondylitis gains momentum gradually, in stages:

• Stage 1 (initial) is marked by the appearance of the first symptoms;
• Stage 2 (advanced) is characterized by an increase in symptoms;
• Stage 3 (late) is characterized by severe articular changes.

Stages of ankylosing spondylitis

How does ankylosing spondylitis manifest? Each stage of the disease has specific symptoms.

Symptoms of the initial stage:

• pain in the sacrum, radiating to the hip, lower back;
• sensations of pain, stiffness in the spine. Particularly pronounced in the morning, after being in a monotonous physical position.
  

  It’s easy to get rid of negative feelings with the help of gymnastic exercises;

• girdle pain in the chest. They appear more strongly when coughing, deep breathing;
• deterioration general condition. This also applies to the clinic of ankylosing spondylitis at this stage. Despite their continued ability to work, patients complain of apathy, depression, and fatigue;
• a feeling of constriction in the chest as a result of limited mobility of the ribs;
• reduction of the distance between the sternum and chin due to deformation of the spine and joints.

In the Video, the candidate of medical sciences talks in detail about the symptoms of ankylosing spondylitis:

Symptoms of the advanced stage:

• incessant pain in the spinal column, worsening at night, when the weather changes, during physical activity;
• shooting pains in thighs, legs, back. This is the result of pinched nerve roots and an increase in the pathological process.

Late stage symptoms:

• manifestations of radiculitis. They consist of severe pain, numbness, tingling, decrease or disappearance of sensitivity near the pinched root, and decreased muscle tone. The pain increases with the slightest movement;
• impaired blood supply to the brain due to compression of the vertebral vessels. Manifests itself in the form of dull, throbbing headaches with ankylosing spondylitis, tinnitus, drowsiness, sudden shifts moods for no reason;
• attacks of suffocation. This is the result of compression of blood vessels, heart, lungs;
• high blood pressure;
• spinal deformity. The cervical spine bends more forward, the thoracic spine bends back. The spine “ossifies” and becomes almost motionless.

Changes in posture with ankylosing spondylitis

Classification

Ankylosing spondylitis is classified not only by stages, but also by other criteria. The following classifications are distinguished: of this disease:

1. downstream:
   • slowly progressive disease;
   • slowly progressing with relapses;
   • rapidly progressing;
   • septic form of the disease (sudden onset of the disease, accompanied by fever, chills, inflammation internal organs; ESR is overestimated).
2. by degree of activity:

   Watch a video about the features of diagnosing ankylosing spondylitis:
   
   It should be noted that the signs of ankylosing spondylitis are easily confused with symptoms degenerative diseases spine - spinal disc disease (spondylosis, osteochondrosis, rheumatoid arthritis). Differential diagnosis consists of establishing the following differences:

   • If ankylosing spondylitis is characterized by increased pain in the morning, then for DZP it is characterized by an increase in pain after physical activity;
   • with DZD, ESR does not increase, unlike ankylosing spondylitis;
   • X-ray does not reveal changes and deformations in DZP;
   • Ankylosing spondylitis, in particular its Scandinavian form, differs from rheumatoid arthritis, which is similar in symptoms.
     

     With ankylosing spondylitis, symmetrical damage to the joints and subcutaneous rheumatoid nodules are not observed.

     In RA, blood tests reveal rheumatoid factor in 80% of cases, and in ankylosing spondylitis, this factor is almost always absent.

   Ankylosing spondylitis and pregnancy

   Often women are afraid to have children after discovering this disease. However, there are no contraindications for pregnancy. It is only necessary to adjust the therapeutic treatment of the disease by replacing the drugs with others or abolishing them altogether.

   
   

   Adjusted therapeutic treatment of ankylosing spondylitis will not affect the course of pregnancy

   As for delivery, most likely it will take place in the form of a caesarean section.

   This decision is often made to avoid unbearable stress on the hip joints at the time of birth.

   Disability

   The limitation of mobility that follows from this disease entails disability.
   Criteria for obtaining disability for ankylosing spondylitis:

   • Group 3: the disease develops slowly, with rare relapses. Dysfunction of the spine and joints of 1-2 degrees. A person cannot exercise professional activity or is severely limited in it;
   • Group 2: rapid progression of the disease, with frequent exacerbations. Restrictions on the functions of the spine and joints – 2-3 degrees.
     

     Internal organs are affected negatively. Labor is reduced only to manual activities at home;

   • Group 1: irreversible, severe damage to the spine and joints. Functional impairment of 4 degrees. Independent movement is impossible.

   Ankylosing spondylitis: prognosis for life

   In addition to the treatment of ankylosing spondylitis under the supervision of a doctor, you must follow the recommendations regarding lifestyle:

   • quitting smoking;
   • performing gymnastic elements, swimming lessons.
     Watch the video for a set of exercises for ankylosing spondylitis:
     
     It is worth noting that running with ankylosing spondylitis is contraindicated;
   • avoiding excessive physical activity.

   So, ankylosing spondylitis can affect absolutely anyone. However correct treatment and, importantly, the right attitude towards an unexpected illness can really make life easier.

Ankylosing spondylitis(synonym - ankylosing spondylitis) - This chronic disease, which affects the joints (and also often the eyes, kidneys, and heart). The joints of the spine are most often affected.

Ankylosing spondylitis in facts and figures:

• The symptoms of the disease were first described in detail in 1892 by Russian academician V.M. Bekhterev. The pathology was named after the surname of the researcher.
• But it is known that people suffered from ankylosing spondylitis long before 1982. Scientists find characteristic changes in the skeletons of medieval Europeans and Indians, ancient Egyptians. Even prehistoric animals suffered from ankylosing spondylitis.
• Among modern people V different countries the prevalence of the disease ranges from 0.5% to 2% (from 5 to 20 patients per 1000 people).
• There is evidence that ankylosing spondylitis occurs in 1% of Europeans, and 0.1% require serious treatment.
• The prevalence of ankylosing spondylitis in Russia ranges from 1 to 9 patients per 10,000 people (the study was conducted in 1988).
• Representatives of the Black race and residents of East Asia suffer from the disease much less frequently. It occurs more often among Indians than among Europeans.
• For every sick woman there are 5-10 sick men.
• Most often, the disease begins at the age of 15-30 years.
• After 50 years, ankylosing spondylitis almost never occurs.

Features of the anatomy of the spine

The human spinal column consists of approximately 33 vertebrae:

• 7 cervical vertebrae– the cervical spine has the greatest mobility.
• 12 thoracic vertebrae- they are almost motionless and have joints with which they articulate with the ribs.
• 5 lumbar vertebrae– this part of the spine, like the cervical part, has great mobility.
• 5 sacral vertebrae- connected into one bone.
• Coccyx – consists of 3 – 5 vertebrae.

Between the vertebrae there are “shock absorbers” - intervertebral discs. Also, adjacent vertebrae articulate with each other using intervertebral joints.

The sacrum is part of the pelvic girdle. It, like a castle, locks the pelvic bones into a ring. On the right and left it connects with the iliac bones - the iliosacral joints are formed. They are most often the first to be affected by ankylosing spondylitis.

Causes of ankylosing spondylitis

The question of the reasons for the development of ankylosing spondylitis still remains open. However, today scientists have already learned a lot.

Disruption of the body's defense system

The immune system and other defense mechanisms of the human body are designed to fight against foreign particles that penetrate inside. With ankylosing spondylitis, their work is disrupted - they begin to attack their own tissues. The reasons for this have not been fully established.

Heredity

It has been established that there is a hereditary predisposition to ankylosing spondylitis. A massive study was conducted, during which the following figures were obtained:

• If both parents were healthy, then only 5 out of 1000 couples had a child who subsequently suffered from ankylosing spondylitis.
• Children with sick parents fell ill in 30 cases out of 1000, that is, six times more often.

The human body has special molecules that are responsible for recognizing “self” and “foreign” cells. A certain type of these molecules is most common in patients with ankylosing spondylitis.

Infection

There is evidence that the bacteria Klebsiella and some other species may play a role in the development of ankylosing spondylitis.

Forms of ankylosing spondylitis

Symptoms of ankylosing spondylitis

Symptoms depend on the stage of the disease. Ankylosing spondylitis is a chronic, incurable pathology during which gradual changes occur in the spinal column and joints.

Stages of ankylosing spondylitis:

• Initial– appearance of the first symptoms.
• Expanded- pronounced symptoms.
• Late– significant changes in the joints.

Early stage symptoms

Ankylosing spondylitis usually develops gradually, while osteochondrosis and other inflammatory diseases of the spine begin with an acute attack.

Symptom	Description
Pain in the sacrum	They are usually the first sign of the disease, since ankylosing spondylitis begins with damage to the sacroiliac joint. The pain is usually worse on one side. Painful sensations may spread to the lower back, thigh.
Pain and stiffness in the spine	They occur in the morning after sleep or after a long stay in a monotonous position. They go away during the day, after doing gymnastics. Unlike osteochondrosis and other inflammatory diseases of the spinal column, pain with ankylosing spondylitis intensifies at rest and becomes weaker, disappears during physical work.
Girdle pain in the chest	They are a consequence of damage to the costovertebral joints. They are characterized by the same features as pain in the spine. They become stronger during deep breathing and coughing. They resemble intercostal neuralgia and are sometimes mistaken for heart pain. Despite the pain, the patient should not limit chest breathing, but, on the contrary, continue to train it.
Violation of general condition	The condition of most patients with ankylosing spondylitis does not suffer. They remain operational for a long time. Some patients begin to worry about increased fatigue and develop apathy and depression.
Feeling of tightness, squeezing of the chest	This occurs due to impaired mobility of the ribs. The patient breathes mainly from the stomach.
Reducing the distance between the chin and sternum	It occurs due to damage to the joints and deformation of the spinal column.

Symptoms of the advanced stage

Signs of a late stage

Signs	Description
Signs of radiculitis	Caused by compression of the nerve roots as a result of increasing pathological changes in the spine. Severe pain, tingling, numbness. Decreased sensitivity in the area of ​​the affected nerve root. Weakness, decreased muscle tone in the area of ​​the affected nerve root. Over time, these muscles atrophy and weaken even more. The pain intensifies during movements and any physical activity.
Impaired blood supply to the brain	The brain receives blood from various vessels, including the vertebral arteries. They got their name because when passing along cervical spine spine (right and left) through holes in the lateral parts of the vertebrae. During ankylosing spondylitis, these arteries are compressed due to deformation and impaired mobility of the spine. The blood supply to the brain is disrupted. Symptoms: Headaches in the back of the head, dull, throbbing. Dizziness. Hearing loss, tinnitus. Forgetfulness, absent-mindedness, inattentiveness. “Floaters before the eyes”, various visual impairments. Sweating, feeling hot, strong rapid heartbeat. Increased irritability, frequent change of mood for no reason. Weakness, increased fatigue, daytime sleepiness.
Attacks of suffocation	They arise as a result of impaired mobility of the chest, compression of the lungs, heart and large vessels.
Promotion blood pressure	Caused by compression of nerve roots and large vessels, the heart, and circulatory disorders in the brain.
Spinal deformity	With ankylosing spondylitis, ossification of the ligaments and joints of the spine and intervertebral discs occurs. As a result, the spinal column practically loses its mobility and becomes like a bamboo cane that cannot bend. The spine is deformed: its cervical spine bends even more forward, and its thoracic spine bends backward. The patient's posture becomes characteristic.

What does a patient with ankylosing spondylitis look like?

Over time, due to deformation of the spinal column appearance the patient becomes characteristic:

Signs of other forms of ankylosing spondylitis

Form of the disease	Signs
Rhizomelic form (defeat hip joints)	Symptoms of spinal damage (see above). The development of the disease is gradual. Pain in the hip joints, usually worse on one side. Spread of pain to the groin, hip, knee joint.
Peripheral form (damage to the knee joints and foot joints)	For several months or years there are only symptoms of spinal damage (see above), then joint damage occurs. Most often, this form of the disease develops in adolescents. The later in life a person begins to get sick, the less likely joint damage is. There is pain in the knee, ankle joint. Mobility is gradually impaired, joints become deformed.
Scandinavian form	Pain occurs in the small joints of the hands and feet. Over time, joints become deformed and mobility is impaired. This form of ankylosing spondylitis is very similar to another disease - rheumatoid arthritis.

Symptoms of damage to other organs in ankylosing spondylitis

Organ	Symptoms of the lesion
Eye	Sometimes eye damage is the first sign of the disease. It can occur long before pain in the spine begins to bother you. The main types of eye damage in ankylosing spondylitis: Inflammation of the iris. Symptoms: pain, photophobia, lacrimation, the iris changes color and appearance, the pupil narrows. Increased intraocular pressure (glaucoma). Symptoms: blurred vision, rainbow circles and spots before the eyes, pain, slight pain in the eye.
Heart and blood vessels	Causes of damage to the cardiovascular system in ankylosing spondylitis: Development of inflammation in the heart and the wall of large vessels. Compression of the heart due to impaired mobility of the thoracic spine. Manifestations of damage to the cardiovascular system in ankylosing spondylitis: Heart rhythm disturbances. The patient feels an increased, frequent heartbeat, interruptions in the work of the heart, and there is a feeling that it seems to be “turning over.” Pericarditis- inflammation of the outer lining of the heart. There is pain in the heart. Inflammation of the aortic wall. Leads to disruption of blood flow and heart function. Inflammation of the wall of other large arteries. Shortness of breath, associated with cardiac dysfunction.
Kidneys	With ankylosing spondylitis, a special substance – amyloid – accumulates in the kidneys, which disrupts their function. Symptoms: swelling on the face in the morning; pallor; the amount of urine gradually decreases; sometimes - lower back pain.
Lungs	Due to impaired mobility of the thoracic vertebrae, the movements of the chest become limited, it cannot expand sufficiently during inhalation, and it compresses the lungs. Because of this, people with ankylosing spondylitis have an increased risk of developing pneumonia, tuberculosis.

Diagnostics

Which doctor should I contact?

If symptoms of ankylosing spondylitis occur, you can contact the following specialists:

• Therapist– a general practitioner who can suspect a disease, make a preliminary diagnosis, prescribe an examination and refer to more specialized specialists.
• Vertebrologist– specialist in spine diseases.
• Rheumatologist– specialist in rheumatism and other joint diseases.
• Orthopedist– a specialist who treats diseases of the musculoskeletal system in children.

How does the conversation with the doctor go?

During the interview with the patient, the doctor may ask questions:

• What worries you at the moment?
• When did the disease begin? What preceded this?
• What symptoms appeared first? Which ones appeared next?
• What medications did the patient take and how much did they help?
• When does it get easier? When do symptoms get worse?
• What other illnesses has the patient suffered in his life?
• Do your parents and immediate relatives suffer from ankylosing spondylitis or other spinal diseases?

It is necessary to give as clear and detailed answers as possible - they will help the doctor quickly establish the correct diagnosis and begin treatment.

How does a doctor examine a patient?

Inspection method	Description
Feeling the spine, sacral area and sacroiliac joints.	During palpation with ankylosing spondylitis, pain is detected at the site of the lesion.
Bend forward test.	The doctor asks the patient to lean forward with straight legs joined together. Normally, a person reaches the floor, or the tips of his fingers are at a distance of no more than 10 cm. In ankylosing spondylitis, this distance is greater.
Feeling the chest	The doctor places his hands on the patient’s chest and slightly squeezes it: from the sides, in the anteroposterior direction. If the mobility of the ribs is impaired, increased resistance is felt.
Measuring chest circumference during deep inhalation and exhalation.	The patient must be naked to the waist. The doctor asks him to take a deep breath, and at this time measures the chest circumference. A similar measurement is then taken during deep exhalation. The difference should be more than 6 cm. Otherwise, we can talk about limited mobility of the chest.

What studies and tests can be prescribed for ankylosing spondylitis?

Study title	What's the point?	How is it carried out?
X-ray of the spine	Signs that can be detected on x-rays of ankylosing spondylitis: inflammation of the sacroiliac joint on both sides; osteoporosis(destruction of bone tissue) of the vertebrae: because of this, they take on a square shape; decreased height of intervertebral discs; arthrosis intervertebral joints; The spine in the pictures looks like a bamboo stick.	Conventional x-rays are taken in two projections - front and back.
X-ray of hip joints	In the photographs, the doctor sees that the joint space is narrowed. And in the later stages the head femur as if “falling” into the articular cavity.
General blood test	During an exacerbation of the disease, a general blood test can reveal: increased erythrocyte sedimentation rate; sometimes – slight anemia(decrease in the amount of hemoglobin and red blood cells). These signs are found in most infectious and inflammatory diseases.	Blood is taken in the usual way from a finger (if you plan to perform a biochemical blood test at the same time, from a vein), usually in the morning.
Biochemical blood test	During an exacerbation of the disease, a biochemical blood test can reveal: C-reactive protein– a special substance that appears during inflammatory processes. Increased content globulins– proteins that perform protective functions, also one of the signs of inflammation.	Blood for research is taken from a vein on an empty stomach.
Additional studies that the doctor may prescribe for special indications
Computed tomography and magnetic resonance imaging.	More accurate studies compared to radiography. The doctor prescribes them if the situation is not entirely clear from x-rays. These methods allow: obtain clear layer-by-layer images of the entire spine or its parts; build visual three-dimensional images. Using computer or magnetic resonance therapy, it is possible to detect signs of damage to the sacroiliac joints much earlier than they become visible on x-rays.
HLA-B27 typing	HLA-B27 – antigen, the presence of which determines predisposition to ankylosing spondylitis, as well as Reiter's syndrome and juvenile rheumatoid arthritis. HLA-B27 typing is used to identify susceptibility to these diseases. When ankylosing spondylitis has already been diagnosed, this study is pointless. The result will not have any effect on treatment.	For the study, blood is taken from a vein into a special tube.
Scintigraphy of the sacroiliac joints	Scintigraphy- a method that allows you to assess the presence of pathological changes in the joints long before they begin to manifest severe symptoms and become visible on x-rays.	Before the examination, a special drug is injected into the patient’s vein - it has the ability to be deposited in the affected joints. Then they take pictures - they show all the places where the drug is deposited. This is used to judge which joints have a pathological process.
Blood test for rheumatoid factor	Rheumatoid factor– a group of antibodies that appear in the blood during rheumatoid arthritis. The study is prescribed when it is necessary to distinguish ankylosing spondylitis from this pathology.	For analysis, blood is taken from a vein.
General urine test	If the kidneys are damaged, protein is detected in the urine - normally it is not present.	Urine is collected in the morning in a clean jar.
Research of internal organs	Depending on the symptoms, the doctor prescribes an examination aimed at identifying damage to the internal organs.

There is no single diagnostic method that could accurately and unambiguously indicate ankylosing spondylitis. The doctor conducts an examination, evaluates the results of various studies together and makes a diagnosis. It is very important to identify ankylosing spondylitis in the early stages - if you start the necessary measures in time, you can slow down the pathological process and ensure a full life for a long time. The patient's initiative is of great importance!

Treatment of ankylosing spondylitis

Ankylosing spondylitis is a chronic disease that lasts for a long time. In fact, it is incurable. The process cannot be stopped, but it can be significantly slowed down. If treatment is started in the early stages and the patient strictly follows the doctor’s recommendations, complications can be avoided and the wellness, normal activity and performance throughout life.

Drug treatment*

Drugs	Description	Directions for use and doses**
Diclofenac(synonyms: Voltaren, Ortofen).	It is an anti-inflammatory and analgesic.	Diclofenac can be used in the form of tablets, solutions for intramuscular injections, ointments. Use in adults: During an exacerbation– 100 – 150 mg of the drug per day daily. After the pain subsides and normalization of the patient’s condition – 50 – 75 mg daily. During the next exacerbation the dosage is increased again.
Indomethacin	Analgesic and anti-inflammatory agent. Belongs to the same group of drugs as Diclofenac.	Dosages are similar to those for Diclofenac.
Prednisolone	Prednisolone is an adrenal hormone that has a powerful anti-inflammatory effect. It is used in cases where Diclofenac and Indomethacin are ineffective.	Prednisolone is available in the form of tablets, solutions for intravenous and intramuscular administration. Patients with ankylosing spondylitis are usually prescribed 10–15 mg of Prednisolone per day.
Sulfasalazine	A drug that has a pronounced antibacterial and anti-inflammatory effect. It is used in cases where Diclofenac and Indomethacin do not have an effect.	Available in tablet form. Typically, a doctor prescribes 2–3 mg of the drug once a day for an adult patient.
Azathioprine; Cyclophosphamide.	Drugs that suppress the immune system. Used for severe ankylosing spondylitis.	Usual dosages for adult patients: azathioprine – 50-100 mg per day; cyclophosphamide – 50-100 mg per day.
Triamcinolone; Methylprednisolone; Kenalog; Metipred; Depo-Medrol; Medrol; Urbanzon.	These drugs, like prednisolone, are synthetic analogues of adrenal hormones. They are used in cases where ankylosing spondylitis manifests itself with severe joint symptoms.	All these drugs are available in the form of solutions. They are introduced into the joint cavity. This is a complex procedure that can only be performed by a doctor. Dosages are also prescribed by the attending physician.
Skutamil-S	Medicine, promoting muscle relaxation. It is used in the presence of severe muscle pain resulting from increased muscle tone.	Typically, adults are prescribed 1 tablet 3 times a day. Strictly as prescribed by the doctor!

It's chronic inflammatory disease spine and joints with progressive limitation of movements. The first manifestations in the form of pain and stiffness occur first in lumbar region spine and then spread up the spinal column. Over time, pathological thoracic kyphosis, typical of ankylosing spondylitis, develops. The range of motion in the joints is gradually limited, the spine becomes motionless. Pathology is diagnosed taking into account clinical symptoms, X-ray data, CT, MRI and laboratory tests. Treatment - drug therapy, exercise therapy, physiotherapy.

General information

In Russia, ankylosing spondylitis (ankylosing spondylitis) is detected in 0.3% of the population. The disease most often affects men aged 15 to 30 years. Women get sick 9 times less often than men.

Reasons

The reasons for the development of ankylosing spondylitis are not fully understood. According to many researchers, the main reason for the development of the disease is the increased aggression of immune cells towards the tissues of their own ligaments and joints. The disease develops in people with a hereditary predisposition. People suffering from ankylosing spondylitis are carriers of a certain antigen (HLA-B27), which causes changes in the immune system.

The triggering point in the development of the disease may be a change in immune status as a result of hypothermia, acute or chronic infectious disease. Ankylosing spondylitis can be caused by injury to the spine or pelvis. Risk factors for the development of the disease are hormonal disorders, infectious and allergic diseases, chronic inflammation intestines and genitourinary organs.

Pathogenesis

Between the vertebrae there are elastic intervertebral discs that provide mobility to the spine. On the back, front and side surfaces of the spine there are long, dense ligaments that make the spinal column more stable. Each vertebra has four processes - two upper and two lower. The processes of adjacent vertebrae are connected to each other by movable joints.

With ankylosing spondylitis, as a result of constant aggression of immune cells, a chronic inflammatory process occurs in the tissue of joints, ligaments and intervertebral discs. Gradually, elastic connective tissue structures are replaced by hard bone tissue. The spine loses mobility. Immune cells in ankylosing spondylitis attack not only the spine. Large joints may be affected. More often the disease affects the joints of the lower extremities. In some cases, the inflammatory process develops in the heart, lungs, kidneys and urinary tract.

Classification

Depending on the predominant damage to organs and systems in rheumatology, traumatology and orthopedics, they distinguish following forms Bekhterev's disease:

• Central form. Only the spine is affected. There are two types of central forms of the disease: kyphosis (accompanied by kyphosis of the thoracic spine and hyperlordosis of the cervical spine) and rigid (the thoracic and lumbar curves of the spine are smoothed out, the back becomes straight, like a board).
• Rhizomelic form. Damage to the spine is accompanied by changes in the so-called root joints (hip and shoulder).
• Peripheral form. The disease affects the spine and peripheral joints (ankle, knee, elbow).
• Scandinavian form. Clinical manifestations resemble the initial stages of rheumatoid arthritis. There is no deformation or destruction of joints. Small joints of the hand are affected.

Some researchers additionally identify the visceral form of ankylosing spondylitis, in which damage to the joints and spine is accompanied by changes in the internal organs (heart, kidneys, eyes, aorta, urinary tract, etc.).

Symptoms of ankylosing spondylitis

The disease begins gradually, gradually. Some patients note that for several months or even years before the onset of the disease they experienced constant weakness, drowsiness, irritability, and mild intermittent pain in the joints and muscles. As a rule, during this period the symptoms are so mild that patients do not consult a doctor. Sometimes persistent, difficult to treat eye lesions (episcleritis, iritis, iridocyclitis) become a harbinger of ankylosing spondylitis.

A characteristic early symptom of ankylosing spondylitis is pain and a feeling of stiffness in the lumbar spine. Symptoms occur at night, worsen in the morning, improve after a hot shower and physical exercise. During the day, pain and stiffness occurs at rest and disappears or decreases with movement.

Gradually the pain spreads up the spine. The physiological curves of the spine are smoothed out. Pathological kyphosis (pronounced stoop) of the thoracic region is formed. As a result of inflammation in the intervertebral joints and ligaments of the spine, constant voltage back muscles.

In the later stages of ankylosing spondylitis, the vertebral joints fuse and the intervertebral discs ossify. Intervertebral bone “bridges” are formed, clearly visible on radiographs of the spine. Changes in the spine develop slowly over several years. Periods of exacerbations alternate with more or less long-term remissions.

Often one of the first clinically significant symptoms of ankylosing spondylitis is sacroiliitis (inflammation of the joints of the sacrum). The patient is bothered by pain deep in the buttocks, sometimes spreading to the groin area and upper thighs. This pain is often considered a sign of inflammation of the sciatic nerve, herniated disc or radiculitis. Pain in large joints occurs in approximately half of patients. The feeling of stiffness and pain in the joints is more pronounced in the mornings and in the first half of the day. Small joints are affected less frequently.

In approximately thirty percent of cases, ankylosing spondylitis is accompanied by changes in the eyes and internal organs. Possible damage to cardiac tissue (myocarditis, sometimes as a result of inflammation, valvular heart disease is formed), aorta, lungs, kidneys and urinary tract. With ankylosing spondylitis, eye tissue is often affected and iritis, iridocyclitis or uveitis develops.

Diagnostics

The diagnosis of ankylosing spondylitis is made based on examination, medical history and additional research data. The patient needs to consult an orthopedist and neurologist. X-ray examination, MRI and CT scan of the spine are performed. Based on the results general analysis blood, an increase in ESR is detected. In doubtful cases, a special test is performed to detect the HLA-B27 antigen.

Ankylosing spondylitis must be differentiated from degenerative spinal diseases (DSD) - spondylosis and osteochondrosis. Ankylosing spondylitis most often affects young men, while DSD usually develops at an older age. Pain with ankylosing spondylitis intensifies in the morning and at rest. DZP is characterized by increased pain in the evenings and after physical activity. ESR does not increase with DZP, and specific changes are not detected on a radiograph of the spine.

The Scandinavian form of ankylosing spondylitis (predominantly affecting small joints) should be differentiated from rheumatoid arthritis. Unlike ankylosing spondylitis, rheumatoid arthritis usually affects women. With ankylosing spondylitis, symmetrical joint damage practically does not occur. Patients do not have subcutaneous rheumatoid nodules; blood tests reveal rheumatoid factor in 3-15% of cases (in patients with rheumatoid arthritis - in 80% of cases).

Treatment of ankylosing spondylitis

The therapy is complex and long-term. It is necessary to maintain continuity at all stages of treatment: hospital (trauma department) – clinic – sanatorium. Glucocorticoids and non-steroidal anti-inflammatory drugs are used. For severe treatment, immunosuppressants are prescribed. Lifestyle and special physical exercises play an important role in the treatment of ankylosing spondylitis.