Ankylosing spondylitis ( ankylosing spondylitis ) - Causes, Symptoms and Treatment .MF .
International name ankylosing spondylitis - ankylosing spondylitis .The disease is an inflammation of the intervertebral joints, which leads to ankylosis (fusion of), due to which the spine is as if in a hard case, limiting movement.The number of patients is 0.5-2% in different countries.Mostly susceptible young men, often 15 - 30 years.Male to female ratio of 9: 1.There is a young age, more often in men, in women is considerably easier.Mainly it affects the spine and sacroiliac joints, large joints of the lower extremities.Can hit the iris (Iritis).It is not necessary that one patient will take place all of the localization of inflammation, occurs very different combination of inflammatory symptoms.
Causes of ankylosing spondylitis is genetic (inherited certain features of the immune system).What matters is the presence of chronic infections (mostly intestinal and urinary tract).Provoking factor act usually intestinal, genital infections, stress and injuries of the musculoskeletal system.
To date, it is believed that the disease occurs due to malfunction of the immune system.In this regard, ankylosing spondylitis is called an autoimmune disease (autos - from the Greek root "self").The sacroiliac joints are especially high concentrations of TNF-a, which is in the direct epicenter of the disease and plays a central role.It can be largely regarded as the originator of the spine due to chronic inflammation and stiffness becomes inoperative.Consequently, there are no effective methods of treatment of ankylosing spondylitis.Fully cured it is impossible, but with the help of various medications, physical therapy and physiotherapy can suspend the development of the disease and significantly improve the patient's quality of life.
diagnosis of ankylosing spondylitis is often also associated with certain problems.Ankylosis of joints, which is indicative of the disease can be distinguished in the diffraction patterns, only when the disease has reached the second stage.In the first stage ankylosing spondylitis can figure out with the help of magnetic resonance imaging, which, unfortunately, is rarely carried out.
In advanced forms of diagnosis does not cause difficulties.But the main problem of people suffering from spondylitis, it is late diagnosis exhibited.Therefore'll focus on manifestations of the disease and distinguish it from others is in its early stages.
What should we look for?
- Stiffness, pain in the sacroiliac area, which can be given in the buttocks, lower extremities, intensified in the second half of the night.
- Persistent pain in the heel bones in young people.
- Pain and stiffness in the thoracic spine.
- Increased blood ESR analysis of up to 30-40 mm per hour and above.
In the case of preservation of these symptoms for more than three months need immediate consultation rheumatologist!
not always a disease starts with the spine, it can start with the joints of hands and feet (resembling rheumatoid arthritis), inflammatory diseases of the eye, with the defeat of the aorta or heart.Sometimes there is a slow progression, when the pain is almost not expressed, the disease is detected incidentally on X-ray examination.
Over time, increases spinal mobility restriction, difficult and painful tilts sideways, forward, backward, there is a shortening of the spine.Deep breathing, coughing, sneezing can also cause pain.Peace and stillness increased pain and stiffness, and movement and moderate physical activity - is reduced.If untreated, complete immobility of the spine may occur, the patient gets a pose "supplicant" (arms bent at the elbows, back hunched, his head bent, legs slightly bent at the knees).
Intrigue ankylosing spondylitis is that without proper care and regular exercise therapy, physical therapy the patient gradually fixed all the joints, and it is confined to bed.In addition, ankylosing spondylitis have a number of co-morbidities.Most often inflamed eyes, due to restrictions of movement in the chest developed pulmonary tuberculosis, frequent reception of strong medicines leads to ulcer disease.However, despite all this, patients with Ankylosing spondylitis - this is, for the most part, strong-willed and cheerful people.They become so, even if not differ optimism to the disease.Ankylosing spondylitis causes a person to collect will in a fist, regularly engaged in physical culture, to appreciate each day, in which he can be a full-fledged member of society.
As from any diseases to be distinguished ankylosing spondylitis?
The first step is to distinguish from degenerative diseases of the spine (PCRs) - osteochondrosis, spondylosis.Diagnosis will help the knowledge of the next:
1. Ankylosing spondylitis primarily occurs in young men and PCRs, in spite of the tendency to "rejuvenate" their recently still predominantly occur after 35-40 years.
2. When ankylosing spondylitis pain worse at rest or during prolonged stay in one position, especially in the second half of the night.When PCRs, on the contrary, the pain occur or are worse after physical exertion at the end of the working day.
3. One of the early symptoms of ankylosing spondylitis - strain the back muscles, their gradual atrophy and stiffness of the spine.When PCRs movement limitation occurs at the height of pain and sciatica, pain at removal of spinal mobility is restored.
4. The early characteristic of ankylosing spondylitis radiographic changes in the sacroiliac joints of the spine do not occur in PCRs.
5. When ankylosing spondylitis frequently observed increase in ESR in the blood test, other positive signs of biochemical activity of the process, which does not happen with the PCRs.
Often lesions of peripheral joints appear before the defeat of the spine, so it is necessary to distinguish the primary form of ankylosing spondylitis and rheumatoid arthritis.Here you need to remember:
1. RA often affects women (75%).
2. For RA is characterized by symmetric joint disease (preferably wrist joints), which is rare with ankylosing spondylitis.
3. Sacroiliitis (inflammation of the sacroiliac joints), loss grudinoklyuchichnyh grudinorёbernyh and joints exceptionally rare in RA, ankylosing spondylitis and for the very characteristic.
4. Rheumatoid Factor in serum occurs in 80% of RA patients and in only 3-15% of patients with Ankylosing spondylitis.
5. Subcutaneous rheumatoid nodules, occurring at the RA in 25% of cases, is not the case with ankylosing spondylitis.
6. HLA-27 (specific antigen, detected by blood test) is characteristic only for ankylosing spondylitis.
How to treat ankylosing spondylitis?
Modern medicine uses three main methods of treatment of ankylosing spondylitis.This suppression of the immune system, which is expected to provoke disease.This hormone therapy - the introduction of artificially synthesized hormones corticosteroids, struggling with inflammation in the joints.Physiotherapy and used in combination with drugs.
Treatment should be complex, lengthy, landmark (hospital - sanatorium - Clinic).Used non-steroidal anti-inflammatory drugs, glyukokorikoidy under heavy current immunosuppressants.Widely used physiotherapy, manual therapy, therapeutic exercises.Therapeutic exercises should be done twice a day for 30 minutes, the doctor picks up the exercise individually.In addition, you need to learn muscle relaxation.In order to inhibit the development of the immobility of the chest, we recommend deep breathing.In the initial stage it is important to prevent the development of perverse postures of the spine (the proud posture, suppliant posture).Showing skiing and swimming, strengthens the back muscles and buttocks.The bed should be hard, the pillow should be removed.
disease is a progressive, but competent care can resist him.The main task - to delay the progression of the disease, do not let her move.Therefore, you must have regular checkups rheumatologist, and in exacerbations go to the hospital.The goal is the removal of pain and the development of the spine stiffness.
course, ankylosing spondylitis - a very serious disease, and the purpose of the article in any case does not call for self-healing.Knowledge should only send to attentive attitude to their own health and help avoid the terrible consequences of this disease.
Causes of ankylosing spondylitis
Causes of ankylosing spondylitis (ankylosing spondylitis) science is still uncertain.However, scientists have deduced the relationship between the disease and the presence of a human antigen HLA B27.This does not mean that the presence of this antigen will sooner or later lead to the development of the disease, but evidence of a genetic predisposition.There is a theory according to which the HLA B27 antigen gives the similarity of articular tissues of people carrying the gene with certain kinds of infections.When the gene is a carrier picks up any infection, the immune system produces antibodies to fight it.Antibodies destroy the infection, this is introduced, followed by "attacking" the joints mistaking them for infection.However, it is one of the hypotheses.
It is known only that the HLA B27 antigen is present in all cases Ankylosing spondylitis.But not all carriers of this gene definitely sick Ankylosing spondylitis.There is a specific mechanism that triggers the disease program.This may be an infectious disease, even banal cold, moved to his feet.By the development of ankylosing spondylitis can cause accidental injury or constant stress.
Oddly enough, the study of ankylosing spondylitis and its causes in the world, almost no one does.The few studies rarely provide new knowledge about the disease.From recent research we can recall only conducted experiments on mice have shown that the disease is similar to ankylosing spondylitis, these rodents occurs when the combination of three factors: the presence of HLA B27 antigen, infection from abroad and the presence of T-lymphocytes in the blood.If the mouse is kept in a sterile environment or she has been removed thymus - the body responsible for the production of T-cells, the disease did not develop.
Since that has not been studied mechanism of development of ankylosing spondylitis, it is difficult to talk about any prevention.Obviously, people-carriers of the antigen HLA B27 should closely monitor their health, avoid traumatic situations, in time to treat infectious diseases.People who already have ankylosing spondylitis, can only prevent complications and slow down the development of spondylitis by constant therapy, physical therapy sessions, spa treatment.
Joint Pain - smptom ankylosing spondylitis
Ankylosing spondylitis (ankylosing spondylitis), do not develop symptoms, but the first manifestations of the disease is often overlooked, not only doctors but also patients.The first and most common symptoms - a pain in the sacrum, which is often mistaken for sciatica, a constant feeling of fatigue and joint pain.More specific is the so-called "morning" syndrome, when he woke up after a night of sleep, the man for some time can not move his limbs.Immobility in the joints usually takes half an hour.
Pain in the joints characteristic of many diseases, ankylosing spondylitis but is distinguished by the fact that in this case the pain persists for the rest of the joint.On the other hand, can bring relief exercise.
Ankylosing spondylitis can occur in three forms: central and peripheral Rizomelicheskaya.In the first two forms, symptoms include pain in the spine, developing a slouch, the inability to straighten themselves.When the peripheral form of the disease begins with the defeat of the knee and ankle joints.Swollen knee joints - one of the reasons to suspect the disease.
Night pain - one more symptom of the disease.They are usually worse towards morning.During the day, in the afternoon, can almost completely disappear.
About ankylosing spondylitis symptoms may indicate not only on the part of the joints but also other organs and body systems.A frequent concomitant symptom is inflammation in the organs of vision.In patients with ankylosing spondylitis there are problems from respiratory disorders due to the form of the chest.
As the disease changes the posture of the patient due to the disappearance of the physiological curves of the spine.Loins becomes unnaturally straight, the person loses the ability to bend not only forward and backward, but also sideways (this feature helps doctors distinguish patients with Ankylosing spondylitis patients from the severe form of degenerative disc disease).Next affects root joints - the hip and shoulder.Usually the disease "goes" from the bottom up, so the latter are affected and lose mobility of the vertebrae of the cervical.
Inflammatory processes in joints often accompanied by a slight fever and elevated erythrocyte sedimentation rate in blood.
diagnosis of ankylosing spondylitis
Diagnostic symptoms of ankylosing spondylitis:
On the recommendation of the Institute of Rheumatology RAMS 1997
1. Pain in the lumbar region is not alone in passing, facilitated by moving and lasting more than 3 months .;
2. Limiting the mobility of the lumbar spine in the sagittal and frontal planes;
3. Limitation of respiratory chest rise with respect to the normal values according to age and gender;
4. Bilateral sacroiliitis stage II-IV.
diagnosis is considered valid if the patient has a fourth feature in combination with any of the first three.
diagnosis of ankylosing spondylitis (ankylosing spondylitis) is often placed only when the disease has already passed into running or severe forms.This is due in part to poor knowledge of the disease, partly with a common first symptoms thereof.doctors often confuse ankylosing spondylitis with other joint diseases, early symptoms are often written off as osteochondrosis.
For suspected ankylosing spondylitis necessarily carried out X-ray examination.This method of diagnosis still remains the most widely used and is considered the most reliable.The patient is a snapshot of the pelvis.Changes in the sacroiliac joints to the doctor - a reason to suspect ankylosing spondylitis.At the first stage of the disease in the picture is much the expansion of joint space, blurred contours of the joints.In the second stage in the picture will be visible single erosion of articular tissues.The third - a partial ankylosis (fixation) of the sacroiliac joint.The fourth stage - is pronounced complete ankylosis.
However, changes in the joints in the early stages of the disease is not always visible on radiographs.A more sensitive method in this respect - magnetic resonance imaging.Unfortunately, in the cities of Russia such devices a little, and such studies are carried out very rarely.
For suspected ankylosing spondylitis conducted a study on the presence of a human antigen HLA B27, as it suggests the presence of a genetic predisposition to ankylosing spondylitis.This antigen is usually detected in 80-90 percent of patients.
additional feature of having the disease may be elevated ESR.But this method of diagnosis only in combination can be used with the other, as a high rate ESR says only that the body takes inflammation.It is not necessary, this process goes exactly in the joints, as in ankylosing spondylitis.For ankylosing spondylitis is characterized by ESR rate of 30-60 mm / h.
diagnosis of ankylosing spondylitis doctor puts on the basis of radiographic examination and clinical implications - the permanent back pain lasting at least three months, the presence of morning stiffness syndrome, disappearing after exercise, mobility restrictions in the spine of the lower divisions, not age-appropriate restriction of respiratory excursion.
Treatment of ankylosing spondylitis
Treatment: physiotherapy, exercise, physical therapy in order to avoid the wrong position or stiffness of the spine and joints.There is a gradual process of "fusion" of the vertebrae together, the spine loses its flexibility and mobility.