Ankylosing spondylitis is a chronic inflammatory disease of the spine and joints with progressive restriction of movements. The first manifestations in the form of pain and stiffness occur first in the lumbar spine, and then spread up the spinal column. Over time, pathological thoracic kyphosis, typical of disease, is formed. The volume of movements in the joints is gradually limited, the spine becomes immobile. Pathology is diagnosed taking into account clinical symptoms, radiography, CT, MRI and laboratory tests. Treatment – drug therapy, physical therapy, physiotherapy.
ICD 10
M45 Ankylosing spondylitis
Ankylosing spondylitis causes
The causes of the development of ankylosing spondylitis have not been fully clarified. According to many researchers, the main reason for the development of the disease is the increased aggression of immune cells against 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 a change in the immune system.
The starting point in the development of the disease may be a change in the immune status as a result of hypothermia, acute or chronic infectious disease. Ankylosing spondylitis can be triggered by a spinal or pelvic injury. Risk factors in the development of the disease are hormonal disorders, infectious and allergic diseases, chronic inflammation of the intestines and genitourinary organs.
Pathogenesis
Elastic intervertebral discs are located between the vertebrae, providing mobility of the spine. On the back, front and side surfaces of the spine there are long dense ligaments that make the vertebral column more stable. Each vertebra has four processes – two upper and two lower. The processes of the adjacent vertebrae are interconnected by movable joints.
In ankylosing spondylitis, as a result of the 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 solid bone tissue. The spine loses mobility. Immune cells in ankylosing spondylitis attack not only the spine. Large joints may suffer. 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 lesion of organs and systems in rheumatology, traumatology and orthopedics, the following forms of ankylosing spondylitis are distinguished:
- The central form. Only the spine is affected. There are two types of the central form of the disease: kyphosis (accompanied by kyphosis of the thoracic and hyperlordosis of the cervical spine) and rigid (thoracic and lumbar spine bends are smoothed, the back becomes straight as a board).
- Rhizomelic form. The lesion of 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. In clinical manifestations, it resembles the initial stages of rheumatoid arthritis. Deformation and destruction of joints does not occur. Small joints of the hand are affected.
Some researchers additionally distinguish the visceral form, in which damage to the joints and spine is accompanied by changes in the internal organs (heart, kidneys, eyes, aorta, urinary tract, etc.).
Ankylosing spondylitis symptoms
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, mild volatile pain in the joints and muscles. As a rule, during this period, the symptoms are so poorly expressed that patients do not consult a doctor. Sometimes persistent, poorly treatable 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, increase in the morning, decrease after a hot shower and exercise. During the day, pain and stiffness occur at rest, disappear or decrease 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, there is a constant tension of the back muscles.
In the later stages of ankylosing spondylitis, the joints of the vertebrae fuse, the intervertebral discs ossify. Intervertebral bone “bridges” are formed, which are clearly visible on radiographs of the spine. Changes in the spine develop slowly, over several years. Periods of exacerbations alternate with more or less prolonged remissions.
Sacroiliitis (inflammation of the sacrum joints) often becomes one of the first clinically significant symptoms of ankylosing spondylitis. The patient is concerned about pain in the depth of the buttocks, sometimes extending to the groin area and upper thighs. Often this pain is considered a sign of inflammation of the sciatic nerve, herniated disc or sciatica. Pain in large joints appears in about half of patients. The feeling of stiffness and joint pain is more pronounced in the morning and in the morning. Small joints are affected less often.
In about thirty percent of cases, ankylosing spondylitis is accompanied by changes in the eyes and internal organs. Possible lesions of cardiac tissues (myocarditis, sometimes as a result of inflammation, valvular heart disease is formed), aorta, lungs, kidneys and urinary tract. With ankylosing spondylitis, eye tissues are often affected, iritis, iridocyclitis or uveitis develops.
Diagnostics
The diagnosis of ankylosing spondylitis is made on the basis of examination, medical history and additional research data. The patient needs to consult an orthopedist and a neurologist. X-ray examination, MRI and CT of the spine are performed. According to the results of a general blood test, an increase in ESR is detected. In doubtful cases, a special analysis is performed to detect the HLA-B27 antigen.
Ankylosing spondylitis must be differentiated from degenerative spinal diseases (DSD) – spondylosis and osteochondrosis. Ankylosing spondylitis more often affects young men, while DSD usually develops at an older age. Pain in ankylosing spondylitis increases in the morning and at rest. DSD is characterized by increased pain in the evenings and after physical exertion. ESR does not increase with DSD, specific changes are not detected on the radiograph of the spine.
The Scandinavian form of ankylosing spondylitis (predominant lesion of small joints) should be differentiated from rheumatoid arthritis. Unlike ankylosing spondylitis, rheumatoid arthritis usually affects women. In ankylosing spondylitis, symmetrical joint damage is practically not found. Patients do not have subcutaneous rheumatoid nodules, when examining blood, rheumatoid factor is detected in 3-15% of cases (in patients with rheumatoid arthritis – in 80% of cases).
Ankylosing spondylitis treatment
The therapy is complex, long-lasting. It is necessary to observe continuity at all stages of treatment: hospital (department of traumatology) – polyclinic – sanatorium. Glucocorticoids and nonsteroidal anti-inflammatory drugs, therapeutic blockades are used. In severe treatment, immunosuppressants are prescribed. Lifestyle and special physical exercises play an important role in the treatment of ankylosing spondylitis.
The program of therapeutic gymnastics is compiled individually. Exercises should be performed daily. To prevent the development of vicious poses (supplicant pose, proud pose), the patient is recommended to sleep on a hard bed without a pillow and regularly engage in sports that strengthen the back muscles (swimming, skiing). To maintain the mobility of the chest, it is necessary to perform breathing exercises. Massage, magnetotherapy, reflexotherapy are used in the treatment. Patients with ankylosing spondylitis are shown radon, hydrogen sulfide, nitrogen therapeutic baths.
Prognosis and prevention
It is impossible to completely recover from ankylosing spondylitis, however, if the recommendations are followed and properly selected treatment, the development of the disease can be slowed down. Patients suffering from this disease should be constantly monitored by a doctor, and in the period of exacerbation, be treated in a hospital.
Literature
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