Ankylosing spondylitis (Bekhterev’s disease) refers to systemic inflammatory diseases in which the spine is predominantly affected.
The pathological process in the spine gradually leads to the fusion of individual vertebrae (ankylosing), which results in the development of restricted mobility of the spine. At the same time, there is ossification of the ligaments surrounding the spine, resulting in a greater or lesser degree of loss of mobility of the spine.
Ankylosing spondylitis affects mostly young men (3-6 times more often than women). The peak incidence of the disease falls on the age interval of 25-35 years. It is believed that men and women over 45-50 years of age are extremely rare.
Causes
The exact causes of the development of Bekhterev’s disease are still unknown. As in other rheumatic diseases, the basis is the improper functioning of the immune system. The body’s defense functions are directed against the cells and tissues of the body and thus cause inflammatory reactions. Ankylosing spondylitis is among the autoimmune diseases.
Specialists associate it in specific cases with genetic inheritance. Hereditary predisposition is at the root of the occurrence of Bekhterev’s disease. If one of the parents has Bekhterev’s disease, the risk of the child’s disease is estimated at 4 to 15%.
Symptoms of Bekhterev’s disease and their features
A characteristic feature of the pathological process in the early stages is the absence of a clinical picture. The main symptoms of Bekhterev’s disease include back pain, and report the appearance of discomfort in the second half of the night.
Common early signs also include:
- Occasional pain in the hip, knee, and shoulder;
- heel pain, change in gait;
- pain or discomfort in one or more tendons;
- increased fatigue with adequate rest;
- weight loss with constant caloric intake;
- pain when coughing or sneezing.
Starting at the sacroiliac joints, the pain spreads to both legs (hip) and buttocks. Discomfort in the buttocks alternates between the left and right side. Bekhterev’s disease is a chronic condition and often occurs in flare-ups. Patients experience periods of intense discomfort and fading.
Diagnosis of Bekhterev’s disease
Diagnosis of Bekhterev’s disease is aimed not only at assessing musculoskeletal damage, but also at determining the degree of activity of the inflammatory process. The examination program may include the following methods:
- radiographic evaluation of the sacroiliac joint and spinal joints;
- general clinical blood test to assess erythrocyte sedimentation rate;
- determination of plasma C-reactive protein levels;
- laboratory determination of circulating immune complex concentrations in the blood.
Radiography can detect the disease at the stage when there is a lesion of the sacroiliac joints. Therefore, according to clinical guidelines for Bekhterev’s disease, the initial stages of the pathological process are not identified on radiographs. For early diagnosis, magnetic resonance imaging is the most informative. It allows detecting pathological changes not only in the sacroiliac joints, but also in the hip joints.
Treatment methods for Bekhterev’s disease
Treatment methods for Bekhterev’s disease are divided into conservative treatment, which is most appropriate in the early stages of the disease, and surgical treatment, which is indicated when bone deformities develop.
Conservative treatment
The main objectives of conservative treatment are:
- complete elimination or significant reduction in the intensity of pain syndrome;
- improvement of mobility in the spine;
- reduction in the severity of muscle fatigue;
- increase in the functional capabilities of the spine;
- slowing of structural changes.
The main directions of the conservative approach in the treatment of Bekhterev’s disease are:
- Kinesiotaping. Properly applied tapes can reduce the load on the spine and activate diaphragmatic breathing.
- Therapeutic exercise. The complex of exercises is developed by a doctor. The specialist composes non-force training, which involves the performance of smooth movements with a dosed load. Swimming has a particularly good effect on the state of the spine.
- Drug therapy. The first line of drugs – these are non-steroids, which allow you to buy pain. If the therapy is ineffective, corticosteroids are prescribed. To reduce muscle spasm, myorelaxing agents are used.
Surgery for Bekhterev’s disease
Surgery for Bekhterev’s disease is recommended when the hip joints are affected with a tendency to develop ankylosis (third stage of functional joint insufficiency). The scope of surgical intervention consists of prosthetic hip joint replacement.
Rehabilitation in Bekhterev’s disease
Rehabilitation in Bekhterev’s disease after surgery is limited to timely restoration of the function of the operated hip joint. For this purpose, courses of physiotherapeutic procedures, massage and physical therapy exercises (under the supervision of a specialist in physical therapy) are recommended.
Immediately after surgery, the operated leg should not be subjected to physical activity for several days. At this time, walking on crutches is recommended. After the doctor’s authorization, you can walk with the lower limb resting on the lower limb, working on its gradual recovery.
Prevention
There is no specific prevention of Bekhterev’s disease. Patients with an already diagnosed diagnosis should control their lifestyle to slow the progression of symptoms. It is important to follow a number of rules:
- sleep only on a hard, flat surface;
- avoid static load on the spinal column, especially lifting weights;
- eat enough protein daily, minimize fats and carbohydrates in the diet.
To monitor the condition in dynamics, it is necessary to regularly visit a doctor.
Conclusion
Bekhterev’s disease is a serious chronic disease that requires a comprehensive approach to diagnosis, treatment and rehabilitation. Despite the fact that complete cure is currently impossible, timely detection and appropriately selected therapy can significantly slow disease progression, preserve quality of life and prevent disability. The key elements of successful management of the disease are regular medical supervision, adherence to treatment, active lifestyle and proper nutrition. Special attention should be paid to physical activity, including physical therapy and physiotherapy, which help to maintain spinal mobility and prevent the development of complications.
