Ankylosing spondylitis

Ankylosing spondylitis ( Bechterew's disease) is a chronic inflammatory disease of the spine. With ankylosing spondylitis, sacroiliac, intervertebral articulations, costal vertebrae joints and vertebral spine joints are affected mainly. Chronic inflammation of articulations and joints of the spine tends to develop ankylosis. Often, arthritis of the limb joints and peripheral enthesopathies are also noted, and in some patients - symptoms of internal organ damage.

Etiology, pathogenesis are unclear. Great importance is attached to the genetic features of the immune system. Mostly male patients are ill. The disease usually begins at the end of the second - the beginning of the third decade of life.

Symptoms, course. Defeat of the spine is an obligatory symptom. Pain in one or another of its departments is noted, more often in the lumbar and sacral, sometimes in all parts, worse at night; Morning stiffness. Later, the restriction of the spine movements is added: the patient can not reach with the fingers of the floor, without bending the knees, with the chin - the sternum, the respiratory excursion of the thorax decreases. Gradually, there is a smoothing of the physiological curves of the spine and the formation of the kyphosis of the thoracic region, so in some cases the correct diagnosis can be made "at a distance", according to the characteristic "pose of the petitioner" of the patient. The course of this (so-called central) form of the disease is usually slow, long-term, with periods of exacerbations and remissions.

With Bekhterev's disease, arthritis of the joints of the extremities, which has certain features, is often noted. More often the large joints of the lower extremities (hip, knee, ankle), as well as brachial and sternocleidic, are affected. Typical are oligoarthritis and asymmetric joint damage. Sometimes arthritis of small joints of hands and feet arises. Arthritis of the limb joints with ankylosing spondylitis is usually short-lived (1 to 2 months), but in some patients it can be prolonged for a long time. Even in these cases, unlike rheumatoid arthritis, as a rule, the destruction of the joints, their deformation does not occur (with the exception of the hip joints in far-reaching cases). Characteristic myalgia (especially the back muscles), the development of antezopathies, mainly in the calcaneal region.

In a number of cases, the internal organs are damaged: the eye (iritis), the aorta (aortitis), myocarditis (myocarditis), rarely the endocardium (possibly the failure of the valves), the kidneys (glomerulonephritis), the lower urinary tract (urethritis), etc. Diseases in a number of patients develop systemic amyloidosis with a predominant kidney damage. Radiography of the spine is of primary importance in diagnosis. Sacroiliitis is the earliest radiologic symptom that can develop 4 to 6 months after the onset of the disease. X-ray signs of lesions of other parts of the spine are revealed much later. The development of ossification of the outer sections of fibrous intervertebral discs, primarily in the thoracic region, is the development of so-called syndesmophytes.

Treatment. The main importance in the treatment is the long-term use of non-steroidal anti-inflammatory drugs, usually indomethacin or orthophene in a daily dose of 100-150 mg (sometimes more) for many months and years. Less important are other drugs of this group (ibuprofen, naproxen, butadione, etc.), which can be prescribed with poor tolerability of indomethacin or orthophene. Corticosteroid preparations for oral ingestion with ankylosing spondylitis are ineffective, they are used only when internal organs are damaged, especially yrite. In the presence of arthritis of joints of the extremities, intra-articular administration of corticosteroids is shown, in these cases, sulfasalazine (2 g per day) is sometimes effective. Gold preparations, quinoline derivatives, O-penicillamine, immunosuppressants in contrast to rheumatoid arthritis are usually ineffective. An important role in the attraction of ankylosing spondylitis is given to physiotherapy exercises aimed at preserving the mobility and strengthening of the spine muscles, as well as massaging the back muscles. Additional value has hardware physiotherapy (hydrocortisone phonophoresis), as well as balneo- and mud therapy