Bechterew’s disease is a chronic inflammatory disease of the spine and joints with progressive limitation of movement. 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 a pathological thoracic kyphosis typical of Bekhterev’s disease is formed. The amount of movement in the joints is gradually restricted, and the spine becomes immobile. The pathology is diagnosed taking into account clinical symptoms, X-ray data, CT, MRI and laboratory tests. Treatment consists of medication therapy, physical therapy and physical therapy.
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The causes of the development of Bechterew’s disease are not fully elucidated. 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 Bechterew’s disease are carriers of a certain antigen (HLA-B27), which causes changes in the immune system.
A change in the immune status as a result of hypothermia, acute or chronic infectious disease can trigger the development of the disease. Bechterew’s disease can be triggered by trauma to the spine or pelvis. Hormonal disorders, infectious-allergic diseases, chronic inflammation of the intestines and urogenital organs are risk factors in the development of the disease.
Between the vertebrae are elastic intervertebral discs that provide mobility to the spine. There are long, thick ligaments on the back, front and sides of the spine that make the spinal column more stable. Each vertebra has four spines, two upper and two lower. The spurs of the adjacent vertebrae are connected by moving joints.
In Bechterew’s disease, the constant aggression of immune cells results in a chronic inflammatory process in the joint, ligament, and intervertebral disc tissue. The elastic connective tissue structures are gradually replaced by hard bone tissue. The spine loses mobility. Immune cells in Bechterew’s disease 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.
Depending on the predominant involvement of organs and systems, rheumatology, traumatology and orthopedics distinguish the following forms of Bechterew’s disease:
The central form. Only the spine is affected. Two types of the central form of the disease are distinguished: kyphosis (accompanied by kyphosis of the thoracic spine and hyperlordosis of the cervical spine) and rigid form (the thoracic and lumbar curves of the spine flatten, the back becomes straight as a board).
Rhizomelic form. The lesion of the spine is accompanied by changes on the side of the so-called root joints (hips and shoulders).
Peripheral form. The disease affects the spine and peripheral joints (ankles, knees, elbows).
Scandinavian form. The clinical manifestations resemble the initial stages of rheumatoid arthritis. Deformation and destruction of joints do not occur. Small joints of the hand are affected.
Some researchers additionally distinguish a visceral form of Behterev’s disease in which damage to joints and spine is accompanied by changes in the internal organs (heart, kidneys, eyes, aorta, urinary tract, etc.).
Symptoms of Bechterew’s disease
The disease begins subtly, gradually. Some patients note that for 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 symptomatology is so weak that patients do not go to the doctor. Persistent, poorly treatable eye lesions (episcleritis, iritis, iridocyclitis) sometimes become a precursor of Bechterew’s disease.
A characteristic early symptom of Behterew’s disease is pain and stiffness in the lumbar spine. Symptoms occur at night, intensify in the morning, and decrease after hot showers 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 flatten. Pathological kyphosis (pronounced stooping) of the thoracic region is formed. As a result of inflammation in the intervertebral joints and ligaments of the spine, there is constant tension in the muscles of the back.
In the later stages of Bekhterev’s disease, the vertebral joints fuse, and the intervertebral discs ossify. Intervertebral bone “bridges” are formed, which are clearly visible on spinal X-rays. Changes in the spine develop slowly over several years. Periods of exacerbations alternate with more or less long remissions.
Often one of the first clinically significant symptoms of Bekhterev’s disease is sacroileitis (inflammation of the sacroiliac joints). The patient is disturbed by pain deep in the buttocks, sometimes spreading to the groin area and upper thighs. This pain is often considered a sign of sciatic nerve inflammation, herniated disc or radiculitis. Pain in large joints occurs in about half of all patients. The feeling of stiffness and pain in the joints is more pronounced in the morning and in the first half of the day. Small joints are affected less frequently.
In about thirty percent of cases, Bechterew’s disease is accompanied by changes in the eyes and internal organs. Heart tissue may be affected (myocarditis, sometimes a valve heart defect is formed as a result of inflammation), aorta, lungs, kidneys and urinary tract. Bechterew’s disease often affects the tissues of the eyes, developing iritis, iridocyclitis, or uveitis.
A diagnosis of Bechterew’s disease is made on the basis of an examination, medical history, and additional examinations. The patient needs a consultation with an orthopedist and a neurologist. X-ray examination, MRI and CT scan of the spine are performed. According to the results of the general blood analysis, an increase in the sedimentation rate is detected. In doubtful cases, a special test is performed to detect the HLA-B27 antigen.
Bechterew’s disease must be differentiated from degenerative spine diseases (DZP) – spondylosis and osteochondrosis. Bekhterew’s disease more often affects young men, while dyspepsia usually develops at an older age. Pain in Bechterew’s disease is worse in the morning and at rest. DZP is characterized by an increase in pain in the evening and after physical exertion. The sed rate in CPD is not increased, and no specific changes are detected on the spinal X-ray.
The Scandinavian form of Behterew’s disease (predominantly affecting small joints) should be differentiated from rheumatoid arthritis. In contrast to Bechterew’s disease, rheumatoid arthritis usually affects women. In Bechterew’s disease, symmetrical joint involvement is almost uncommon. Patients have no subcutaneous rheumatoid nodules, and in blood tests, rheumatoid factor is detected in 3-15% of cases (in patients with rheumatoid arthritis, in 80% of cases).
Treatment for Bechterew’s disease
Therapy is complex and prolonged. It is necessary to observe continuity at all stages of treatment: hospital (traumatology department) – polyclinic – sanatorium. Glucocorticoids and nonsteroidal anti-inflammatory drugs, therapeutic blockades are used. In severe treatment immunosuppressants are prescribed. A great role in the treatment of Bechterew’s disease is played by lifestyle and special physical exercises.
The program of therapeutic gymnastics is made up individually. Exercises must be done daily. To prevent incorrect postures (beggar’s pose, proud pose), the patient is recommended to sleep on a hard bed without a pillow and to take regular exercises to strengthen the muscles of the back (swimming, skiing). Respiratory exercises should be done to maintain the mobility of the chest. Massage, magnetic therapy and reflexotherapy are used in treatment. Patients with Bechterew’s disease are recommended for radon, hydrogen sulfide, nitrogen therapeutic baths.
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