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Bechterew’s disease – this is an inflammation of the intervertebral joints, leading to the formation of ankylosis. As a result, the spinal column is enclosed in a rigid bone corset, which greatly limits its mobility. Bechterew’s disease is also called ankylosing spondylitis, as the term “ankylosis” means fusion.
If we turn to statistics, the number of people with this disease in different countries varies from 0,5 to 2%. Women get sick less often, so, for nine male patients, there is only one woman. In addition, representatives of the weaker sex endure Bechterew’s disease much easier. Mostly young people aged 15 to 30 are ill. After the age of 50, pathology is diagnosed extremely rarely. Among all rheumatological diseases, Bechterew’s disease occupies the last position in terms of frequency of occurrence. As for the Russian Federation, in the country this pathology is diagnosed in an average of 400 thousand people.
The disease is often confused with osteochondrosis, which is also manifested by back pain. However, ankylosing spondylitis leads to complete immobility of the joints of the spinal column, which is its main danger.
Causes of ankylosing spondylitis
Pathology refers to idiopathic diseases. This means that the causes of Bechterew’s disease are still not exactly known to science. However, it has been established that 96% of people have damage to the inherited gene of the HLA system. It is these genes that are responsible for normal immune responses to various diseases, they regulate the severity of the immune response, etc.
Damage to the normal structure of the gene occurs due to the impact on the body of pathogenic factors, as a result, it is transformed into an antigen. This antigen is passed from parents to children and is called HLA-B27.
Interacting with healthy cells, this antigen forms certain complexes, to which the immune system reacts as foreign. He begins to attack them, thereby provoking an inflammatory reaction.
Factors that can provoke the disease:
Diseases of the genitourinary system of an inflammatory nature.
Inflammation of the intestines and other organs due to infection with streptococci and Klebsiella.
Dysfunction of the endocrine glands.
Fractures of the pelvis.
Subcooling the body.
However, gene mutations are not the only cause of the development of the disease, since a thorough examination of healthy people reveals the HLA-B27 antigen in them. It is present in 9% of the population, while only 25% of them will have a latent course of the disease. The rest of the people who carry the antigen do not suffer from this pathology at all, but trauma or a severe cold can provoke it. In addition, in about 15% of people suffering from Bechterew’s disease, this antigen is not detected at all, but they are able to transmit the disease to their descendants by inheritance.
Recent studies on mice, which were conducted about the study of Bechterew’s disease, showed that the pathology develops in rodents in the presence of antigen, infection and T-lymphocytes circulating in the blood. That is, a combination of at least three pathogenic factors is necessary. The disease did not develop in those animals in which the thymus responsible for the production of T-lymphocytes was removed.
The first signs of ankylosing spondylitis
The first signs of Bechterew’s disease are as follows:
Stiffness and pain in the loin and in the region of the sacrum. Possible irradiation of painful sensations in the lower limbs, in the buttocks. The pain tends to get worse in the morning.
At a young age, pain occurs in the heel area.
Stiffness extends to the thoracic spine.
If you perform a clinical blood test on a patient, then the ESR will be increased in the range from 30 to 60 mm / h.
If such signs persist in a person for several months, then contacting a specialist should be immediate. In this case, you need to insist on a consultation with a rheumatologist.
Symptoms of ankylosing spondylitis
Symptoms of Bechterew’s disease are primarily manifested in pain that occurs in the spinal column, then other clinical signs of pathology appear. It is important to be able to distinguish them not only for the doctor, but also for the patient himself, which will allow for a faster diagnosis.
Features of pain in Bechterew’s disease
Pain occurs in the region of the sacrum. They are especially intense in the morning. So, after waking up, a person cannot move his arms and legs for some time. Within 30 minutes, this stiffness usually resolves.
A distinctive feature of the disease is that after the cessation of movement, the pain does not become less intense, but, on the contrary, intensifies. Physical exercise brings relief.
The nature of painful sensations depends on the form of Bechterew’s disease. So, with the rhizomelic and central forms of the disease, pain is localized in the spinal column, as the disease progresses, a stoop is formed. If the patient has a peripheral form of the disease, then the joints of the knees and legs will initially swell and hurt.
You can suspect this pathology by the time of onset of pain. They often begin to disturb a person at night, and during the day they practically disappear.
Organ and organ system disorders
The first to suffer are small vertebral joints, as well as those joints that connect the ilium to the sacral vertebrae and the joints of the pubic articulation. The surface of the bones that form the joint, as the disease progresses, begins to break down, resulting in an acute, and then a chronic process of inflammation.
The cells that form cartilage begin to grow, the articular surfaces fuse, and then bone tissue grows into them. Articular ligaments also ossify. As a result, the person becomes immobilized.
The entire spinal column undergoes a pathological process, starting from the first lumbar vertebra and ending with the seventh thoracic vertebra. When the bone tissues grow to the maximum, the spine in its appearance begins to resemble a bamboo stalk.
As for other joints, at the first stages of the development of the disease, the process of inflammation in them is passing, with periodic relapses. As the pathology progresses, the inflammatory process becomes chronic with the replacement of connective tissue with fibrous tissue and with the growth of bone tissues. As a result, the joints of the legs and arms, as well as the joints of the chest, are exposed to ankylosis.
About 25% of patients suffer from inflammation of the vascular and iris. In the future, they develop secondary glaucoma.
In a small part of patients, atrophic processes are observed inside the membrane of large vessels located in the upper body. The aorta is also affected. This leads to the appearance of intravascular fibrous fibers, which disrupts the functioning of the valves of the main artery of the heart. As a result, a person has rhythm disturbances, pericarditis develops. Similar manifestations of the disease affect from 2 to 8% of patients.
The upper parts of the lungs are sometimes inflamed. They form cavities similar to cavities in cavernous tuberculosis. Damage to the liver and kidneys leads to the gradual failure of these organs to function normally.
Other symptoms of Bechterew’s disease
Diagnosis of the disease solely on the basis of symptoms is often difficult, as they are very diverse. The beginning of the pathological process can proceed in different ways. There are five options for the development of the clinical picture:
The inflammatory process is localized in the lumbar region and the sacrum, the intensity of pain is constantly increasing. In parallel, there are painful sensations in the joints of the limbs.
Perhaps inflammation of one or more joints, and it is not necessary that they will be located symmetrically. Inflammation is characterized by frequent exacerbations and remissions. The lumbosacral zone is involved in the process of inflammation somewhat later. Most often, this type of disease develops in young people.
In childhood and adolescence, the manifestation of the disease most often resembles a rheumatic attack. Large joints are inflamed, they swell, the skin over them turns red, the body temperature increases. The sacroiliac joints are involved in the pathological process after some time.
The rarest variant of the course of the disease is accompanied by such signs as: an increase in body temperature to high levels, temperature instability with a tendency to increase by 1-2 degrees in the morning. The patient begins to lose weight, feels weak, sweating increases. Pain in the joints and muscles occurs after 14-21 days.
Sometimes in patients, blood vessels and the heart muscle are primarily affected. Signs of inflammation can be seen on a blood test. In parallel, symptoms of iritis and iridocyclitis are observed. Articular inflammation manifests only months later.
Differences in the course of Bechterew’s disease in men and women
It was found that the disease proceeds differently in men and women.
Criteria | Symptoms of the disease in women | Symptoms of the disease in men |
How the disease manifests | Symptoms are mild, acute inflammation is absent. | It develops acutely, the symptoms are pronounced. |
Calm periods. | Long. | Short. |
Time from the onset of the disease to the onset of the first symptoms. | From 10 to 20 years old. | From 4 to 5 years old. |
The predominant site of localization of inflammation. | Spine and large joints. | Spine and small joints. |
Damage to the spinal column. | The sacral and lumbar department suffers, but no strong changes are observed. | All parts of the spine suffer, its pathological curvature develops, mobility is severely limited. |
Damage to blood vessels, lungs and other organs. | Occurs rarely. | Seen frequently. |
Other drug therapy
To reduce inflammation in the joints and to provide a bactericidal effect, the drug Sulfasalazine (Salazosulfapyridine) may be prescribed. However, the therapeutic effect may occur after 3-7 months from the start of treatment.
To reduce muscle tension, Tolperison or Mydocalm is prescribed.
Glucocorticoids quickly and effectively relieve inflammation, but their prolonged use can cause a number of complications from the digestive system. Probable development of osteoporosis and diabetes.
If a person has a severe course of the disease, then he is shown taking cytostatics and corticosteroids.
Such drugs as Plavenil, Delagil, Kuprenil do not have a pronounced effect on the course of the disease.
Treatment with stem cells
One of the modern methods of treating Bechterew’s disease is stem cell therapy. It should be started in the early stages, when the ossification of the spinal column and diseased joints has not yet occurred.
Stem cells are able to stop the progression of the disease and prevent the process of bone tissue growth. At the same time, pain decreases, the range of motion increases, the person begins to feel much better. If you combine stem cell treatment with gymnastic exercises, the effect will come even faster.
As for the prognosis, with timely treatment, it is quite favorable. Of course, it will not be possible to completely get rid of the disease, but it is quite possible for every patient to slow down its development. The main thing is to regularly visit the doctor’s office, and in case of exacerbation of the pathology, carefully follow all the recommendations of the doctor.
Which doctor to contact?
A vertebrologist is a specialist in diseases of the spine.