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Ankylosing spondylitis in women and men

Ankylosing spondylitis is an inflammation of the intervertebral joints, leading to the formation of ankylosis. In the end, the vertebral column is contained in a hard bone the corset, which greatly limits his mobility. Ankylosing spondylitis is also called ankylosing spondylitis, as the term "ankylosis" means the fusion is done.

If you look at the statistics, the number of people with the disease in different countries varies from 0.5 to 2%. Women suffer less so, nine male patients accounted for only one woman. In addition, the fairer sex Bechterew disease is transferred much easier. Ill mostly young people aged 15 to 30 years. After the age of 50 years, the pathology is diagnosed very rarely. Among all rheumatic diseases are ankylosing spondylitis frequency of occurrence occupies the last position. As for the Russian Federation, in the country this pathology is diagnosed in an average of 400 thousand people.

The disease is very often confused with osteoarthritis, which is also manifested by pain in the back. However, ankylosing spondylitis leads to complete immobility of the joints of the spinal column it, what is his main danger.

The first pain is almost always regarded by the doctors of General practice, such as low back pain. The correct diagnosis is made much later, on average after 4-5 years from the manifestation of pathology. During this time the patient has time to develop gross violation of the joints of the spine, which greatly complicates the subsequent treatment and reduces its effectiveness.

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Causes of ankylosing spondylitis

Pathology refers to idiopathic diseases. This means that causes of ankylosing spondylitis science is still not exactly known. However, it was found that 96% of people there is corruption inherited gene HLA system. These genes are responsible for the normal response of the immune system in various diseases, they regulate the severity of the immune response, etc.

Damage the normal structure of the gene is due to the influence on the organism of pathogenic factors, as a result, he transformered to the antigen.This antigen is passed from parents to children and is called HLA-B27.

Engaging in interaction with healthy cells, this antigen forms specific complexes that the immune system reacts as alien. He begins to attack them, thus provoking an inflammatory reaction.

Factors that can trigger the disease:

  • Diseases of the genitourinary system 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.

  • Hypothermia.

However, gene mutation is not the only cause of the disease, because a careful examination of healthy people reveals they have the antigen HLA-B27. It is present in 9% of the population, with only 25% of them will have latent period of the disease. The rest of the people-the carriers of the antigen from this disease do not suffer at all, but it is able to trigger injury or severe cold. In addition, approximately 15% of people suffering from ankylosing spondylitis, this antigen is not detected at all, but the disease they can pass on to their descendants by inheritance.

There is still no scientific evidence about what the development of the disease have an impact of pathogenic micro-organisms. Because ankylosing spondylitis not responsive to therapy with antibiotics. However, irregularities in the immune protection occurs at the level of genetics.

Recent research on mice that was conducted on the learning of ankylosing spondylitis, demonstrated that pathology develops in rodents in the presence of antigen, infection and circulating T-lymphocytes. That is, a combination of at least three pathogenic factors. The disease did not develop in those animals that have been deleted in the thymus responsible for the production of T-lymphocytes.


The first signs of ankylosing spondylitis

The first signs of ankylosing spondylitis are the following:

  • Stiffness and pain in the lower back and sacrum. Possible irradiation of pain in the lower limbs, buttocks. Pain tend to increase during the morning hours.
  • At a young age painful sensations arise in the area of the heels.
  • The stiffness extends to the thoracic spine.
  • If you perform a patient clinicala blood test, the ESR will be increased in the range of 30 to 60 mm/hour.

If these signs still persist among the people for several months, the contact has to be immediate. Thus it is necessary to insist on consultation of a rheumatologist.


The symptoms of ankylosing spondylitis

The symptoms of ankylosing spondylitis is primarily manifested in the pains which occur in the spinal column, then there are other clinical signs of disease. It is important to be able to distinguish between them not only the doctor but to the patient, which will soon put the diagnosis.

Features of pain in ankylosing spondylitis

  • Pain occurs in the sacrum. They are particularly intense in the morning. So, a person after waking up for some time could not move his arms and legs. Within 30 minutes, the stiffness often takes place.
  • The hallmark of the disease is that after cessation of motion, pain does not become less intense, but on the contrary, increase. Physical exercises bring relief.
  • The nature of pain depends on the form of ankylosing spondylitis. So, when rhizomelic and Central form of the disease localized pain in the spinal column, the disease progresses formed the stoop. If the patient has peripheral form of the disease, then it would swell and aching of the knees and shins.
  • To suspect this pathology can be the time of onset of pain. They often begin to disturb the person on night watch and the day is almost gone.

Violations of the organs and organ systems

The first to begin to suffer a small vertebral joints and those joints that connect the Ilium with the sacral vertebrae and joints symphysis. The surface of the bones that form the joint, the disease progresses, begins to break down, the result is acute, and then chronic inflammation.

Cells that form cartilage, begin to grow, the articular surface spliced, and then grows bone tissue. Also ossify articular ligaments. In the end, the person becomes immobilized.

The pathological process is subjected to the entire spine, starting from the first lumbar vertebra and ending with the seventh thoracic vertebra. When bone tissue is maximally grow, the spine in its appearance begins to resemble a stalk of bamboo.

As for the other joints, then in the early stages of the disease process of inflammation in their passing, with periodic relapses. Asthe progression of the pathology is chronicization inflammatory process of replacing connective tissue to fibrous and with the growth of bone tissue. As a result, undergo ankylosis of the joints of the feet and hands, and joints of the thorax.

About 25% of patients suffering from inflammatory processes of the vascular and iris. In the future, they develop secondary glaucoma.

A small proportion of patients have atrophic processes in the sheath of the large vessels located in the upper part of the body. Also suffers from the aorta. This leads to the appearance of intravascular fibrous fibers, which disrupts the valve main artery of the heart. As a result of human disturbance of rhythm, develop pericarditis. Such manifestations of the disease affects 2 to 8% of patients.

Inflammation sometimes remain top of their lungs. They formed cavities similar to the cavities in the cavernous tuberculosis. Liver and kidney lead to a gradual failure of these organs to function normally.

Other symptoms of ankylosing spondylitis

The disease diagnosis solely on symptoms is often difficult, because they are very diverse. The beginning of the pathological process can occur in different ways. There are five options for the development of the clinical picture:

  • The inflammatory process is localized in the lumbar region and sacrum, the intensity of the pain is continuously increasing. In parallel, appear painful sensations in the joints of the extremities.
  • It may cause inflammation one or more joints, it is not necessary that they will be symmetrical. Inflammation is characterized by frequent exacerbations and remissions. Lumbosacral area involved in the process of inflammation later. More often for this type the disease develops in young people.
  • In childhood and adolescence manifestation of the disease often resembles a rheumatic attack. Inflammation undergo major joints, they become swollen, the skin over them is red, the body temperature increases. The sacroiliac joints are involved in the pathological process after some time.
  • The most rare course of disease is accompanied by such features as: increased body temperature to high levels, temperature instability with a tendency to the increase of 1-2 degrees in the morning. The patient begins to lose weight experiencing weakness, increased sweating. Pain in the joints and muscles occur after 14-21 days.
  • Sometimes patients primarily affects the bloodvessels and heart muscle. Signs of inflammation can be seen in blood tests. Parallel symptoms of iritis and iridocyclitis. Articulate inflammation manifests only after months.

The differences in the course of ankylosing spondylitis in men and women

It is established that the disease different occurs in men and women.

Criteria

The symptoms of the disease in women

The symptoms of the disease in men

Manifests as disease

The symptoms are mild, acute inflammation is absent.

Develops acutely, the symptoms bright.

Periods of calm.

Long.

Short.

The time from manifestation of disease until the first symptoms.

From 10 to 20 years.

4 to 5 years.

The predominant site of localization of inflammation.

The spine and major joints.

The spine and small joints.

The defeat of the spine.

Suffers from sacral and lumbar, but strong changes are observed.

Suffer all spine, develop abnormal curvature, mobility is severely limited.

Damage to the blood vessels, lungs and other organs.

Rarely happens.

It is commonly observed.



Forms of ankylosing spondylitis

There are four forms of ankylosing spondylitis, including:

  • The peripheral form. It is considered the most common. According to various sources it afflicts 20 to 75% of people with ankylosing spondylitis. Inflammation of the exposed spine and small joints.
  • The Central form of the disease is characterized by inflammation solely of the spinal column. This form of the disease found in 46.6% of cases.
  • The root form, which is also called rhizobiaceae. In addition to the spinal column in the process of inflammation involves large joints. The prevalence of this form of the disease – 18%.

  • Least frequently diagnosed Scandinavian form of the disease in which affects the spine and small joints of upper and lowerextremities. Current patterns this form of the disease very similar to rheumatoid arthritis.

Diagnosis of ankylosing spondylitis

Diagnosis of ankylosing spondylitis is complicated enough, as it is often confused with other pathologies. RAMS recommend for diagnosis to focus on the following symptoms:

  • For three months or more a person experiences pain in the lumbar region. Pain have a tendency to worn when performing movements, but the rest strengthens.
  • The hampered mobility of the spine in all directions.
  • People can't take a full inhale and exhale.
  • Observed inflammation of the sacroiliac joint 2-4 degree (sacroiliitis). Inflammation is bilateral in nature.

If a person is observed sacroiliitis and there is at least one of the previous symptoms, then the doctor can put the appropriate diagnosis. These standards were adopted in 1997 and are still effective. However, we should not forget about the existing modern methods of diagnostics which allow to specify the diagnosis and to determine the degree of spread of the disease.

If the therapist suspects from a patient of ankylosing spondylitis, it is mandatory to send it for consultation to a podiatrist, neurologist, rheumatologist. There are additional instrumental methods of examination, such as radiography, CT and MRI of the spine. The blood analysis reveals a General increase in ESR. When experts doubt remains, the patient is directed to conduct a special analysis aimed at the detection of the antigen HLA-B27.

Equally important differential diagnosis of Bechterew's disease other degenerative diseases of the spine, including degenerative disc disease and spondylosis. Distinctive signs are:

  • All patients are mostly young men;
  • The nature of pain. They arise in the morning and do not cease at rest, while osteochondrosis pain worse towards evening and after exercise;
  • ESR degenerative lesions of the spine is not increased.

Often the Scandinavian form of ankylosing spondylitis confused with rheumatoid arthritis. However, doctors should be remembered that rheumatoid arthritis often affects women, also for this diseasecharacterized by the appearance of subcutaneous rheumatoid nodules. In 80% of cases in rheumatoid arthritis patients in the blood is found rheumatoid factor.


Treatment of ankylosing spondylitis

Treatment of ankylosing spondylitis involves the whole complex of therapeutic measures, which have the only aim to have a process to stop ankylosauria:

  • When the acute phase subsides, the patient demonstrates physical therapy, it is useful to go skiing, work out in the pool.
  • The effect of balneotherapy.
  • Conducted phonophoresis with hormonal drugs, effective paraffin, ultrasound treatment.
  • It is important that the patient follow your posture, sleep on a flat and solid surface.
  • During the active stage of treatment is forbidden static load on the spine, as well as running and performing other hard physical exercise.

The introduction of corticosteroids into the joint cavity. Cryotherapy with liquid nitrogen in the region of the spine helps to eliminate pain and facilitate the patient's condition. As auxiliary methods of treatment can be used hirudotherapy and back massage. However, to perform these procedures only in remission.

Generally about physiotherapy are active disputes between doctors. Many of them are of the opinion that the impact of heat on the sore joints can only strengthen the process of inflammation. This applies, first and foremost, paraffin. Patients indicate that a positive effect can be obtained from a hike in the bath, but bathing with hot water only aggravates the disease.

No less controversial question remains regarding the application of cryotherapy for the treatment of ankylosing spondylitis. So, almost every patient after the first session, a deterioration of General health. The patient should know that a similar effect is expected. Pain relief should come only after a week of cold treatment.

The purpose of the selective immunosuppressants

Drugs that manage the operation of the factors of tumor necrosis, are increasingly used for the treatment of ankylosing spondylitis.

Selective immunosuppressants prescribed only in the case when basic therapy does not give the desired effect. These drugs are quite expensive, and taking them increases the risk of tuberculosis, sepsis and other severe infections on the background of oppressionimmunity. Such medicines include Etanercept (Enbrel), Adalimumab (Humira) and Infliximab (Remicade).

Nutrition

Experts recommend all patients to switch to protein foods. You should minimize the menu flour products, to give up potatoes, pasta, fatty foods. Useful products such as: fish, eggs, cottage cheese, boiled meat, cheese, vegetables (cabbage, carrots, beets, greens).

Physical therapy and massage

Performing exercises is a required component of complex treatment of ankylosing spondylitis. It is important that exercise therapy consisted of vigorous exercise with the amplitude of the joints. You should diversify your classes tilts, turns, spins. It is important that the joints were the most involved during the execution of gymnastic complex. Only regular physical activity for 30 minutes a day can have a positive effect.

Very effective in impeding the process of ossification joints water aerobics. The alternative classes are in a dry basin on a dedicated machine "Fear".

As for the massage, it operates only during remission. The impact on the joints should not be too intense. Sessions only the massage therapist with a medical background.

Organization of sleeping space

The patient needs to organize his sleeping place. You should choose smooth and hard mattress. In the initial stages of the disease from the pillow should be abandoned. This will help prevent the development of cervical lordosis. It is best to sleep on your stomach. Progression of disease can be placed under the head cushion or a thin pillow. Legs should be kept straight.

The NSAIDs

Nonsteroidal anti-inflammatory drugs are the leading drugs for the treatment of ankylosing spondylitis. Most often they are recommended to take for a year or more. The maximum course of treatment is 5 years. During the acute stage of the disease is prescribed the maximum dosage, and with the subsiding of the acute process, reduce the dose.

More often than other medicines the patient is recommended reception Ketoprofen (Flexen, Flomax, Ketonal), Meloxicam (Artrozan, Movalis, Amelotex) or Diclofenac (Ultrafan, Voltaren). Perhaps the appointment of Butadiene and indole derivatives, including Indomethacin and Indomethacin.

If NSAIDs are ineffective, then it is an occasion to revision of the diagnosis.

Other drug therapy

  • To reduce inflammation in the joints and to provide a bactericidal effect can be assigned to the drugSulfasalazine (Salazosulfapyridine). However, the therapeutic effect may occur after 3-7 months from the start of treatment.
  • To reduce muscle tension or appoint Tolperison Mydocalm.

  • Glucocorticoids rapidly and effectively reduce inflammation, but prolonged use can cause a number of complications in the digestive system. Likely to develop osteoporosis and diabetes.

  • If a person has observed a severe course of the disease, he is shown receiving cytotoxic drugs and corticosteroids.
  • Drugs such as Pluvinel, Delagil, Kuprenil the disease with pronounced effect do not have.

Stem cell treatment

One of the modern methods of the treatment of Bechterew's disease is stem cell therapy. It should start in the early stages, when there was no ossification of the vertebral column and the joints of patients.

Stem cells can stop the progression of the disease and to prevent the outward expansion of bone tissue. This reduces pain, range of motion increases, the person begins to feel much better. If you combine stem cell therapy with gymnastic exercises, the effect will come even faster.

As for the forecast, at time begun treatment it is quite favorable. Of course, to fully rid of the disease will fail, but slow down its development is the power of each patient. Important to regularly visit a doctor's office, but with worsening pathology carefully follow all recommendations of the doctor.


To what doctor to address?

M. D. – specialist in diseases of the spine.