Ankylosing spondyloarthritis – is a chronic inflammatory disease that manifests itself in pain in the iliac sacral joints, shoulder, hip joints, as well as in the spine and soft tissues that surround the joints and spine. With ankylosing spondylitis, inflammation is also possible in other parts of the human body.
Ankylosing spondylitis also called rheumatoid spondylitis is a chronic systemic disease. Treating ankylosing spondylitis (ASA) can reduce pain and slow the progression of the disease. Effective treatment can prevent complications and spinal deformities that occur with ankylosing spondylitis.
Initial symptoms of ankylosing spondylitis:
Among the early signs of ankylosing spondylitis are the following: - constant pain mainly in the lower half of the back and hips, especially in the morning and after periods of rest; - stiffness in the lower back and hips.
With the progression of ankylosing spondylitis
Over time, the disease can change its manifestations, the symptoms can worsen, weaken or disappear at any time. Over time, pain and stiffness, which usually appear gradually, can progress, spreading to other vertebrae and joints. Inflammation and pain can occur in other parts of the body:
- in the joints between the ribs and the spine
- in the joints of the pelvis, shoulders, knees, feet
- symptoms of eye inflammation may appear: conjunctivitis, uveitis, iridocyclitis; eye inflammation may be the first symptom of the disease
In the later stages, the following symptoms may appear:
- restriction of chest movements
- chronic stoop
- inactive spine
- loss of appetite
- weight loss
- inflammation of the choroid of the eyeball (uveitis)
- intestinal inflammation
A doctor should be consulted immediately after the onset of symptoms. It is also necessary to tell the doctor about new symptoms if the patient is already on treatment for ankylosing spondylitis. This is especially true for eye pain, sensitivity to light and blurred vision.
The causes of ankylosing spondylitis are unknown, although it is believed that genetic factors play an important role in its occurrence. People who carry the HLA-B27 gene are at increased risk for the disease. With a prolonged course of ankylosing spondylitis, the connective tissue that surrounds the spine and joints is exposed to inflammation, and the body, trying to recover, forms new bone tissue. The spine begins to grow together, forming a vertical outgrowth (syndesmophyte), the so-called bridge between the vertebrae as a result of this, the spine loses its flexibility. Such intergrowths can also reduce the range of motion in the chest, limiting the volume of the lungs and their functionality.
Who is most at risk of getting ankylosing spondylitis?
- Paul Ankylosing spondylitis often affects men.
- Age. More often begins in adolescence and by the age of forty.
- Heredity. Genetic propensity can play a role in the appearance of ankylosing spondylitis.
Most people with ankylosing spondylitis are carriers of the HLA-B27 gene. Although the presence of this gene does not necessarily lead to disease. If a person passes the HLA-B27 gene to his child, the probability that the child will develop ankylosing spondylitis is one in five.
Complications The severity of symptoms and the occurrence of complications vary from person to person.
- Difficulty walking and standing. As a rule, ankylosing spondylitis begins with a feeling of discomfort and pain in the lower back. As the disease progresses, the affected bones can grow together, making the joints and spine motionless. If such a fusion occurs in an upright position, then the person will be more active in everyday life. Equal posture is more conducive to movement.
- Difficulty breathing. Inflammation can occur in the upper spine and cause the fusion of the bones of the chest. This explains respiratory failure. If the ribs are motionless, it is difficult for a person to fill the lungs with air. If the patient does not have lung disease, then he can continue his daily activities and may not feel breathing difficulties due to the presence of compensatory abdominal breathing.
- Inflammation of the choroid (uveitis). This complication is characteristic of 40% of patients with ankylosing spondylitis. It can cause pain in the eyes, increased sensitivity to light, and blurred vision. You should immediately consult a doctor if you identify symptoms.
- Heart problem. If inflammation affects the heart, problems with the aortic valve, aortitis (aortic inflammation) may occur.
The inflammatory process can affect other parts of the body, causing diseases such as:
- intestinal inflammation
Diagnostics Diagnosis of ankylosing spondylitis (ankylosing spondylitis) may be delayed if the symptoms are minor or you mistakenly attribute them to other simpler back problems. To determine the causes of discomfort, the doctor studies the medical history and conducts a full physical examination. Then prescribes the following diagnostic procedures:
- X-ray or other radiation diagnostic methods. An x-ray allows the doctor to detect changes that occur in the joints and bones, although the specific manifestations of ankylosing spondylitis may not be visible at the beginning of the disease. Other examinations, such as computed tomography (CT) or magnetic resonance imaging (MRI), are also prescribed to determine inflammation and other changes in the joints and spine.
- blood test. Your doctor can check for signs of inflammation by taking one or more blood tests, including red blood cell sedimentation rate (ESR) and C-reactive protein. An increase in these indicators indicates the presence of an inflammatory process in the body.
Treatment of ankylosing spondylitis The goal of treatment is to reduce the intensity of pain and stiffness, as well as to prevent or slow down the occurrence of complications and deformity of the spine. The treatment of ankylosing spondylitis is most successful when there are still no irreversible changes in the joints and spine – we are talking about ankylosis (fusion), especially in a position that limits the mobility of a person.
The doctor recommends the following drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs). This group of drugs reduces inflammation, pain, and stiffness. But these medications can cause some side effects. The main thing is gastrointestinal bleeding. Less commonly, side effects are associated with problems of the liver, kidneys, and cardiovascular system.
- Antirheumatic drugs that change the course of the disease (DMARDs). Your doctor may prescribe antirheumatic drugs such as sulfosalazine or methotrexate to treat joint inflammation. These medicines prevent joint damage. Side effects are changes in blood formation and impaired liver function.
- Corticosteroids. Drugs such as prednisone can reduce inflammation and slow down damage to the joints and spine. As a rule, they are taken in the form of tablets and for a long time. In some cases, corticosteroids are injected directly into the joint.
- Tumor Necrosis Factor Blockers (TNF). TNF is a cellular protein that acts as an inflammatory agent in rheumatoid arthritis. These drugs block this protein and reduce joint pain and stiffness. Adalimumab (Humira), etanersept (Enbrel) and inflixamab (Remicade) can reduce inflammation and relieve a person from pain and stiffness. While taking these medicines, there is a risk of reactivating a latent infection such as tuberculosis, and there is also an increased risk of some neurological problems.
Physiotherapy Physiotherapeutic treatment occupies a key position in the treatment of ankylosing spondylitis. The use of physiotherapy significantly reduces inflammation, and pain, respectively. Improves flexibility and physical strength. Increases the physical ability of a person. «Medical practice» uses modern and highly effective devices in the treatment of ankylosing spondylitis. In addition to hardware treatment, massage and therapeutic exercises are widely used. Exercises to improve the flexibility of the joints and spine. In addition, special breathing exercises increase the respiratory volume of the lungs. As the disease progresses, the person begins to slouch. Special provisions for sleeping and working, exercises for the abs and back will help maintain normal posture. Despite treatment, ankylosis of the spine may develop, therefore, correct posture helps the spine to form ankylosis with an even posture, which is much more profitable than a bent condition. In the «Medical Practice of Health», a comprehensive treatment of ankylosing spondylitis is carried out, including the appointment of drugs, physiotherapy and therapeutic exercises under full medical and laboratory control.
Surgical intervention Many patients with ankylosing spondylitis do not require surgery. But the doctor may recommend surgery in case of severe pain or in case of joint damage, especially if the joint is so damaged that it requires replacement.
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- Need to quit smoking. Smoking is harmful to health and creates additional problems for people with ankylosing spondylitis. Depending on the severity of the disease, ankylosing spondylitis already negatively affects lung function, reducing the range of motion of the chest.
- You need to sleep on a hard surface. The workplace should be well adapted to the characteristics of your back and joints. Keep your back straight. Take short breaks during work, during which exercise every hour.
- Over time, the nature of the disease can change, respectively, there will be exacerbations and remissions throughout life. But, despite possible complications, most people with ankylosing spondylitis live productively, despite the diagnosis.