Ankylosing spondylitis - it is a disease with systemic flow character and a strong inflammatory response. For this disease is characterized by damage joints of the spine and paravertebral tissues, often prone to inflammation sacroiliac Department. Pathology accompanied ankilozirovaniya spinal joints and calcification of the ligaments that support the spine. When during progressive pathology in most cases, damaged articular extremities apparatus.
GENERAL
The first clinical manifestation of the joint pathology were described domestic neuropathologist VM Bekhterev in the late XIX century. He offered to provide pathology as a separate nosological unit. The literature often found another name for ankylosing spondylitis - ankylosing spondylitis.
Prevalence ankylosing spondylitis widely varies depending on the region and is 0,14-2%. Ankylosing spondylitis It is more common in males. According to many researchers, men are affected 3 to 9 times more often than women. Described isolated cases of ankylosing spondylitis in patients older than 45 years. As a rule, this pathology affects the joints as a teenager.
CAUSES
Clear etiological factors that trigger the start of ankylosing spondylitis, It has not yet been identified. Modern research has made it possible to define a list of features, the most common in patients who may be provocative for the development of ankylosing spondylitis.
Predisposing factors:
- Genetic susceptibility to joint pathology;
- excessive growth of Enterobacteriaceae with the development of inflammatory processes in the intestine;
- qualitative or quantitative breach of intestinal microflora;
- infectious diseases in history.
The main pathogenetic link in the development of ankylosing spondylitis is considered incorrect operation of the cellular immune system. Circulating blood antigenic protein compounds leads to excess proliferation of T-lymphocytes, which in turn stimulates the activation of autoimmune reactions. As a result of a complex process of immunological damaged articular extremities apparatus.
CLASSIFICATION
Classification of ankylosing spondylitis is finalized and updated in the light of new clinical data on the forms and pathology course. At the moment, the division is considered relevant ankylosing spondylitis on 4 criteria:
- in stages;
- with the flow;
- of activity;
- depending on the dysfunction of the joints.
Stage of the disease:
- initial stage characterized by a slight disturbance of the mobility of the affected joints. When X-ray signs of Bakhterev disease may be absent.
- moderate stage, Which signs may be partially ankilozirovaniya affected joint and limit its slit. The clinic is increasing arthropathy symptoms.
- late stage - the development and accumulation of irreversible ankylosis in bundles of mineral salts, which is manifested complete lack of movement in the joint.
For ankylosing spondylitis:
- with a slow progression;
- with a slow progression, but may be prone to frequent relapses;
- With the rapid progress;
- septic.
disease activity
Activity is determined by pathological process laboratory parameters and patient complaints:
- Minimal activity was observed in patients with erythrocyte sedimentation rate not exceeding 20 mm per hour, and complaining of joint tightness immediately after the lifting of the bed;
- moderate activity, characterized by the erythrocyte sedimentation rate in the range of 20-40 mm per hour and continuous pain syndrome;
- Activity expressed process, which are symptoms of intense persistent pain, immobilization the affected area of the body, the spread of a pathological process in the other organs, a significant deviation blood tests.
The degree of insufficiency of the joints:
- The first - a violation of posture, a slight restriction of mobility of the spine;
- second - marked limitation of mobility in the spine, leading to a change in the patient's profession;
- third - complete restriction of mobility to incapacity or inability to self-service.
SYMPTOMS
The clinical picture of ankylosing spondylitis develops gradually, often with non-specific symptoms. Onset of the disease occurs in adolescents or young adults.
Non-specific symptoms:
- violation of the general condition of the patient;
- fatigue;
- decreased appetite with weight loss;
- insomnia;
- low-grade fever.
Progression of the disease is accompanied by characteristic symptoms of ankylosing spondylitis.
Specific symptoms:
- constant pain in the sacrum, the buttocks, the posterior thigh with increasing intensity in the early morning;
- reduction in the volume of the gluteal muscles;
- stiffness in the lower back, which decreases after physical activity or thermal treatments.
When the inflammatory process involves the overlying spine, the symptoms of the disease are accompanied by the following symptoms:
- dyspnea associated with limiting the volume of the chest when breathing due to movements ankylosis sterno-costal joints;
- pain manifestations at the level of destruction;
- limiting movement of the neck;
- neurological symptoms occurring as a result of compression of spinal arteries.
The debut of ankylosing spondylitis by peripheral type
Often the first sign Bakhterev diseases are inflammation of the articular extremities apparatus. In these cases, the patient's complaints, have their own characteristics:
- It affects mainly the large joints;
- pathological processes in joints occur symmetrically;
- persistent inflammatory processes contribute to the development of contractures;
- characterized by intense pain, smack in the course of the nerve plexus.
visceral lesions
About a third of patients with a clinical picture of the disease is characterized by symptoms of other organs and systems. The most common manifestations of the disease are:
- inflammatory eye disease recurrent nature;
- symptoms of heart failure;
- arterial hypertension Nephrology and swelling genesis;
- spontaneous bone fractures;
- dyspnea.
DIAGNOSTICS
In the diagnosis of ankylosing spondylitis using different methods, which include:
- functional assays;
- instrumental investigations;
- laboratory research.
functional tests
Good results give the author's techniques for the diagnosis of ankylosing spondylitis, which reveal the characteristic features of the course of the pathological process:
- the definition of symmetrical lesions symptoms joints sacroiliac spine;
- identification of location, nature and extent of the pain;
- diagnosing disorders of mobility in the joints.
diagnostics
Standard examination in patients with suspected ankylosing spondylitis is an X-ray which reveals the following symptoms of ankylosing spondylitis:
- narrowing of the joint space;
- Lots of erosions;
- Partial or complete ankylosis;
- foci of bone fracture;
- evidence osteoporosis.
For early diagnosis of disease using magnetic resonance and computed tomography.
Laboratory research
Characteristic features of ankylosing spondylitis are:
- a significant increase in erythrocyte sedimentation rate;
- increase in C-reactive protein;
- increase in the concentration of serum immunoglobulins.
TREATMENT
The main areas of treatment of ankylosing spondylitis are:
- conservative treatment;
- surgical correction.
conservative therapy
A significant role in the treatment of ankylosing spondylitis takes kinesitherapy - specially designed methods of physical activity to preserve mobility of the spine and the activation of the phrenic breathing.
You need to perform exercises under the supervision of a specialist, since a small amount of movement. Patients shown swimming, physiotherapy, cross-country skiing.
Besides kinesotherapy to treat manifestations of ankylosing spondylitis use integrated medical approach:
- Nonsteroidal anti-inflammatory drugs that reduce the symptoms of inflammatory reactions as well as reduce pain manifestations.
- Immunosuppressants.
- Glucocorticosteroids.
- Cardiovascular drugs.
- Chondroprotectors.
When expressed using visceral manifestations symptomatic therapy.
operative intervention
With further progression of the pathological process development and ankylosis operate surgical correction:
- vertebrotomiyu - excision of posterior spinal structures in the projection of losses, which reduces the deformation of the body;
- total hip replacement, which is performed at the major joints in their full ankilozirovaniya.
Patients with ankylosing spondylitis should be under medical supervision for timely correction of the treatment volume.
COMPLICATIONS
The most serious complication of ankylosing spondylitis is a defeat of the urinary system. It arises because of the high activity of the inflammatory process and is characterized by development of renal failure. Renal amyloidosis - the most common cause of death in patients with ankylosing spondylitis.
PREVENTION
Specific preventive maintenance is not developed. For the prevention of ankylosing spondylitis is necessary to adhere to the following guidelines:
- undergo an annual preventive examination in the clinic;
- sanitize the centers of a chronic infection;
- avoid traumatic spinal injury;
- normalize physical activity, with an emphasis on restorative kinds of exercises;
- conduct correction of the intestinal microflora.
FORECAST
There are risk factors for an unfavorable course of ankylosing spondylitis:
- gender identity;
- onset of the disease up to 19 years;
- Early disturbance of mobility in the spine;
- peripheral type of the debut of the disease;
- pronounced changes in a blood test;
- close family members with the disease.
The required amount of treatment to reduce clinical manifestation of ankylosing spondylitis and decrease the frequency of exacerbations. However, the development of irreversible changes in the affected joints can lead to total disability and disability of the patient.
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