Ankylosing Spondylitis (Bechterew)

The disease was first described by VMBekhterev in the late nineteenth century. It is now established that the development of disease is important hereditary predisposition. The disease occurs chronically. The disease onset between the ages of 15 to 30 years.

Ankylosing spondylitis or Bechterew’s Disease – a chronic disease of the joints of the spine and joints of the other localization of the inflammatory nature. Thus there is limited mobility of joints due to ankylosis (fusion articulate in the joint ends of bones), seam and calcification (deposition of calcium salts) ligaments.

The first signs of joint damage found in the sacroiliac joint. First, inflammatory manifestations occur in the inner (synovial) joint in the shell sacroiliac joints, intervertebral joints or costovertebral joints, less frequently in the joints of limbs. As a result of inflammation increases the number of intra-articular fluid. In the joint cavity is delayed protein formed as a result of inflammation - fibrin.
Gradually shifts to an inflammation of the cartilage of the joint. Inflammatory changes in the cartilage is destroyed, formed by fusion in the joint, which initially consists of soft tissue, then shaped fusion of bone ends - ankylosis. The disease develops slowly.In the beginning, pain in the sacrum, the spine. They may be aching, dull. Often pain arises in the second half of the night or by morning. Pain in other joints occurs less frequently, and usually is less strong. In the morning, patients noted difficulty in the beginning of the movement, which is gradually taking place. This is a symptom of morning stiffness.

Gradually, the inflammatory process develops further. Inflammation of the sacroiliac joint pain is manifested in the buttocks. Give pain in the hip, knee, at least in the lower leg. Movements in the lumbosacral spine are reduced in volume. When the inflammatory process extends to the spine, thoracic spine, the patient has pain in the thoracic spine with irradiation in the course of the intercostal nerves. This is manifested symptoms of intercostal neuralgia.
The inflammatory process spread to the cervical spine, causing pain in the neck, smack in the shoulder and arm. Some patients develop a syndrome of vertebro-basilar insufficiency. It manifests dizziness, stagger while walking, and headaches. The defeat of the peripheral joints is less common. Normally occurs for a long time But, as might occur in ankylosis of the knee, hip joints, leading to loss of function of the joint.

There are four forms of ankylosing spondylitis:

• Central form. This form is manifested only defeat of the spine. It develops slowly, imperceptibly for the patient. Pain first appear in the sacrum, then climb up the spine. The pain intensified when driving, the load. There are often nocturnal pain. Gradually, the patient's posture changes: increased curvature of the cervical spine, concave forward, and the thoracic spine convexity ago. The head of the patient leans forward, his chin close to chest. In the thoracic spine is bent and chest respiratory movements are restricted. In the later stages of motion sickness in the spine is limited significantly. Patients develop asthma, muscle spasms, increased blood pressure. All this is accompanied by pain in all parts of the spine.
• Rizomelicheskaya form. In this form of the disease lesion of the spine is accompanied by the defeat of large joints. Most often suffer shoulder and hip joints. The disease also develops gradually. Depending on the affected joint pain occur in the buttocks, thigh, hip joint, give the groin and knee, or shoulder, upper arm pain with irradiation in the arm.
• The peripheral shape. When the peripheral form of the disease Ankylosing Spondylitis  first signs of the disease appear in the sacroiliac joints. Then, after a few months or even several years, developing inflammatory lesions of the knee, ankle joints. In the joints develops deforming arthrosis, near the joints of muscle contractures. This form is more common among adolescents.
• Scandinavian form of Bechterew's disease. This form is similar to the peripheral, but unlike her suffers even more small joints. These joints of hands and feet. Pain in the joints in this form of disease slack.

Ankylosing spondylitis is accompanied by the defeat of the internal organs. The part of the cardiovascular system - is myocarditis (inflammatory disease of the heart muscle), inflammation of the aortic valve. If kidney damage develops a serious condition - renal amyloidosis. Eye manifests iritis, iridotsiklita.
Diagnosis of ankylosing spondylitis is based on the clinical picture of disease, X-ray examination, a blood test.
Treatments of ankylosing spondylitis are mainly symptomatic. It is aimed at reducing pain, reducing inflammation. To do this, apply non-steroidal anti-inflammatory drugs (indomethacin, reopirin, diclofenac). In severe and rapid course of illness are used the adrenal cortex hormones, immunosuppressants. Appointed physiotherapy procedures, physiotherapy, spa treatment. In severe forms of destruction of joints used surgical treatment (total joint replacement) surgery on the spine.