Treatment Of Ankylosing Spondylitis’s Disease (Bechterew’s Disease)

Therapeutic program for Ankylosing Spondylitis’s disease includes a variety of medical factors (drugs, physiotherapy, etc.) and activities (compliance with treatment, exercise therapy, spa treatment, etc.) and calls from the patients themselves and their families patience.

Mode

Patient with Ankylosing Spondylitis’s disease is recommended to lead a normal active life, to engage in sports such as swimming, tennis, volleyball. Must continuously monitor the bearing. The bed should be rigid, and those engaged in clerical work, must periodically get up from the table to change unfavorable to the spine forced posture. With a sharp aggravation of the disease and of pain patients need bed rest, but even in this period should be continuously engaged with instructor on physiotherapy exercises to prevent serious violations of the posture and function of the spine. After hospital treatment of patients with Ankylosing Spondylitis’s disease (Bechterew’s disease) must undergo sanatorium treatment and then observed in the clinic.

Use of NSAIDs
NSAIDs have pronounced anti-inflammatory and analgesic effects, often mild immunodepressantny effect. It is believed that such drugs as indomethacin and phenylbutazone treatment of Ankylosing Spondylitis’s disease (butadion) are almost specific effect in ankylosing spondylitis. Unlike rheumatoid arthritis suppression of clinical symptoms is often rapid and almost complete. Many patients take these funds in the months and years, they improve the well-being even in the later stages of the disease. In connection with a pronounced therapeutic effect of NSAIDs in Ankylosing Spondylitis’s disease their application even has a diagnostic value.

Patient with Ankylosing Spondylitis’s disease is recommended butadion or reopirin (pirabutol) 1 tablet 4 times a day, with strong pains reopirin can be administered by intramuscular injection of 5 ml. Due to the pronounced side effects pirazolonovyh compounds (leukopenia, gastroenteropathy, hematuria) should be applied no more than 2 weeks, then going to receive indomethacin (metindola) oral 50 mg 3-4 times daily or as suppositories 50 mg 2 times day. It is convenient method of preparation metindol retard to 0.075 g, 2 times a day. You can also use Voltaren, and other NSAIDs.

Treatment With Glucocorticoids
Glucocorticoids are shown at high disease activity Ankylosing Spondylitis’s (Bechterew’s disease) and the absence of effect of NSAID treatment. In this case, intraarticular injection of hydrocortisone, with the active and prolonged arthritis (at 125 and 50 mg in large and medium-sized joints), as well as other long-acting drugs (kenalog 40 and 20 mg respectively). If pronounced polyarthritis with severe pain and swelling of NSAIDs is sometimes added prednisolone (15 - 20 mg) for a short time. Also in this case doctor recommend the smaller dose of prednisolone (5 - 7.5 mg / day). At very high disease activity and treatment failure can be carried out pulse prednisolone therapy (administered intravenously 1 g of prednisolone 1 times per day for 3 days).

Treatment Sulfasalazine
In recent years, as the reference drug, acting on the pathogenic mechanisms of disease, were used sulfasalazine for 2 - - 3 grams a day for several months.

Treatment Nonhormonal Immunosuppressant
Indications nonhormonal immunosuppressive agents (cytostatics) are: severe illness with fever and vistseritami. Used azathioprine (Imuran) to 50-100 mg / day, cyclophosphamide at 50-100 mg / day, hlorbutin (leykeran) 5-10 mg per day. The treatment lasts for 2-3 months; the doses are reduced upon the occurrence of significant improvement. The treatment is conducted under the supervision of compulsory blood testing (possible tsitopenichesky syndrome).

Protivospasticheskaya Miorelaksiruyuschaya Therapy
For relaxing muscle spasm in patients with Ankylosing Spondylitis’s disease (Bechterew’s disease) designate izopretan of 0.25 g 2 - 3 times a day, skutamil - P: 1 tablet 3 times a day and massage the back muscles. The patient is recommended annual treatment of radon baths (Tskhaltubo Khmelnik, Pyatigorsk), hydrogen-sulfide baths (Sochi, Pyatigorsk, Nalchik, Kemer), mud (Saki, Evpatoria). Contraindications to the sanatorium treatment are high disease activity, damage to internal organs.

Ankylosing Spondylitis’s disease patients are subject to clinical examination in rheumatology. Patients with peripheral form of the disease examined 1 time in 1 - 2 months, with a central form - 1 times 4 - 6 months, with the defeat of the eyes and internal organs - a monthly basis. X-ray of the joints and the spine is held 1 time per year. Occasionally patients are examined by a urologist and oculist. In the presence of acute and inefficiencies out-patient treatment addressed the issue of hospital treatment.

Exercise Therapy, Massage, And Physiotherapy
Therapeutic exercises and kinetic therapy should be conducted systematically and daily 1 - 2 times a day for 30 minutes, thus reducing the functional impairment of the spine and joints. A good therapeutic method is gymnastics in the pool that allows you to achieve muscle relaxation and exercise therapy in the office "ugul" ( "Dry Pool"), when the patient does the exercises, being suspended on special suspensions, in the supine or sitting position (while fully relax muscles, removes pain, increases mobility in the affected joints).

Massage the muscles reduce back pain in the spine, reduce muscle stiffness, strengthen muscles.

Physiotheraty appointed with minimal activity or in an inactive phase of the disease: ultrasound, phonophoresis with hydrocortisone, currents Bernard inductothermy, reflexology, magnet therapy. In recent years, with great effect applied laser therapy.

Spa treatment
At a low disease activity and the stage of relative remission good effect give balneotherapy (hydrogen sulfide, radon baths) and mud therapy.
In the inactive stage of disease, while maintaining the patient's ability to show self-spa treatment.