Bekhterev's disease (the international name – ankiloziruyushchiya spondiloartrit). Inflammatory changes in intervertebral joints cause their union (anchylosis). The volume of movements in joints is gradually limited, the backbone becomes motionless. The first displays of a disease in the form of pain and constraint arise in lumbar department of a backbone in the beginning, and then extend up a spine column. Over time it is formed typical for Bekhterev's disease pathological chest . In Russia Bekhterev's disease comes to light at 0,3% of the population. The disease affects men aged from 15 up to 30 years more often. Women are ill 9 times less often than men.
Bekhterev's disease (the international name – ankiloziruyushchiya spondiloartrit). Inflammatory changes in intervertebral joints cause their union (anchylosis). The volume of movements in joints is gradually limited, the backbone becomes motionless. In Russia Bekhterev's disease comes to light at 0,3% of the population. The disease affects men aged from 15 up to 30 years more often. Women are ill 9 times less often than men.
The reasons of development of a disease are up to the end not found out. According to many researchers, the increased aggression of immune cages in relation to tissues of own ligaments and joints is the main reason for development of a disease. The disease develops at people with hereditary predisposition. The people having Bekhterev's disease are carriers of a certain anti-gene (HLA-B27) which causes change of immune system.
Change of the immune status as a result of overcooling, an acute or chronic infectious disease can become the starting moment in development of a disease. Bekhterev's disease can be provoked by a spine injury or a basin. Risk factors in development of a disease are hormonal violations, infectious and allergic diseases, a chronic inflammation of intestines and urinogenital bodies.
Between vertebras the elastic intervertebral disks providing mobility of a backbone are located. On back, a lobby and the side surfaces of a backbone there are long dense sheaves which do a spine column steadier. Each vertebra has four shoots – two top and two lower. Shoots of the next vertebras are connected among themselves by mobile joints.
At Bekhterev's disease as a result of constant aggression of immune cages there is a chronic inflammatory process in tissue of joints, sheaves and intervertebral disks. Gradually elastic soyedinitelnotkanny structures are replaced with a firm bone tissue. The backbone loses mobility.
Immune cages at Bekhterev's disease attack not only a backbone. Large joints can suffer. More often the disease affects joints of the lower extremities. In some cases inflammatory process develops in heart, lungs, kidneys and urinary tract.
Depending on primary defeat of bodies and systems allocate the following forms of a disease of Bekhterev:
- Central form. Only the backbone is surprised. Allocate two types of the central form of a disease: kifozny (is followed kifozy chest and giperlordozy cervical department of a backbone) and rigidny (chest and lumbar bends of a backbone smooth out, the back becomes a straight line, as a board).
- Rizomelichesky form. Damage of a backbone is followed by changes from so-called root joints (coxofemoral and humeral).
- Peripheral form. The disease affects a backbone and peripheral joints (talocrural, knee, elbow).
- Scandinavian form. On clinical manifestations reminds initial stages of rheumatoid arthritis. Deformation and destruction of joints does not arise. Small joints of a brush are surprised.
Some researchers in addition allocate a visceral form of a disease of Bekhterev at which damage of joints and a backbone is followed by changes from internals (heart, kidneys, eyes, an aorta, urinary tract etc.).
The disease begins gradually, gradually. Some patients note that within several months or even years before a disease they tested constant weakness, drowsiness, irritability, mild flying pains in joints and muscles. As a rule, during this period the symptomatology is expressed so poorly that patients do not see a doctor. Sometimes the persistent, badly giving in to treatment damages of eyes (an episklerita, an irita, an iridotsiklita) become a harbinger of a disease of Bekhterev.
- Symptoms of damage of a backbone at Bekhterev's disease
Characteristic early symptom of a disease of Bekhterev is pain and feeling of constraint in lumbar department of a backbone. Symptoms arise at night, amplify by the morning, decrease after a hot shower and physical exercises. In the afternoon pain and constraint arises at rest, disappears or decreases at the movement.
Gradually pains extend up a backbone. Physiological bends of a backbone smooth out. It is formed pathological (the expressed stoop) chest department. As a result of an inflammation in intervertebral joints and ligaments of a backbone the constant tension of muscles of a back appears.
At late stages of a disease of Bekhterev joints of vertebras grow together, intervertebral disks stiffen. The intervertebral bone "bridges" well noticeable on roentgenograms of a backbone are formed.
Changes in a backbone develop slowly, within several years. The periods of aggravations alternate with more or less long remissions.
- Symptoms of damage of joints at Bekhterev's disease
It becomes frequent one of the first clinically significant symptoms of a disease of Bekhterev sakroileit (an inflammation of joints of a sacrum). The patient is disturbed by the pain in the depth of buttocks sometimes extending to inguinal area and upper thighs. Quite often this pain is considered a sign of an inflammation of a sciatic nerve, hernia of an intervertebral disk or radiculitis.
Large joint pains develop approximately at a half of patients. The feeling of constraint and joint pain are more expressed in the mornings and in the first half of day. Small joints are surprised less often.
- Extra articulate symptoms
Approximately in thirty percent of cases Bekhterev's disease is followed by changes from eyes and internals. Defeats of heart fabrics (myocarditis, sometimes as a result of an inflammation is formed valvate heart disease), aortas, lungs, kidneys and urinary tract are possible. At Bekhterev's disease tissues of eyes quite often are surprised, Irit develops, iridotsiklit or uveit.
The diagnosis is exposed on the basis of survey, the clinical record and these additional researches. Consultation of the orthopedist and neurologist is necessary for the patient with suspicion of Bekhterev's disease. The radiological research, backbone MPT and KT is conducted. By results of the general blood test increase in SOE comes to light. In doubtful cases the special analysis for identification of an anti-gene of HLA-B27 is made.
Bekhterev's disease needs to be differentiated from diseases of a backbone of degenerate character (DZP) – a spondilez and osteochondrosis. Bekhterev's disease affects young men more often while DZP usually develop at more advanced age. Pains at Bekhterev's disease amplify in the morning and at rest. Strengthening of pains and after physical activity is characteristic in the evenings of DZP. SOE at DZP does not raise, specific changes on the roentgenogram of a backbone do not come to light.
The Scandinavian form of a disease of Bekhterev (primary damage of small joints) should be differentiated from rheumatoid arthritis. Unlike Bekhterev's disease, rheumatoid arthritis, as a rule, affects women. At Bekhterev's disease symmetric damage of joints practically does not meet. Patients have no hypodermic rheumatoid small knots, at blood test the rheumatoid factor comes to light in 3-15% of cases (at patients with rheumatoid arthritis – in 80% of cases).
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Therapy at Bekhterev's disease complex, long. It is necessary to observe continuity at all stages of treatment: a hospital (office of traumatology) – policlinic – sanatorium. Glucocorticoids and nonsteroid anti-inflammatory medicines are applied. At heavy treatment appoint immunodepressants.
The large role in treatment of a disease of Bekhterev is played by a way of life and special physical exercises. The program of remedial gymnastics is formed individually. Exercises have to be carried out daily. For the warning of development of vicious poses (a pose of the applicant, the arrogant man's pose) to the patient recommend to sleep on a hard bed without pillow and to regularly do sports strengthening back muscles (swimming, walking on skis). For preservation of mobility of a thorax it is necessary to carry out breathing exercises.
In treatment apply massage, magnetotherapy, reflexotherapy. Radonic, hydrosulphuric, nitric medical bathtubs are shown to patients with Bekhterev's disease. Completely it is impossible to recover from Bekhterev's disease, however, at observance of recommendations and correctly picked up treatment development of a disease can be slowed down. Patients with Bekhterev's disease need to be followed up constantly by a doctor, and in the period of an aggravation to undergo treatment in the conditions of a hospital.