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Treatment of Bechterew’s disease (Marie-Strumpell disease) abroad

Bechterew’s disease or rheumatoid spondylitis is a chronic illness that causes an inflammation of the intervertebral joints with the development of their ankylosis (immobility due to the fusion of joint surfaces).

 

This is a very common pathology also known as Marie-Strumpell disease. From 0,2 to 2% of the adult population suffer from it in different countries. Bechterew’s disease will lead to disability sooner or later as a result of pain, mobility disorders of the joints and spine. 

 

Bechterew’s disease treatment abroad

 

Causes of Bechterew’s disease

Causes of Bechterew’s disease remain unknown. Risk factors of the illness are:

  • Male sex
  • Ages below 45 years old
  • Genetic predisposition
  • Infectious factor (Klebsiella bacteria)

 

Symptoms of Bechterew’s disease

Bechterew's disease usually begins between the ages of 15-30 years. Initial symptoms are nonspecific. It can be:

  • Decreased appetite
  • Weight loss
  • Fever
  • Fatigue
  • Weakness

 

Bechterew’s disease symptoms

 

Further, bilateral inflammation of the sacroiliac joint (sacroiliitis) develops, which is clinically manifested by the following symptoms:

  • Pain in the buttocks and the sacrum
  • Pain increases in the second half of the night
  • Atrophy of the gluteal muscles
  • Tension of gluteal muscles

 

The next symptom is the stiffness of the movements in the lower back that usually occurs in the morning and decreases after physical exertion or a hot shower. Simultaneously, there is a flattening of the lumbar lordosis (bending the spine anteriorly) until its complete absence.

 

Further, the thoracic area of the spine is involved in the pathological process. Hence new symptoms start to appear:

  • Pain in intercostal spaces
  • Reduction of chest excursion during breathing
  • Strong anterior curvature (bending of the spine posteriorly) in the thoracic region

 

If the cervical area of the spine is involved in the process there are following symptoms:

  • Sharply restricted neck mobility
  • Inability to reach the sternum with a chin
  • Headache, fluctuations in the blood pressure (a consequence of the compression of the vertebral arteries)

 

Bechterew’s disease treatment

 

The other symptoms of Bechterew’s disease clinical are:

  • Bowstring symptom means that when you bend forward rectus muscles of the back do not relax
  • Hip or shoulder joints are often damaged and their mobility is decreased
  • In 15% of patients other joints get affected in the pathological process
  • 30% of patients frequently have inflammatory eye diseases
  • 20% of patients have cardiac muscle damage
  • 4% of patients have their lungs damaged (apical pneumofibrosis)
  • 15% of patients have affected kidneys that usually occur at the latter stages of the disease

 

Sometimes the horse tail syndrome develops which means the final part of the spinal cord is infringed. In this case, there is sexual malfunction and incontinence.

 

Bechterew’s disease diagnostics

 

Diagnostics of Bechterew’s disease

Bechterew’s disease is diagnosed in a clinical way and also with the help of X-ray techniques. Presence of such clinical signs as bilateral sacroiliitis on the X-ray plus 4 of the following five features is required to establish a diagnosis:

  • Stiffness and painful sensations in the sacrum, which does not disappear after rest, lasting no less than 3 months
  • stiffness and pain in the thoracic spine
  • mobility is limited in the lumbar region
  • Iritis (inflammation of the iris of the eye) in an anamnesis or at the time of examination;
  • Restriction of chest excursions during breathing

 

A special scale is used for the early diagnostics of Bechterew’s disease where the points and certain symptoms are summed up. Clinical, genetic, laboratory and X-ray signs are accounted. 

 

Bechterew’s disease treatment abroad

 

Treatment of Bechterew’s disease abroad

Bechterew’s disease is not curable. Moreover, modern medicine doesn’t have therapeutic techniques that have proven to slow down the progression of the illness. This pathology poorly responds to the doctor’s control.  Hence, the main goal of the treatment is to support a patient’s satisfactory life-quality and preserve his work capacity. 

 

Conservative treatment is applied at the beginning stage of the disease. Next drugs are prescribed for life-long administration (NSAIDs, glucocorticoids). Therapeutic exercise, physiotherapy, massage are used for treatment. From time to time, plasmapheresis or hemosorption courses are conducted to purify the blood from immunoglobulins. They help to relieve the aggravation of the disease.

 

Surgical treatment is required in the certain cases that aim to restore the patient’s mobility. The following techniques are applied if necessary: 

  • Endoprosthetic replacement of the joint (usually the hip) in the case of ankylosis of the 3rd degree
  • Operations on the spine to correct the angle of the neck or lower back
  • Osteosynthesis or dorsal fixation for neck fractures

 

Further, the maintenance therapy continues, aimed at eliminating the symptoms of Bechterew's disease. If first-line drugs become ineffective, TNF inhibitors (tumour necrosis factor) are prescribed.

 

Bechterew’s disease prognosis

 

Prognosis for Bechterew’s disease 

Bechterew’s disease can be of various clinical types starting from the slowly progressing up to the peracute when symptoms become more severe within a few months.

 

Negative prognostic factors are:

  • Illness onset before the age of 19
  • Arthritis of the hip joints develops or the mobility in the spine is limited within the first 2 years of the illness
  • Association with antigen B27 of the histocompatibility complex
  • Male sex
  • High level of C-protein
  • High level of ESR in the blood
  • Damage of small joints

 

Prognosis for work capacity is not favourable. Physical abilities of the patients are severely restricted as a consequence of hip joints ankylosis and restricted mobility of the spine.

 

Life prognosis is favourable if kidneys are unaffected in the pathological process. Amyloidosis of the kidneys and heart muscle damage leads to a decrease in life expectancy.

 

 


 

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