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.
Causes of Bechterew’s disease remain unknown. Risk factors of the illness are:
Bechterew's disease usually begins between the ages of 15-30 years. Initial symptoms are nonspecific. It can be:
Further, bilateral inflammation of the sacroiliac joint (sacroiliitis) develops, which is clinically manifested by the following symptoms:
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:
If the cervical area of the spine is involved in the process there are following symptoms:
The other symptoms of Bechterew’s disease clinical are:
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 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:
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 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:
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 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:
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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