Bekhterev's disease (Ankylosing spondylarthritis)

Description:

Bekhterev's disease (ankylosing spondylarthritis) – the chronic general disease with preferential damage of joints of a rachis of inflammatory character leading to an anchylosis.

Etiologies of Bekhterev (Ankylosing spondylarthritis):

In an etiology of a disease of Bekhterev play a role hereditary (availability of HLA-B 27 antigen at 90-97% of patients), infectious and allergic factors, an injury, cooling. Razvity diseases proceeds as autoimmune process.

Symptoms of the Disease of Bekhterev (Ankylosing spondylarthritis):

Males at the age of 15-30 years get sick in most cases. Distinguish the following forms of a disease of Bekhterev:
- the central form – is surprised only a rachis (a kifozny and rigid look);
- a rizomelinichesky form – in addition to a rachis, hip and shoulder joints are surprised;
- a peripheral form – except a rachis, knee, elbow and ankle joints are surprised;
- the Scandinavian form – small joints of brushes are involved in process;
- a visceral form – internals are surprised: heart, aorta, kidneys, lungs, and also eyes.
Defeat of a rachis and krestsovo-ileal joints is conducting in a clinical picture of a disease. In the beginning the disease proceeds as a lumbar krestsovogo of radiculitis or a sciatica. Gradually there is moderate periodic pain in lumbar area, in the field of a tailbone, feeling of weight and constraint. Pain is causeless, amplifies especially in the second half of night, at long stay in one situation, disappears or decreases after walking, physical exercises.
At an active current a disease bystry emaciation and astenisation is observed. Objective symptoms is tension of the longest muscles of a back and restriction of mobility in the side and back directions. Damages of grudino-clavicular joints, clinical and radiological signs of a sacroileitis, and also damage of peripheral joints, preferential lower extremities are characteristic.
In a late stage there are typical changes. Patients are disturbed by pain along all rachis, especially in chest and cervical departments, it is less – in lumbar (as a result of approach of an anchylosis). Sharp restriction of a respiratory excursion of a thorax (it is normal of 8-10 cm) develops, the type of breath becomes belly, ZhEL decreases. The bearing changes, there is a kyphosis of chest department, a hyperlordosis cervical and a smoothness of a lordosis of a lumbar rachis of departments more often. The atrophy of the longest muscles of a back is sharply expressed. At rigid defeat flattening of a thorax is noted, the rachis takes a form of a bamboo cane. Mobility in cervical department (is sharply limited normal at the maximum bending distance between a chin and the handle of a breast of 0-2 cm, and at the maximum extension – 16-22 cm). At defeat of chest department the positive symptom of Ott appears: from the VII cervical vertebra measure 30 cm down and repeatedly measure this distance at the maximum bending. At healthy people this distance increases by 4-5 cm, and at Bekhterev's disease does not change. Restriction of mobility of lumbar department of a rachis comes to light Shober's symptom: from the V lumbar vertebra measure 10 cm up and do a mark. At the maximum bending at healthy faces this distance increases to 14-15 cm, and at Bekhterev's disease – does not change. At restriction of a respiratory excursion the symptom of "thread" comes to light: in the provision of an exhalation the thread is tightened around a thorax; during a breath at a good respiratory excursion of a thorax the thread breaks (a negative symptom), at sharp restriction of a respiratory excursion it is not broken off (a positive symptom).
Morbidity in krestsovo-ileal joints is revealed at a palpation, and also Kushelevsky's symptoms: 1) pressing breakthrough on ileal crests in position of the patient on spin or on a rigid couch; 2) the same in edgewise position; 3) in position of the patient on spin, the leg is bent in a knee joint and taken aside, leaning on this joint, press on an opposite ileal bone.
Defeats of cardiovascular system (aortic incompetence, an aortitis, is more rare – a pericardis, conductivity disturbance), the alimentary system (from functional dispeptic frustration to the developed picture of ulcer colitis)), kidneys (amyloidosis), lungs (apical or superlobar fibrosis are characteristic of visceral manifestations up to formation of cavities), an eye (an iritis which has crucial importance at diagnosis, often occurs at teenagers, an iridocyclitis, an episcleritis).

Diagnosis:

At inspection find the increased SOE (in 50-60% of patients), especially at damage of peripheral joints, hypochromia anemia, change of indicators of inflammatory process, increase in level of lizosomalny enzymes of blood serum and synovial fluid.
Crucial importance in diagnosis of a disease of Bekhterev belongs to a X-ray analysis by which define sacroileitis signs, defeat of a rachis, a syndesmophyte, changes of a pubic symphysis, sciatic, pozvzdoshny and calcaneal bones. The rachis takes a form of a bamboo cane. Absolute specificity is gained by an anchylosis of krestsovo-ileal joints, then bilateral subchondral cysts, bilateral erosion, narrowing of a joint crack, the centers of a subchondral osteosclerosis join. The sacroileitis comes to light early, more often happens bilateral. The syndesmophyte is found in a late stage, in the place of a fibrous ring, often bilateral. At X-ray inspection of peripheral joints note lack of symmetry of defeat and osteoporosis; existence of small erosion and special regional periostitis.

Treatment of the Disease of Bekhterev (Ankylosing spondylarthritis):

The first what it is necessary to remember at Bekhterev's disease, is physiotherapy exercises. Regular trainings of LFK help to keep mobility of a backbone, to remove stress of paravertebral muscles and to normalize diaphragmal respiration. With the same purpose classes in swimming are useful. It is recommended to replace a soft bed with a rigid mattress.
For reduction of painful feelings it is necessary to appoint NPVS group drugs, and at their low performance – kortkosteroida. Glyukokrortikosteroda it is recommended to enter vnutrisustavno or vnutriartikulyarno.
One more group of drugs with the proved efficiency at Bekhterev's disease – tumor necrosis factor inhibitors. Treatment by these drugs is carried out in the form of courses of injections.

Sulfanamide drugs, in particular Sulfasalazinum, are applied as basic. Prolonged treatment, up to 6 months, with gradual reduction of a dose of drug.

In late stages of disease of Bekhterev performing symptomatic surgical therapy is possible. Surgery takes place in the volume of a synovectomy, endoprosthesis replacement and a vertebrotomiya.