ankylosing spondylitis

Ankylosing spondylitis - causes, symptoms and treatment

Ankylosing spondylitis is an incurable and difficult to diagnose inflammatory rheumatic disease. The term "ankylosing spondylitis" describes the predominant form of the disease, in which the joints of the spine are affected by the inflammation and tend to stiffen. But also other joints or organs can be affected by the very individually pronounced inflammatory processes occurring in bouts. Various treatment methods enable many affected people to significantly reduce their symptoms and have a positive influence on the course of the disease over the long term.

contents

• Ankylosing spondylitis - causes, symptoms and treatment
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment
• Current state of research

A short overview

Below is a brief summary summarizing key facts about Bechterew's disease and providing a quick overview. The other article provides comprehensive information for those affected and interested.

• definition: Ankylosing spondylitis is a chronic inflammatory rheumatic disease that primarily affects the spine and can lead to bony stiffening of the spine during the course of disease. Inflammations in the joints of the lumbar and thoracic spine and in the region of the crura and iliac joints (sacroiliac joints) are most frequent..
• symptomsThe most common are low back pain and alternating buttocks that radiate to the thighs. In addition, typical signs include morning stiffness, restricted mobility and poor posture, which in the worst case can lead to a strong and stiffened curvature of the spine (kyphosis).
• causes: The exact causes are so far unclear. It is assumed that several factors cause the disease to develop. A malfunction of the immune system seems to be ultimately responsible for the inflammatory processes (autoimmune disease). In addition, a certain predisposition for this disease is hereditary.
• diagnosis: The diagnosis is difficult especially in the early stage of the disease and with a rather slight symptomatology. Taking into account specific criteria, blood tests, X-ray images and results of a magnetic resonance tomography, many, but not all, cases of illness can be diagnosed today.
• treatment: The basis of a successful treatment is a consistent and regular exercise therapy in which special exercises are integrated into everyday life. In addition, therapies with heat or cold as well as a drug treatment are used. This includes some controversial treatments. Operations are rarely performed. Experience has shown that naturopathic treatments can provide a good alternative to traditional painkillers for controlling pain and inflammation.

In the worst cases, Bechterew's disease can lead to stiffened spine curvature. (Image: groisboeck / fotolia.com)

definition

There are many names for Bechterew's disease. The medical term "ankylosing spondylitis" (also known as ankylosing spondylitis) is generally used to describe ankylosing spondylitis. Disease in Latin means illness, Bechterew refers to the Russian neurologist Vladimir Bechterev, who drew attention in the late 19th century with significant scientific findings on the disease.

Ankylosing spondylitis can be translated as "stiffening vertebral inflammation". This describes the chronic inflammatory rheumatic disease, which mainly affects the spine and can lead to a bony stiffening of the spine in the course of the disease. Inflammatory processes in the joints of the lumbar and thoracic spine and in the region of the connection between the sacrum and the ilium, the so-called sacroiliac joints, are most common. The disease can also affect other joints, tendons and organs (for example, the eyes) or occur associated with other diseases.

Ankylosing spondylitis is not a disease of the spine, as is often mistakenly believed, but a malfunction of the immune system (autoimmune disease). It is estimated that just under two percent of the adult population suffer from this disease. Contrary to earlier opinions, according to the German Association of Morbus-Bechterew e.V. (DVMB), both women and men fall ill with equal frequency. However, the disease, despite very individual disease patterns, usually shows milder effects in female patients. Mostly, the disease begins between the age of 15 and 30, but even younger or older people can fall ill.

symptoms

The first signs of the disease are often nonspecific and are therefore often not associated with Bechterew's disease. Also, very individual characteristics and symptoms as well as the progressively occurring course of disease make it difficult to recognize the specific spinal inflammation.

Back pain, low back pain and joint pain are most commonly reported. Specialists refer mainly to reciprocal and thigh-radiating buttocks pain, along with lumbar spine motion restriction, as a possible first sign. Contrary to many other back complaints, the symptoms typically worsen at rest.

Other criteria relate primarily to the timing and duration of the pain. These are particularly noticeable at night, and especially in the morning after waking up, a joint stiffness (morning stiffness) sets in, which can last for more than 30 minutes. In contrast to osteoarthritis, the symptoms improve under exercise. The buttocks pain comes from the often first affected sacroiliac joints ago.

A stiffening spine inflammation is accompanied by pain and it often shows a morning stiffness. (Image: Paolese / fotolia.com)

accompanying complaints

In addition to the typical complaints that come from the spine, pain in other parts of the body can also occur. So it is not uncommon to complaints (pain, swelling, limitation of movement) in the area of ​​the sternum or in the hip, knee and hock. In most cases, these pains only occur on one side, since they are usually asymmetrical inflammatory processes of individual joints. Also, heel pain or tendinitis inflammation (enthesitis), which makes standing on hard ground uncomfortable, often indicates ankylosing spondylitis.

About 40 percent of all patients have a single or multiple iris inflammation (iritis) in the eye. Eye pain, eye redness and sensitivity to pressure on the eye occur. In addition, other eye inflammations (for example, uveitis and iridocyclitis) may occur.

late effects

The inflammatory, painful relapses and progressive stiffening of the spine often lead to postural damage. If there are severe ossifications on the spine, it is also called a "bamboo spine" and there is typically a pronounced hunchback with a stiffened, bent-over posture (kyphosis). This in turn is associated with severe restrictions on movement and back and lower back pain. A stiffened spine also tends to bone porosity (osteoporosis) and thus to vertebral fractures. According to DVMB, fractures occur in seven percent of those affected.

Especially in the late stages of the disease, internal organs may also be affected by the disease, such as the lung, the heart, the kidneys and the nervous system.

The entire course of the disease and the prognoses are very different. Thus, the disease can be very aggressive and associated with severe symptoms or show a rather mild course. Which predominant symptoms manifest themselves in which body regions is very individual. The personal medical history decides whether and to what extent the affected person is subject to physical restrictions.

The inflammatory thrusts of ankylosing spondylitis are often followed by ossifications, which in extreme cases can lead to a stiff "bamboo spine". (Image: Alila Medical Media / fotolia.com)

Associated diseases

Ankylosing spondylitis may occur in combination with psoriasis or with chronic enteritis (Crohn's disease or ulcerative colitis). In professional circles one speaks then of a Psoriasis Spondylitis or of an enteropathic Spondylitis.

In addition, there are other related diseases from the group of Spondyloarthritiden. Among these are summarized certain inflammatory rheumatic diseases. An example of this is reactive spondyloarthritis (reactive arthritis), a joint inflammation that occurs after a bacterial infection. Combination of inflammation of the urethra (urethritis) and the conjunctiva (conjunctivitis), one speaks of the so-called Reiter syndrome.

If a disease from the group of spondyloarthritis mainly affects the spine, they are referred to as axial spondyloarthritis (axial refers to the axial skeleton). It is possible that these forms, with the addition of changes in the crural bowel joints, develop into ankylosing spondylitis. Radiographic axial spondyloarthritis is also used as a synonym for ankylosing spondylitis. Non-radiographic axial spondyloarthritis refers to the early stages and mild manifestations of Bechterew's disease, which are not usually imaged on an X-ray.

causes

The exact cause of ankylosing spinal inflammation is not yet known. It is believed that this is a malfunction of the immune system, in which the immune system is not directed as usual against invading pathogens, but fights own body cells (autoimmune disease). Thus, Bekhterev's disease, as well as rheumatism, falls under the systemic diseases.

All previous findings suggest that there is a link between the disease and the presence of a particular antigen on the white blood cells (leukocytes), the so-called "human leucocyte antigen (HLA-B27)". It is striking that this antigen is detectable in 90 percent of those affected. Even if the trait is not pathogenic in itself, one speaks in this connection of a certain susceptibility (predisposition) for Bechterew's disease. It is thought that this susceptibility in combination with other factors (such as certain bacterial infections) is a trigger for the disease. The predisposition for the disease is therefore presumably inheritable.

Why joint inflammation occurs, which primarily occurs in the areas of the lumbar and thoracic spine and the sacroiliac joints, is still unclear. (Image: bilderzwerg / fotolia.com)

diagnosis

Especially in the initial stage, ankylosing spondylitis is difficult to detect. It is not uncommon for the first symptoms to persist for several years before a definite diagnosis can be made. If it is a very slight manifestation, the disease may even remain permanently undetected. The technical term for these difficult-to-diagnose forms is non-radiographic axial spondyloarthritis. X-ray images make these phenomena unrecognizable. Also, no other methods are currently available that sufficiently improve the possibilities of making a diagnosis.

Experienced subject matter experts and rheumatologists who are able to make a reliable diagnosis based on a number of criteria are particularly in demand during the early phase of the disease. The basis of the diagnosis is usually the assessment of already existing complaints - mostly in the area of ​​the spine and the surrounding body regions. It also determines the curvature of the spine and its mobility. There is also an accurate pain diagnosis.

X-rays are taken as the standard examination procedure, and magnetic resonance imaging is being carried out more and more frequently. The latter forms certain soft tissue changes as a result of inflammation. Ankylosing spondylitis can thus be visualized earlier than with X-ray images, which reveal later bony changes.

A blood test may provide additional evidence of ankylosing spondylitis. As a rule, specific values ​​are determined, which provide information about existing inflammations in the body. In addition, detecting the specific protein (antigen) HLA-B27 on the surface of the leukocytes in the blood can provide an additional clue to the disease. However, other test results must be considered equally, because HLA-B27 may be present even in completely healthy people.

A consistent movement therapy is the basic building block of each individually coordinated treatment concept for ankylosing spondylitis. (Image: Thomas Reimer / fotolia.com)

treatment

Bechterew's disease is not curable and requires a lifelong therapy that ensures the sufferers a high quality of life as long as possible. Various treatment methods as well as a good and comprehensive specialist medical care allow the affected people to influence their illness favorable.

The best points of contact after diagnosis are rheumatologists or even a specialized rheumatism clinic. Temporary in-patient intensive care treatment can be helpful for some patients to learn how to deal with the lifelong illness individually and to create an individual therapy concept. Furthermore, a regular outpatient medical care and consistent therapeutic measures form the basis for successful treatment.

movement therapy

The most important part of the treatment is physiotherapy. In individual therapy sessions, sufferers learn targeted exercise exercises to counteract the stiffening and the associated pain. The exercises must be carried out consistently (preferably in the morning and in the evening) in order to prevent impending movement restrictions as long as possible. Offers of special therapy groups can supplement the individual treatment, such as (Bechterew) -oriented (water) gymnastics groups.

Heat and cold treatments

In addition to physiotherapy, various forms of circulation-promoting cold and heat therapy can help alleviate the stiffness and pain. These include in domestic use, for example, warm baths or heat wraps and hot water bottles. In ambulatory or inpatient therapy fango packs, infrared radiation or thermal and mud baths can support. Also, cold applications are often helpful in inflammatory rheumatic complaints and can be useful, especially during very painful episodes of illness, to allow a subsequent active movement therapy.

Medical therapy

Cortisone-free nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly used in drug therapy. These anti-inflammatory and analgesic drugs cause a relatively rapid resolution of the symptoms over the period of ingestion. Whether and in which intervals sufferers should take these drugs is individually very different. Any side effects are also here an effective benefit for the sufferers.

In an advanced stage of disease, where ossification, malalignment and possibly osteoporosis play a greater role than previous inflammations, simple analgesics such as acetaminophen are used. Only in an emergency cortisone-like drugs are used, which can have many harmful side effects over a longer period of use.

The advantages and disadvantages of the new treatment option with drugs that block tumor necrosis factor (TNF-alpha) are still being discussed and researched among experts for ankylosing spondylitis. (Image: molekuul.be/fotolia.com)

Controversial treatment approaches

Some people are offered the much-discussed treatment with the radioactive noble gas radon (radonbalneology, radon therapy). An assessment of the success of the treatment against possible radiation-related side effects must always be taken together with the persons affected.

If other areas of the body, such as the shoulder, hip or knee are affected (and not the spine), a so-called basic therapy with long-term disease-modifying drugs (sulfasalazine, methotrexate) can be used. But here too, it is a controversial concept, which is mainly used in rheumatoid arthritis (chronic polyarthritis).

Among the newer and more expensive treatment options are drugs that counteract inflammation by blocking a specific cytokine as tumor necrosis factor (TNF-alpha). This signaling substance is involved in the systemic inflammation and plays an important role in the immune system. TNF-alpha blockade not only relieves discomfort but also increases the risk of infectious diseases.

Last chance: operation

Improved diagnostic and treatment options have influenced the course of the disease in a way that nowadays operations are rarely necessary and only in particularly severe cases. Surgical procedures involve various joint operations, such as the insertion of artificial joints (endoprostheses), and an erection operation in the presence of kyphosis. These operations are in some cases the only way to restore mobility.

The body's own protection against various inflammatory processes can be improved by a sufficient intake of vitamin E. (Image: vaaseenaa / fotolia.com)

Naturopathic treatment

Naturopathy can also help sufferers alleviate the symptoms and deal well with the disease. According to patient experience, different approaches can even help to the extent that the use of painkillers (temporarily) unnecessary.

Alternative medical procedures often used in ankylosing spondylitis, for example, are methods of traditional Chinese medicine (acupuncture or Chinese herbal therapy). But also homeopathy and special nutrition programs are chosen by many sufferers.

When diet is mainly paid attention to a low-meat diet. In addition, the intake of vitamin E and various enzyme preparations plays an important role. Vitamin E provides natural protection to the body against oxidizing oxygen radicals involved in the development of inflammation. Hazelnuts are a perfect source of vitamin E and provide an effective protective function for the body.

Current state of research

In order to further optimize the diagnosis and treatment of ankylosing spondylitis and thus to improve the prognosis for this disease, various studies and research activities are constantly taking place. In particular, the difficult diagnoses in the early stages and mild manifestations as well as controversial and newer treatment methods are important research topics.

For example, a recent clinical trial on ankylosing spondylitis (2016-2020) is investigating a simple TNF-alpha-blocker therapy with combination therapy with the addition of NSAIDs.

The DVMB regularly awards a research prize in the field of ankylosing spondylitis and related diseases. Decisive scientific findings in German can be found among the work of the award-winning researchers.

Further up-to-date information can also be found in the Morbus Bechterew Journal, which is written regularly and in particular by those affected for those affected. (tf, cs; updated on 14.11.2018)

To read more:
Stiff back
Stiff joints
Krummer back

Further information on ankylosing spondylitis::
Ankylosing Spondylitis - A Guide for Patients
The German Association Morbus Bechterew e.V.
German Morbus Bechterew Foundation