Ankylosing spondylitis in women and men. Features of the development

Bechterew’s disease or ankylosing spondylitis in men and women

Ankylosing spondylitis is a chronic progressive disease, named after the Russian scientist who described the clinical manifestations and suggested to place it in a nosological form.

When there are inflammatory changes in the joints, mainly of intervertebral and sacroiliac.

The result — significantly limited mobility in them, and the whole spine over time takes the form of «bamboo stick».

International name of the disease — ankylosing spondylitis or spondylitis (ankylosis — fusion).

The disease affects mainly males aged 15 — 30 years. The marked increase in the disease among women.

Causes

The reason to this day not been established. It is believed that the disease can be due to several reasons, one of which is genetic predisposition. Precipitating factor was considered as infection of the genitourinary system.

However, in recent years the preference is given to microorganisms of the intestinal group, namely, the Klebsiella. Part of scientists the greater the importance of streptococcal infection. But direct evidence of an infectious origin of ankylosing spondylitis is not.

Prevalent autoimmune theory of the origin and development of the disease. Its essence lies in the appearance of specific substances (in genetically predisposed people) as a result of precipitating factors (trauma, chronic infections) causing the acceleration of the differentiation of connective tissue cells and their transformation into cartilage and bone tissue. The formation of antigens in the affected areas contributes to ongoing immune «attack» their body.

Symptoms and characteristics of disease in men and women

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Onset of the disease has no specific symptoms and develops gradually.

It begins to manifest itself by pain in the sacrum and spine, peripheral small and large joints, lumbar-sacral region radiating to the buttocks and back of the thigh, disease of the eye in iritis and iridocyclitis. Less often the disease begins with a sensation of stiffness in joints of extremities and spine in the morning, pain in the neck and back.

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These symptoms at the beginning, as a rule, are not expressed in nature and does not attract the attention of the patient and the doctor.

Thus, the high variability of disease onset, causes conditionally divided into several options:

  1. In adolescence and childhood Bechterew’s disease begins with symptoms of acute arthritis, accompanied by flying pains in the joints, sometimes with swelling, mild fever, palpitation, increased erythrocyte sedimentation rate. The localization of damage in large joints like the clinic of acute rheumatism, and small — rheumatoid arthritis. After a while you begin to join the symptoms sacroiliac joint.
  2. At a young age often affects first one or two joints. The course is of a subacute character, and sacroiliitis (inflammation of the joints of the sacroiliac joint) manifests itself much later.
  3. Occasionally the disease may start with severe fever, accompanied by temperature fluctuations during the day up to two degrees, pouring sweat, pain in the joints and muscles, rapid weight loss. After 2 — 3 weeks appear arthritis.
  4. Extra-articular form the onset of the disease begins with inflammation of the eyes, at least — the aorta and the heart muscles. These symptoms are accompanied by laboratory data showing in favor of the expressed activity of inflammatory processes. Under this option, the symptoms of arthritis and sacroiliitis occurs only in a few months.
  5. Onset source localization in the sacrum occurs on the type of sciatica. Gradually increasing pain in the lumbar region and joints.

There have been some differences in the manifestations of the beginning and course of the disease in men and women.

At first they are much sharper and with a large number of complications. After the deterioration in women not have any pain and feel for many years quite satisfactorily. Remission periods are 3 — 10 years.

Unlike men, the onset of the disease rarely manifests itself by pain in the region of the hip joints, sacroiliitis and spinal mobility to women retained in full for many years. Thus, for ankylosing spondylitis in women is much better, the symptoms below and the forecast is positive.

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Forms of the disease also differ: women have a much more — rhizomelic. The development of the disease in men, unlike women, more often progresses rapidly, affecting the entire spine.

Depending on the localization and course of the disease there are the following 4 forms:

  • rhizomelic which comes as lesions of the spine and one or two large joints, usually hip, at least — the shoulder; the beginning was gradual; with time the process becomes more intense and constant, the formation of muscle contractures and limited mobility in the joints;
  • Scandinavian is a rare form of currents, which affects the spine and the small joints of the feet and hands; development resembles rheumatoid arthritis; in connection with the later appearance of symptoms of sacroiliitis, as well as benign diagnosis difficult;
  • Central — localization process only within individual departments or throughout the spine and is characterized by the formation of kyphosis of the thoracic combined with a pronounced lordosis of the cervical or a combination of absence of thoracic kyphosis and lumbar lordosis; the onset of the disease is imperceptible, gradual, because of what the diagnosis is established only a few years;
  • peripheral, in which the disease captures the average (knee, ankle) and small joints (foot, hand), as well as the sacroiliac joint; recurrent arthritis is characterized by a subacute course, asymmetry of the lesion and is accompanied by a gradual development of muscle contractures, deformity and severe limitation of one or two joints.

Complications and prognosis

In addition to the above, there may be complications in the form of lesions of the aortic valves and of the heart with the development of related symptoms. The limitation of the chest contributes to the frequent respiratory diseases, pneumonia and development of tuberculosis and fibrosis of the upper lung.

Complications from the nervous system are manifested in the form of sciatica, shoulder syndrome with severe pain, and osteoporosis leads to fractures even cervical vertebrae with subsequent respiratory failure, disability and death.

Frequent complication is renal amyloidosis with progressive severe course.

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Diagnosis

The diagnosis is based on clinical presentation and characteristic radiological studies, which are determined by: expansion of the joint space of the sacroiliac joint, their stiffness, blurring of the articular slits, characteristic of erosion with areas of sclerosis in the region of the corners of the vertebral body, destruction of the disc, changes in the field of hip and small joints and the other.

Laboratory studies of blood there are more or less specific.

Revealing of disease at early stages helps the use of magnetic resonance imaging.

Treatment

It is the use of anti-inflammatory and painkillers pirazolonovogo series and derivatives of indole, steroidal and hormonal drugs, antibiotics and antibacterial drugs (in the case of inflammatory complications in other organs).

As adjunctive therapy in the treatment of ankylosing spondylitis useful to use traditional medicines. One of them is herbal, made from the roots of elecampane, Valerian, rhizome, herbs St. John’s wort and plantain, burdock, Helichrysum, ground oats and corn. A mixture of plants infused and taken in a certain dosage.

Also used rice diet to remove toxins from the body.

The use of traditional medicine should be agreed with the doctor and can be used in combination with the main treatment.

A significant effect of swimming, massage, mud treatments and therapeutic baths, and exercise therapy to prevent ankylosing pronounced changes in the joints.

To learn more about ankylosing spondylitis, and about how to treat the disease can of the video story.

Video: physiotherapy in ankylosing spondylitis. A set of exercises