Ankylosing spondylitis (a disease Strumpell -Marie- Bechterew )
The etiology of the disease is unknown . Of great importance is a genetic predisposition , genetic marker which is the antigen HLA B27, occurring in 90-95 % of patients , 20-30% of their first-degree relatives , and in only 7-8 % of the population . It is believed that the sensitivity of the gene linked to ankylosing spondylitis HLA B27 gene .
The first signs of joint damage found in the sacroiliac joints . First, inflammatory manifestations occur on the inside ( synovial ) joint in the shell of the sacroiliac joints , intervertebral joints or edge- vertebral joints , at least in the joints of the limbs. As a result of inflammation increases the amount of synovial fluid . In the joint cavity is delayed protein formed as a result of inflammation – fibrin.
Gradually, the inflammation goes on the cartilage of the joint. Inflammatory changes of the cartilage is destroyed , formed adhesions in the joint, which initially consists of soft tissue is then formed fusion of bone ends – ankylosis . The joint loses its mobility . The disease develops slowly . In the beginning, pain in the sacrum , spine . They may be aching , dull . Often the pain occur in the second half of the night or in the morning . Pain in other joints arise less , and typically are less strong . In the morning, patients reported difficulty initiating movement, which is gradually taking place . It is a symptom of morning stiffness .
Gradually, the inflammatory process develops further. Inflammation of the sacroiliac joint is manifested by pain in the buttocks . Give pain in the hip , knee, less frequently in the shin. Movement in the lumbosacral spine are reduced in volume. When the inflammatory process extends to the spine , thoracic spine, the patient has pain in the thoracic spine radiating along the intercostal nerves. This is manifested symptoms of intercostal neuralgia.
There are four forms of ankylosing spondylitis :
• The central form . This form shows only the defeat of the spine. It develops slowly, imperceptibly to the patient. Pain in the sacrum first appear , then climb up the spine . The pain intensified when driving the load. There are often nocturnal pain . Gradually, the patient’s posture changes : increased bending of the cervical spine bulge forward and the spine bulge ago. The patient’s head is tilted forward , chin, close to the sternum . In the thoracic spine is bent and the respiratory motion of the chest is limited . In the later stages of the disease in the spine movement is limited considerably . The patient developed asthma , muscle spasms , increased blood pressure . All this is accompanied by pain in all parts of the spine .
• Rizomelicheskaya form . In this form of the disease is accompanied by a spinal lesion involvement of large joints. Often suffer from shoulder and hip joints . The disease also develops gradually. Depending on the affected joint pains occur in the buttocks , thigh , hip , groin, and give to the knee or shoulder , upper arm , radiating pain in the arm.
• The peripheral shape . When the peripheral form of ankylosing spondylitis first signs of the disease appear in the sacroiliac joints . Then , a few months or even several years , developed inflammation of the knee, ankle joints. In developing joint deforming arthrosis, near the joints muscle contractures . This form is more common in adolescents.
• The Scandinavian form of ankylosing spondylitis . This form is similar to the peripheral , but unlike the latter suffer even smaller joints. This is the joints of the hands and feet. Joint pain in this form of disease slack .
Diagnosis of ankylosing spondylitis is based on the clinical picture of the disease , X-ray examination , special blood tests .
Treatment of ankylosing spondylitis is mainly symptomatic. It is aimed at reducing pain , reducing inflammation. For this purpose non-steroidal anti-inflammatory drugs ( indomethacin, reopirin diclofenac ) . In severe and rapid course of the disease are used adrenocortical hormones , immunosuppressants . Appointed physiotherapy , physiotherapy, spa treatment . In severe forms of joint damage is applied surgery ( total joint replacement ) , spinal surgery .