Back pain is now one of the common ailments. However, in addition to lack of exercise, overweight and age, a rheumatic disease can also be a possible cause. About 1 % of the population, i.e. ca. 750.000 people in Germany suffer from Bekhterev's disease, a disease that is mainly characterized by back pain. Unrecognized, the disease progresses rapidly and leads to severe, irreversible impairment and even disability. A quick diagnosis and rapid initiation of therapy is therefore the be-all and end-all.
But what are the causes of ankylosing spondylitis? How to recognize the disease? And what are the treatment options? In this article you will find a lot of information on the topic of ankylosing spondylitis.
What is meant by ankylosing spondylitis??
Ankylosing spondylitis is an inflammatory rheumatic disease that affects the lumbar spine in particular. The vertebral joints, the vertebral-pelvic connections and the vertebral-rib connections become inflamed in episodes, leading to ossification of the musculoskeletal apparatus and thus to stiffening and deformation of the back. The rheumatic attacks are accompanied by severe pain. In a few cases, other areas of the skeleton may also be affected.
Ankylosing spondylitis is classified as a rheumatic disease and, like all other diseases in this category, is associated with complaints of the musculoskeletal system, as well as pain and restricted movement.
Ankylosing spondylitis is a chronic disease that develops individually in each patient. Symptoms, severity, pain, progression, and disability vary from person to person. Despite intensive research, a cure has not been found to date. With consistent treatment, however, the course of the disease can be positively influenced. Thus, pharmacological therapy and physiotherapy have proven particularly effective in reducing inflammation and maintaining mobility.
Bekhterev's disease, in contrast to other rheumatic diseases, appears mainly at a young age (18-35 years) and manifests itself already at the beginning in severe back pain or muscle tension. Due to the young age of the patients, most doctors tend to ame incorrect posture, sports injuries or other causes at the initial presentation. This illusion often delays the start of therapy, so that valuable time goes by unused.
While ankylosing spondylitis used to be considered a man's disease, research has now shown that the ratio of men to women is 2:1.
Even though the neurologist Vladimir Bekhterev described the symptoms of the disease in several publications in 1890 and thus made them known, the disease already existed in the times of the ancient Egyptians.
What are the causes of the rheumatic disease??
Researchers have discovered that the cause of ankylosing spondylitis is both a malfunction of the immune system and a genetic predisposition. This interaction ensures that ankylosing spondylitis can develop.
More than 90% of all patients have a specific protein component called HLA-B 27. This normally occupies the surface of various immune cells to recognize pathogens or foreign substances and initiate a defense cascade.
In the case of ankylosing spondylitis, these proteins are inactive against some pathogens, so that the immune system must make other cells available for defense in order to ward off potential dangers. If an infection nevertheless occurs, these proteins then react instead to the body's own tie, in particular to cells of the spinal joints and the pelvic bones. They cause inflammation and send cytotoxic T-cells and phagocytes to destroy the tie.
Even if a genetic predisposition becomes clear, especially if there are several sufferers within a family, ankylosing spondylitis is not a classic hereditary disease and is also not inherited in a dominant manner. In addition, not all people with the inactive protein HLA-B 27 develop ankylosing spondylitis.
Various studies show a connection between an ankylosing spondylitis flare-up and stress, physical exertion or cold, wet weather. However, these factors are not causative.
How ankylosing spondylitis manifests itself?
Ankylosing spondylitis does not occur suddenly like lumbago, but develops gradually over weeks and months. Complaints such as back and buttock pain are usually present over a very long period of time and significantly limit the sufferers. The pain gets progressively worse under rest, which is why people experience the symptoms most clearly at night and in the morning hours. It is not uncommon for sufferers to report morning stiffness lasting an hour or more. During the day, the pain often subsides with movement.
Since it is an autoimmune disease, it is possible that the inflammatory foci also manifest themselves outside the spine, for example in the eyes, on the skin, in the joints of the fingers, knees, elbows or feet. In addition, most sufferers feel tired, fatigued and complain of a general feeling of illness, which is due to the confused immune system.
Ankylosing spondylitis occurs in relapses, which means that symptom-free intervals alternate with acute phases of the disease. If left untreated, Bekhterev's disease can lead to stiffening of the spine and thus to immobility. The cause is the inflammation of the tendon attachments, so that granulation tie is formed. This is replaced by fibrocartilage during curative treatment and subsequently ossifies. The proliferating bone formations in the intervertebral joints, in the intervertebral discs and in the ligaments restrict mobility and promote malpositions. In addition, bone spurs form in the spine, which further worsen the clinical picture.
Course of the disease and prognosis
In very rare cases, Bekhterev's disease heals spontaneously on its own after the first episode. As a rule, however, the disease is not curable, but takes a progressive course. The variance ranges from mild stiffness to bony fusion of the spine with the pelvis.
Due to the ossifications, the physiological lordosis of the lumbar spine disappears over the years, the gluteal muscles atrophy and a kyphosis of the thoracic spine develops. In common parlance, this picture is called "turtle back". As a result of the poor posture, gastrointestinal complaints such as digestive problems or intestinal inflammation occur. Respiratory problems and associated lung damage are also a consequence of kyphosis. Likewise, the heart and aorta are pressed and dysfunction occurs.
Because of the porous bones, even minor trauma can break bones in the spine and damage the spinal cord.
frequent accompanying inflammation of the middle eye skin can lead to glaucoma or cataracts.
How can the disease be diagnosed?
In contrast to many other diseases, it takes between 4 and 6 years for ankylosing spondylitis to be diagnosed. Symptoms are very diffuse and in young people are more likely to indicate sports injuries or poor posture than a rheumatic disease.
If you suspect you have Bekhterev's disease, you should therefore consult a rheumatologist in your area as soon as possible. The rheumatologist discusses the symptoms in an initial medical consultation. Particularly important for the diagnosis are
The duration of the back pain
the first appearance
the duration of morning stiffness
The intensity of the pain at rest and during movement
The onset of pain
Complaints in other regions of the body
If the rheumatologist has a suspicion, he can consolidate it by clinical examinations. In the Mennel test, the pain in the sacroiliac joint is tested in the prone position. The Schober-Ott test provides information on the extent to which the mobility of the lumbar and thoracic spine is restricted.
Imaging procedures such as X-rays, MRIs or CT scans can be used to determine the extent of bony destruction, the formation of new bone tie and the condition of the joints. Blood tests, on the other hand, do not provide any information about the ankylosing spondylitis, as they are too unspecific.
Treatment of ankylosing spondylitis
Therapy for ankylosing spondylitis is based on the pillars of conservative therapy, medication and surgical intervention. The treatment plan is individually adapted to the patient. Adapted to their needs.
Proper exercise such as cycling, swimming, Nordic walking, yoga or gymnastics can help strengthen the muscles to support the spine in its erection.
As with all rheumatic diseases, nutrition also plays a significant role. Arachidonic acid, which is primarily found in meat, promotes inflammation. Fish, linseed oil, rapeseed oil as well as fruit, vegetables and dairy products, on the other hand, are recommended due to their variety of nutrients.
Also try to aim for normal weight. Because with excess weight it is much more difficult for the body to maintain an upright posture.
Physiotherapy also makes an important contribution to people with Bekhterev's disease. Specific exercises at the onset of the disease can strengthen muscles and ligaments to stabilize the musculoskeletal system. You can easily continue the exercises at home or in a group together with like-minded people.
Especially in the case of progressive disease, it makes sense to seek the connection with an occupational therapist. This develops a program to compensate for impairments through the use of assistive devices. Occupational therapy also teaches patients how to perform movements in a way that is easy on the joints or how to manage their daily lives independently with limitations.
Drug therapy aims to reduce inflammation, pain, and limited mobility and to maintain mobility.
Above all, NSAIDs (non-steroidal anti-inflammatory drugs) are used to relieve inflammation and pain. Severe joint pain during a relapse is a classic indication for cortisone. The inflammations go away very quickly. Immunomodulators or TNF alpha blockers are also prescribed to interfere with the metabolism of the inflammatory messengers in the immune system.
Sometimes it is necessary to consider surgery for Bekhterev's disease. When joints are severely damaged or completely destroyed, an endoprosthesis makes sense to restore mobility.