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Ankylosing spondylitis (Bechterew's disease)

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Ankylosing spondylitis (Bechterew's disease)

Ankylosing spondylitis is a systemic disease characterized by chronic inflammatory lesions of the joints of the spine, the sacroiliac joint and paravertebral tissues with ankylosis of the intervertebral joints, the formation of kyphosis, the development of stiffness, and in the severe course of the disease - complete loss of mobility of the spine.

Bechterew's disease (ankylosing spondylitis) affects only adult men and women.

In patients with ankylosing spondylitis, all parts of the spine will be in a "frozen" position.

 

Ankylosing spondylitis treatment

The treatment program for ankylosing spondylitis includes many therapeutic factors (drugs, physiotherapy, etc.) and measures (compliance with the regimen, exercise therapy, Spa treatment, etc.) and requires patience from the patients themselves and their relatives.

In ankylosing spondylitis, the spine is fixed in a flexed position.

 

Regime

A patient with ankylosing spondylitis is recommended to lead a normal active lifestyle, engage in sports such as swimming, tennis, volleyball. It is necessary to constantly monitor your posture. The bed should be hard, and people involved in clerical work should periodically get up from the table to change the forced posture unfavorable for the spine.

With acute exacerbation of the disease and severe pain syndrome, patients need bed rest, but even during this period, one should constantly engage with a physiotherapy specialist to prevent severe violations of posture and spinal function. After inpatient treatment, a patient with ankylosing spondylitis should undergo spa treatment and then be monitored in the clinic.

In the treatment of ankylosing spondylitis, elimination of puffiness, inflammation, a symptom of pain, restoration of range of motion in the sacrum and muscles of the lower back and buttocks is accelerated with the use of physiotherapy.

 

Use of NSAIDs

NSAIDs have a pronounced anti-inflammatory and analgesic effect, exhibit a mildly immunosuppressive effect. Drugs such as indomethacin and phenylbutazone (butadione) are believed to have an almost specific effect in ankylosing spondylitis. In contrast to rheumatoid arthritis, symptomatic suppression is often rapid and nearly complete. Many patients take these remedies for months and years, they improve their well-being even in the later stages of the disease. In connection with the pronounced therapeutic effect of NSAIDs in ankylosing spondylitis, their use even has diagnostic value.

For a patient with ankylosing spondyloarthritis (ankylosing spondylitis), it is recommended to use butadion or reopirin (pyrabutol) 1 tablet 4 times a day; in case of severe pain, 5 ml of reopirin can be administered intramuscularly. In connection with the pronounced side effects of pyrazolone compounds (leukopenia, gastroenteropathy, hematuria), they should be used for no more than 2 weeks, then switching to taking indomethacin (methindol) orally 50 mg 3-4 times a day or in the form of suppositories 50 mg 2 times in a day. It is convenient to take the drug metindol-retard 0.075 g 2 times a day. It is also possible to use voltaren, brufen, and other NSAIDs.

The lumbar spine in the "frozen" position in Bekhterev's disease, side view on the radiograph.

 

Treatment with glucocorticoids

Glucocorticoids are indicated with a high activity of ankylosing spondylitis and the absence of an effect from NSAID treatment. In this case, intra-articular administration of hydrocortisone is recommended for active and prolonged arthritis (125 and 50 mg in large and medium joints), as well as other long-acting drugs (Kenalog 40 and 20 mg, respectively). In the presence of severe polyarthritis with severe pain and swelling, prednisolone (15–20 mg) is sometimes added to NSAIDs for a short time. Also, in this case, a lower dose of prednisolone is recommended (5–7.5 mg per day). With a very high activity of the disease and ineffectiveness of treatment, pulse therapy with prednisolone can be performed (1 g of prednisolone is administered intravenously, 1 g of prednisolone once a day for 3 days).

 

Treatment with sulfasalazine

In recent years, sulfasalazine, 2-3 g per day for several months, has been used as a basic drug acting on the pathogenetic mechanisms of the disease.

With ankylosing spondylitis all parts of the spine will be limited in movement.

 

Treatment with non-hormonal immunosuppressants

Indications for the appointment of non-hormonal immunosuppressants (cytostatics) are severe course of the disease with fever and visceritis. Azathioprine (imuran) is used at 50-100 mg per day, cyclophosphamide at 50-100 mg per day, chlorobutin (leukeran) at 5-10 mg per day. Treatment continues for 2-3 months, doses are reduced when significant improvement occurs. Treatment is carried out under the obligatory control of a blood test (cytopenic syndrome is possible).

 

Anti-spastic muscle relaxant therapy

To relax muscle spasm, a patient with ankylosing spondylitis (ankylosing spondylitis) is prescribed isoprethane 0.25 g 2-3 times a day, scutamil-C 1 tablet 3 times a day, and massage of the back muscles. The patient is recommended annual treatment with radon baths (Tskhaltubo, Khmelniki, Pyatigorsk), hydrogen sulfide baths (Sochi, Pyatigorsk, Nalchik, Kemeri), mud (Saki, Evpatoria). Contraindications to spa treatment are the high activity of the disease, damage to internal organs.

Patients with ankylosing spondylitis are subject to clinical examination by a rheumatologist. Patients with the peripheral form of the disease are examined once every 1-2 months, with the central form - once every 4-6 months, with damage to the eyes and internal organs - monthly. X-rays of the joints and spine are performed once a year. Patients are periodically examined by a urologist and ophthalmologist. In the presence of an exacerbation and ineffectiveness of outpatient treatment, the issue of inpatient treatment is resolved.

Magnetic resonance imaging (MRI) of the spine with ankylosing spondylitis helps to exclude other organic lesions.

 

Exercise therapy, massage, physiotherapy treatment

Therapeutic gymnastics and kinesitherapy should be carried out systematically and daily 1-2 times a day for 30 minutes, which helps to reduce the functional insufficiency of the spine and joints. A good therapeutic method is exercise therapy in the pool, which allows you to achieve muscle relaxation, as well as exercise therapy in the apparatus "ugul" ("dry pool"), when the patient does exercises, being suspended on special suspensions, in a lying or sitting position (while completely relaxing muscles, pain is relieved, mobility in the affected joints increases).

Back muscle massage reduces pain in the spine, reduces muscle stiffness, and strengthens the muscles.

In the treatment of ankylosing spondylitis, the elimination of inflammation, pain, restoration of the range of motion in the joints and muscles of the lower back is accelerated with the use of physiotherapy.

Physiotherapy treatment is prescribed with minimal activity or in an inactive phase of the disease: ultrasound, phonophoresis with hydrocortisone, Bernard's currents, inductothermy, reflexotherapy, magnetotherapy. In recent years, laser therapy has been used with great effect.

In the treatment of ankylosing spondylitis, the elimination of inflammation, pain, restoration of the range of motion in the joints and muscles of the neck is accelerated with the use of physiotherapy.

 

Spa treatment

With the low activity of the disease and in the stage of relative remission, balneotherapy (hydrogen sulfide, radon baths) and mud therapy give a good effect.

In the inactive stage of the disease and with the patient's ability to self-care, a Spa treatment is indicated.

In the treatment of ankylosing spondylitis, the elimination of inflammation, pain, restoration of the range of motion in the joints and muscles of the thoracic spine is accelerated with the use of physiotherapy.