What is peripheral spondyloarthritis? Spondyloarthritis: causes, symptoms, diagnosis, treatment Centers for the treatment of peripheral spondyloarthritis
Spondyloarthritis belongs to a group of rheumatological diseases in which the joints of the spine undergo pathological changes and the patient’s mobility is gradually limited. Most often, this disease is associated with infectious polyarthritis. The disease is characterized by inflammation of the intervertebral joints with accompanying pain along the location of the spinal nerves.
Spondyloarthritis causes fusion of the vertebrae and, as a result, a decrease in human mobility
Basic Concepts
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When the disease occurs, the inflammatory process begins to develop at the junction of the sacrum and iliac bones. Gradually, the disease affects the lumbar region and spreads up the spinal column. Often spondyloarthritis affects other groups of joints - hip, elbow, hand joints, etc.
Fact! Spondyloarthritis is several times more likely to affect men under 40 years of age than women. Pediatric spondyloarthritis occurs in 8% of cases of the total number of patients.
As the disease progresses, the spine changes pathologically: the vertebrae gradually fuse together, “ossification” of the ligaments occurs, the spine loses its flexibility and becomes immobile. Without timely medical care, spondyloarthritis can lead to ankylosis or complete immobility of the spine; a forward convexity develops in the lumbar region, and a backward curvature develops in the chest area.
Important! Ankylosing of the spine turns it into a solid bone with curvature of posture. This appearance of a patient in medicine is called “ supplicant posture».
On the left - “supplicant pose” - the most pronounced symptom of the disease
Main symptoms
Spondyloarthritis can develop either acutely or almost imperceptibly without specific symptoms. Usually the disease is preceded by an infectious disease, joint injury, hypothermia. Patients with spondyloarthritis complain of the following symptoms:
- restriction of motor activity of the spine, especially in the morning;
- low-grade fever;
- swelling of the joints;
- lower back pain that subsides by the afternoon;
- discomfort when straining the back muscles, etc.
Types of spondyloarthritis
There are several types of spondyloarthritis. Highlight:
- Seronegative spondyloarthritis. The disease has classic symptoms. The disease affects the joints of the spine and gradually leads to limitation of motor activity.
- Ankylosing spondylitis or ankylosing spondylitis or ankylosing spondylitis-Marie disease. The disease is characterized by inflammatory-degenerative pathological changes in the spine, gradually leading to ankylosis. The prognosis for ankylosing spondylitis is unfavorable, in a third of patients kidney degeneration occurs, some patients become disabled.
- Psoriatic spondyloarthritis. This type of disease is most often observed in patients with psoriasis of the skin and nails. The disease is characterized by asymmetry of joint damage, swelling and pathological changes in internal organs.
- Axial or undifferentiated spondyloarthritis. Doctors distinguish this type of disease as a separate stage that precedes ankylosing spondylitis. At this stage of the development of the disease, the patient does not have X-rays.
Diagnosis and treatment
The main methods for diagnosing spondyloarthritis are laboratory, physical and instrumental examination. Patients undergo a general and biochemical blood test, undergo an X-ray examination, and scintigraphy. According to statistical data, the following indicators are recorded in the majority of patients with spondyloarthritis:
- presence of HLA-B27 antigen;
- increased C-reactive protein in the blood;
- increasing the level of circulating immune complexes and immunoglobulins of class M and G;
- negative rheumatoid factor;
- increase in fibrinogen, seromucoid, etc.
Based on the results of radiographic examination, patients are diagnosed with the growth of bone bridges and vertebral squaring syndrome with the disappearance of concavity.
Patients with suspected spondyloarthritis are examined by an ophthalmologist, especially if there are inflammatory eye lesions. Particular attention is paid to patients with lumbodynia, tuberculosis of the spine - all of them are at risk for developing ankylosing or seronegative spondylitis.
Treatment of spondyloarthritis is carried out in several directions:
- sanitation of the infectious focus - relieving pain, swelling, inflammation;
- immunocorrective therapy (sulfasalazine);
- taking hormonal (glucocorticoids), pyrazolone drugs, cytostatics (prednisolone, butadione, etc.);
- plasmapheresis or plasmasorption;
- taking medications to improve microcirculation (trental, etc.);
- physiotherapeutic procedures (laser therapy, electrophoresis, reflexology, etc.);
- mud therapy;
- massotherapy;
- swimming;
- balneotherapy, etc.
Important! Treatment of spondyloarthritis helps patients regain physical activity and relieve symptoms of inflammation. However, in most cases, therapeutic treatment only alleviates the disease. With the development of ankylosis, patients are advised to undergo surgical treatment, prosthetics of the affected joints, etc.
The prognosis for life of spondyloarthritis is favorable, with the exception of pathology of the hip joints in childhood and the development of kidney damage.
Spondyloarthritis or ankylosing spondylitis is a systemic chronic disease of the spine, which is characterized by ankylosis of the sacroiliac symphysis, which, as it progresses, develops into a pronounced form of thoracic kyphosis. If no action is taken, the spine will become an inactive conglomerate.
Statistical data
The history of the disease dates back to ancient times, although serious research began about two centuries ago. One of the first to speak and describe the disease in his works in 1559 was the scientist Realdo Colombo. The book was called “Anatomy” and became the first in history to cover this topic.Speaking of statistics, it can be noted that the disease varies widely and mainly depends on the presence of the HLA-B27 antigen. For example, among adults the rate in France starts at approximately 0.15%, in Norway it is up to 1.4% of the population.
According to research data, in Russia, as of 1988, the incidence of the disease among people aged 20 to 30 years ranged from 0.01% to 0.09%. According to statistics, spondyloarthritis was found in men 5 times more often than in women. About 8% of the total mass are pediatric patients aged 10 to 15 years.
Classification
If you turn to ICD-10, the disease in question is in the “Spondylopathies” block. Spondyloarthritis is a disease that affects the musculoskeletal system and its connective tissues. He was assigned the code M45.
Also among rheumatologists, the following types of ankylosing spondylitis are distinguished:
- primary or, as it is also called, idiopathic;
- secondary, which is a consequence of diseases such as psoriasis, arthritis, intestinal inflammation and others.
- Psoriatic arthritis. This is a type of spondyloarthritis that develops mainly in patients suffering from psoriasis of the nails and skin. Often this disease affects the knee and hip joints, as well as the area around the extremities of the toes and hands. The diagnosis can be made based on the patient's symptoms.
- Ankylosing spondylitis. This type is characterized by inflammation of large joints and the spine, which is often accompanied by severe pain and stiffness of movement. Doctors can make a diagnosis through the use of x-rays as well as the patient's symptoms.
- Reactive arthritis. Previously, it was also called Reiter's syndrome. It leads to inflammation of the tendon attachment in the joints and often occurs after a long infectious process in the body. Most often these are consequences of an infection of the gastrointestinal tract or genitourinary system. Symptoms may include pain, rash, tendon inflammation and red eyes.
Causes of the disease and risk group
In fact, the causes of this disease have been little studied today and there are no exact answers to why a person begins to suffer from it. They are generally inclined to believe that the cause is an infection, although the genetic factor also plays an important role. If we explore the issue deeper, one of the main hypotheses is the presence of the histocompatibility antigen HLA-B27.The process of occurrence, as well as the development of the disease, is influenced by:
- genetic factor;
- a person’s lifestyle (exposure to the cold, low temperatures, back injuries and infectious diseases).
In their research, psychologists have discovered a certain relationship between ankylosing spondylitis and a person’s emotional background. They are inclined to believe that most patients at one time suppressed anger in themselves, were constantly in a state of stress and other unfavorable atmospheres.
One of the working hypotheses about the mechanism of development of spondyloarthritis has approximately the following structure:
- By inheritance, a person receives the HLAB27 antigen, which is able to exist in the tissues of the joints and has absolute immunity to infectious diseases.
- Next, an infection enters the human body, which begins to interact with this antigen, thereby giving the joint tissues new properties.
- In response to an infection, the human immune system sends lymphocytes to fight the already changed tissues of the joint, as it perceives them as the infection itself.
- Lymphocytes begin to deform tissues, thereby destroying them, resulting in an inflammatory process.
- The body continues to fight and begins to grow new bone at the joints.
IN risk group fall:
- men, because they are about 5 times more likely to develop this disease;
- people aged 20 to 30 (sometimes up to 40) years;
- people with heredity of the HLA B27 antigen;
- patients who have suffered serious spinal injuries.
Symptoms of the disease
Symptoms of the disease appear equally in men and women of different ages. The disease develops quite slowly, and over time the following symptoms appear:
- periodic pain in the buttocks and spinal column;
- in the morning a person feels stiffness and spontaneous pain occurs;
- asymmetric arthritis appears in the lower extremities;
- against the background of pathologies, there is a possibility of urethritis and cervitis.
Primary spondyloarthritis manifests itself in chronic pain that occurs in the lower back and hips. Most often it is in the morning after sleep or a period of rest.
Pain syndrome
Spondyloarthritis is characterized by pain in different parts of the body. First, pain syndromes appear in the lumbosacral regions, after which they spread to the pelvic and thoracic regions. Sometimes pain is present in the gluteal muscles and can radiate to the thigh.If problems arise in the cervical region, this is often accompanied by constant headaches, loss of coordination and compression of blood vessels during damage to the vertebrae.
Pain may occur while chewing food. This means that the disease has reached the maxillofacial joints.
Non-vertebral symptoms
Among them are spasms of the muscles of the back, chest and neck, inflammation of the kidneys, pathologies in the genitourinary system, changes in the skin, eye damage with fear of light, lacrimation, and visual impairment.Symptoms may also include damage to other organs and systems in the body, which can be caused by:
- An inflammatory process that occurs in the tissues of the heart. This may be valve defects or myocarditis.
- The body's reaction to joint disease is increased body temperature, muscle atrophy, and general malaise.
- A person is able to lose weight sharply in a short time, shortness of breath and difficulty breathing appear.
- Other manifestations include problems during urination, fibrosis of the upper lungs, various types of neurological disruptions, and dysfunction of the myocardium.
Over time, the pain progresses and begins to spread to all joints and vertebrae. It is possible that inflammatory processes can occur in other parts of the body.
In the later stages of spondyloarthritis, symptoms manifest themselves in the form of limited chest growth, chronic stoop, and an inflexible spine. At the same time, a person loses appetite, severe fatigue appears, weight decreases, and the intestines may become inflamed.
Other signs
Other symptoms that may appear with spondyloarthritis include:- frequency of pain attacks from three to five in the morning;
- restriction of body mobility, which goes away after a little exercise;
- constant or periodic spasms in the vertebral muscles due to the appearance of atrophic processes in it;
- Over time, the patient becomes crooked, with the head and body tilting forward;
- knees swell, headaches and dizziness occur, pressure surges or attacks of nausea occur.
You should definitely see a doctor if you have spondyloarthritis and discover a new symptom. This is especially true for eye pain, blurred silhouettes, or sensitivity to daylight.
Degree of development of spondyloarthritis
Spondyloarthritis has three stages, with the help of which it is possible to determine the level and severity of the disease:- First stage– this is the onset of the disease with minimal disturbances, gaps and cracks in the spine. At this stage, a person may have limited motor abilities, and a slightly noticeable curvature of posture appears.
- Second stage– these are more serious violations. Here the gaps between the joints narrow, which, in turn, leads to severe restrictions on the patient’s ability to move freely. The danger is that a person may lose his ability to work, and the disease gets worse every day.
- Third stage considered the most dangerous. The mobility of the spine and joints is reduced to a catastrophic level or completely absent. The patient completely loses his ability to work and becomes disabled.
Complications and consequences
Complications of the disease develop very slowly, but this does not mean that they should be forgotten. Over time, the spine atrophies and becomes immobile. The sensations are unpleasant, because it is difficult for a person to coordinate his movements, and severe discomfort occurs during any action.The chronic form of spondyloarthritis most often becomes a cause of disability, as significant deformation and changes in the structure of the vertebrae occur.
Among the types of spondyloarthritis that can occur as the disease progresses are the following:
- rhizomelic type (deformation of the joints of the pelvis, spine and knees occurs);
- central type (changes occur only in the spine);
- peripheral (mostly damage occurs in the area of the feet and elbow joints);
- Scandinavian type (symptoms similar to rheumatoid arthritis);
- visceral type (disturbances in the functioning of internal organs occur).
Spondyloarthritis does not have a clear pattern of symptom development, so complications and their consequences for each person will be individual. The most common problems that arise with neglect or complications of the disease include:
- Difficulty walking or standing. Mostly, the first signs appear in the lower back. Pain and discomfort appear. As the disease progresses, complications arise in the form of fused bones, immobile joints, and, as a result, immobility of the spine. The joints may heal even while the patient is undergoing treatment.
- Breathing problems. It happens that spondyloarthritis occurs in the upper part of the spine, thereby greatly affecting the chest, the bones of which can grow together. As a result, breathing problems arise, because the ribs become motionless, and it is difficult for the patient to fill the lungs with air.
- Inflammation of the membrane of the eyeball. Another name for the disease is “uveitis”. This complication is typical for approximately 40% of patients who have spondyloarthritis. It manifests itself as rapid-onset eye pain, severe sensitivity to light, and gradually blurred vision occurs.
- Complications with the heart. If the inflammation reaches the heart area, problems with the heart valve begin. There are cases when the largest artery of the body, the aorta, becomes inflamed. There may also be problems with regurgitation of the aortic valve. Occurs when the aortic valve and annulus are deformed.
Diagnostics
Criteria for the diagnosis of spondyloarthritis were adopted in 1984 in New York. They are divided into:1. Clinical indicators:
- prolonged stiffness and pain in the lumbar back, which lasts for more than three months, and the state of health does not improve even in a calm state;
- limited movement of the lumbar region in the sagittal and frontal planes;
- limited movement of the chest.
- the presence of bilateral sacroiliitis stages 2-4;
- unilateral sacroiliitis stage 3-4.
- functional;
- laboratory;
- differential.
Functional diagnostic method
This option uses functional tests:- With the patient lying on his back, sharp pressure is applied to the crests of the iliac bones. If severe pain appears in the sacral area, it means that the person may suffer from spondyloarthritis.
- Lying on the side, with the leg bent at the knee joint, with a jerk-like load in the pelvic area, the patient feels pain in the sacral region.
- They also check the symptoms of Kushelevsky, Zatsepin and Forestier.
- Makarov tests (I, II) and the bowstring symptom test are often prescribed.
Laboratory diagnostics
It is a series of studies in which the most important element is a blood test. Biochemical diagnostics can determine increased bilirubin, C-reactive protein, gamma globulins, seromucoid, thymol test, fibrinogen, alkaline phosphatase, urea, creatine and other components.In order to determine the severity of the disease, the level of glucose in the body, a general urine test and rheumatological tests are additionally examined.
Differential method
To definitely determine spondyloarthritis in a patient, the doctor needs to exclude many other diseases associated with the joints and spine - osteochondrosis, Forestier hyperostosis, sacroiliitis, rheumatoid arthritis and others. That is why additional diagnostic procedures are carried out:- objective examination;
- instrumental method;
- X-ray and magnetic resonance imaging;
- Ultrasound and so on.
- presence of symptoms of vertebral squaring;
- symmetry of obvious signs in the sacral joints;
- uniform damage to all parts of the spine.
Treatment
The main goal of treatment is to relieve the pain that a person experiences during ankylosing spondylitis. It helps prevent complications and deformation of the vertebrae. Good results are observed in those who began taking the course before the disease caused irreversible damage to the body.The following types of drugs are used as prescribed by a doctor:
- Anti-inflammatory non-steroidal medications will help relieve pain and relieve inflammation (Diclofenac sodium, Meloxicam, Ibuprofen).
- Drugs aimed at antirheumatic changes in the disease treat inflammation of the joints of the hands and feet, as well as other affected tissues. This may be Methotrexate or Sulfasalazine.
- Corticosteroids reduce inflammation and slow down damage to the body (for example, Prednisolone).
- Tumor-promoting factor blockers relieve pain and stiffness in swollen joints (Cytokine, cellular protein).
Physiotherapy
For the treatment of spondyloarthritis, physical therapy is required. Particular attention is paid to proper breathing.Physiotherapy is used during remission:
- Breathing exercises – helps slow the development of pathologies associated with the chest.
- Therapeutic gymnastics – a set of daily exercises is developed individually for each patient.
- Manual therapy.
Surgical intervention
Most patients do not need such extreme measures as surgery, however, on the recommendation of a doctor, in cases of severe lesions and unbearable pain, this method of treatment may be used. It includes joint replacement and spinal straightening.Straightening surgery involves removing the vertebral body, thereby making it possible to straighten the spinal column. The rehabilitation period is long, and during this time the person must wear a plaster corset.
In cases where joint mobility is severely impaired, doctors perform endoprosthetics. This surgical intervention involves replacing the diseased joint with a prosthesis.
Massage and exercise therapy
They help reduce the rate of disease development and the progression of spinal deformity. They are used not only for treatment, but also to prevent spondyloarthritis. The methods are aimed at restoring posture, relieving spasms, and correcting the functioning of the body and internal systems.- isometric exercises aimed at the collar area;
- coordination and balance exercises;
- breathing exercises that will help increase the volume of inhalation;
- isotonic exercises aimed at straightening the back.
A special massage course will provide a person with:
- blood flow to the affected areas;
- replenishment of organs with oxygen;
- protection against waste and ankylosis.
After the massage, be sure to cover the sore areas with a warm blanket and lie motionless for some time.
Folk remedies
Some people turn to folk secrets and wisdom when treating. For treatment use:- Various ointments made from natural ingredients. One option is a mixture of camphor, laundry soap, alcohol and vodka. Lubricate sore spots with it 4-5 times a day.
- A bath based on pine needles and wild rosemary will help. One bath will require about 250 grams of collection.
- Rosehip decoctions or sunflower tinctures.
- For treatment, dietary supplements based on herbal components are used.
- Herbal medicine and decoctions, which include wild rosemary, pine buds, eucalyptus leaves, tricolor violet and other herbal elements.
- Oils. To do this you will need thamus and sunflower oil. The product is infused for at least two weeks and used during massage.
Diet
In the treatment of any disease, you need to adhere to an appropriate diet. If you have spondyloarthritis, be sure to exclude such harmful foods as:- meat, sausages and semi-finished products;
- alcohol and caffeine;
- confectionery;
- sauces, mayonnaise;
- fast food, as well as products that contain “E” additives;
- salted, fried, peppered and spicy foods.
Forecast
With spondyloarthritis, the prognosis is usually not good. It all depends on how quickly you discovered the disease and what treatment methods you chose to combat it.Good treatment, although it is unlikely to completely eliminate spondyloarthritis, will help stop the development of the disease and significantly improve the quality of everyday life.
Prevention
To prevent the disease, doctors recommend:- lead a correct and active lifestyle;
- control the state of posture;
- sleep on a hard bed;
- stop smoking, eat right;
- undergo a comprehensive examination by a doctor in a timely manner.
Disability
To determine and assign disability due to spondyloarthritis, a person must have a doctor’s report containing the following points:- rapid progression of the disease;
- frequent relapses;
- exacerbation of the disease, which affects the functioning of internal organs and affects them;
- serious disturbances in the functioning of the shoulder girdle and hip system.
Depending on the symptoms and test results, doctors determine one of the disability groups.
Spondyloarthritis in children
Patients include not only adults, but also children. Basically, there are several reasons why a child can get sick:- Heredity. There is a possibility that the disease will be passed on to the child from the parents.
- The baby suffered a serious infectious disease, which caused such complications.
- Weak immunity and increased amounts of immunoglobulins.
- minimize the level of physical activity;
- sleep on a hard, flat bed;
- eat properly and fully;
- make sure your back is straight and don’t slouch;
- attend classes in the pool or do gymnastics.
Spondyloarthritis– chronic diseases of the spinal column, characterized by limited mobility in one area or another, the appearance of severe pain that spreads along the spinal nerves.
This collective concept includes a group of rheumatological diseases, which includes: reactive and psoriatic arthritis, ankylosing spondylitis, inflammatory bowel diseases, which are accompanied by spondylitis.
Ankylosing spondylitis
Ankylosing spondylitis(AS, ankylosing spondylitis) is expressed by changes in the intervertebral discs and vertebral bodies with the subsequent development of immobility of the intervertebral joints. In some cases, the disease affects peripheral joints and ligaments. Genetic predisposition is recognized as a generally accepted risk factor for the development of the disease. The cause of AS may be chronic inflammatory joint disease.
This disease is most often observed in men at a young age during the period of highest activity (up to 40 years), but it is possible later.
The disease is characterized by the following manifestations of the inflammatory process:
- pain for more than 3 months, mainly in the sacral region, back;
- gradual increase in pain;
- morning stiffness, limited movement;
- direct dependence of the level of pain and activity: pain increases during rest and sleep.
To make a diagnosis, a rheumatologist at ON CLINIC conducts a full examination, which necessarily includes x-rays of the pelvis and spine, laboratory testing of inflammation indicators, as well as determination of the HLA-B27 antigen.
Timely treatment of the disease is the key not only to good health, but also to slow down the progression of the disease.
Reactive arthritis
Reactive arthritis(ReA) is an inflammatory disease of the joints caused by an infectious disease, most often localized in the genitourinary system (caused by sexually transmitted infections) or in the gastrointestinal tract.
Signs of the disease include:
- acute onset;
- pain and swelling of the knee, elbow joints or joints of the fingers, toes (but more often the joints of the lower extremities), and spine; in this case, the joints are affected asymmetrically, with the involvement of tendons and ligaments;
- in the presence of a genitourinary infection, ReA accompanies inflammation of the pelvic organs with the appearance of corresponding symptoms and complications;
- the presence of disorders in other body systems: stomatitis, conjunctivitis and other manifestations that can be observed before the development of ReA or immediately after it;
- negative RF (rheumatoid factor) blood.
With timely treatment, the prognosis of the disease is favorable.
Psoriatic arthritis
Psoriatic arthritis(PsA) is a chronic inflammatory disease of the joints, spine, tendon and ligament attachments, observed in patients suffering from psoriasis. It is the second most common inflammatory joint disease after rheumatoid arthritis. Patients suffering from cutaneous psoriasis are necessarily referred by an ON CLINIC rheumatologist for examination for the purpose of early diagnosis of PsA.
The main signs of PsA include:
- psoriasis of the skin and/or nails;
- arthritis of peripheral joints;
- damage to the spine, sacroiliac joints;
- inflammation at the site of attachment of ligaments, tendons and joint capsule to the bone;
- negative rheumatoid blood factor;
- characteristic radiographic changes.
When the first signs of inflammation in the joints appear, a patient suffering from cutaneous psoriasis should immediately consult a rheumatologist.
Inflammatory bowel diseases accompanied by spondylitis
The lack of adequate treatment provokes the progression of more and more parts of the spinal column, joints, the appearance of severe pain, deformities, and limited movements. All this significantly worsens a person’s quality of life and leads to loss of ability to work at a young age.
It should be noted that spondyloarthritis is much more difficult to recognize than rheumatoid arthritis or osteoarthritis, which is associated with erroneous diagnoses and improper treatment. A fundamental role in the diagnosis and treatment of diseases of this group is played by the diagnostic and treatment equipment of the medical center, the knowledge and experience of a rheumatologist.
ON CLINIC is one of the leading medical centers with the most powerful diagnostic and treatment facilities and the latest equipment. A rheumatologist at ON CLINIC provides therapeutic and diagnostic care to patients in accordance with high international standards, using the latest medical technologies and knowledge.
Due to the high prevalence of inflammatory diseases affecting the musculoskeletal system, patients should pay close attention to the preventive recommendations of an ON CLINIC rheumatologist, which can be obtained directly at an appointment with a doctor.
The administrator will contact you to confirm your appointment. IMC "ON CLINIC" guarantees complete confidentiality of your request.
Among the pathologies of the spine, inflammatory lesions occupy a significant place. One of these diseases is ankylosing spondylitis, also called. It is characterized by systemic changes affecting not only the musculoskeletal system, and occurs in less than 1% of the population. But the serious consequences that patients face increase the importance of the problem, even if its prevalence is low.
Causes
Scientists have not yet fully figured out how ankylosing spondylitis appears. But there are some factors that have a proven influence on the development of pathology. As a rule, ankylosing spondylitis affects young men under the age of 40. And the main predisposing factor is considered to be a hereditary predisposition to systemic damage to the skeletal system. A connection has been established between the occurrence of spondyloarthritis and polymorphism of the HLA-B27 gene.
In addition to idiopathic cases, when the disease develops against the background of clinical well-being, inflammatory damage to the spine can be secondary, developing under the influence of another pathology. These conditions include:
- Reactive arthritis.
- Nonspecific ulcerative colitis.
- Crohn's disease.
Damage to the axial skeleton during the disease is characterized by the fact that various structures become inflamed: bones (osteitis), joints (intervertebral, facet, costovertebral), as well as entheses - places of attachment of fibrous tissue of discs and ligaments. These areas change over time, tissue ossification occurs, which leads to ankylosis.
Among the causes of spondyloarthritis, the influence of genetic factors is clearly indicated, but questions of the origin of the disease require further study.
Symptoms
Ankylosing spondylitis is characterized by damage to the spinal column, namely the lumbosacral region (), however, other areas of the axial skeleton are often subject to inflammation. But the disease does not always begin precisely from this - arthritis of large joints (hip, knees, etc.) and enthesitis can occur. This debut is more often observed in childhood and adolescence. In some people, the pathology manifests itself with cardiovascular disorders, confirming its systemic nature. Thus, it is necessary to highlight the following clinical manifestations of the disease:
- Sacroiliitis.
- Arthritis.
- Enthesitis.
- Uveitis.
- Damage to the heart and aorta.
- Renal dysfunction.
Most often, patients experience a combination of these nosological units, creating various combinations of the course of the disease. And among the general symptoms one can note weight loss, low-grade fever, and a feeling of weakness.
Spondylitis
Inflammation can develop in any segment of the spine, but most often begins in the lumbar region. At first, patients feel discomfort in the back, which they may not even pay attention to. But other symptoms appear relatively quickly, and the detailed clinical picture of spondylitis consists of the following signs:
- Aching back pain that worsens at rest and at night.
- Feeling of stiffness in the spine in the morning.
- Limitation of body movements.
During the examination, smoothness of the physiological lordosis and hypotrophy of the paravertebral muscles are noted. The surrounding tissues are usually painless to the touch.
As the pathology develops, pain spreads to the chest and neck. They often radiate along the intercostal spaces and intensify when coughing or taking a deep breath. In the later stages, persistent contractures develop, the paravertebral muscles atrophy, and due to pathological kyphosis, a “supplicant pose” is formed. Ankylosing is usually accompanied by a decrease in pain, but complications may appear in the form of vertebral displacement and spinal cord compression.
Damage to the vertebrae occupies a central place among the symptoms of ankylosing spondylitis, leading to a sharp decrease in the patient’s physical activity and often causing disability.
Sacroiliitis
The development of sacroiliitis is a mandatory diagnostic criterion for ankylosing spondylitis. In most patients it is completely asymptomatic. And in a third of cases, peculiar sensations of such a lesion are noted - transient, which often lead to lameness. Their duration does not exceed several weeks, after which spontaneous disappearance is observed. On examination, tenderness in the sacroiliac region is also noticeable. But the main signs of sacroiliitis are detected radiographically.
Arthritis
More than half of patients with ankylosing spondylitis sooner or later experience arthritis. And in children, spondyloarthritis often begins with inflammation of the peripheral joints. The pathological process can affect any joints, but mainly the lower limbs are affected. As a rule, unilateral mono- or oligoarthritis of the knees and ankles, hips, and less often the mandibular and shoulder is observed.
Arthritis develops acutely, which is similar to reactive inflammation. There is also a chronic course, as well as spontaneous remissions. In general, joint damage progresses quite slowly, but can become a real problem for patients, given the following symptoms:
- Severe pain.
- Swelling of joint tissues.
- Function limitation.
In some patients, destruction of cartilaginous surfaces, osteoporosis, effusion into the joint cavity, and bone ankylosis are observed. Fixed joints, in particular the pubic symphysis, can also be affected.
Arthritis is another sign of damage to the musculoskeletal system in ankylosing spondylitis, which in some cases prevails over other symptoms.
Enthesitis
With spondyloarthritis, peri- and extra-articular soft tissues are also affected. The most distinct signs of inflammation are observed at the sites of attachment to the bones of tendons and ligaments, where enthesitis develops. Their localization can be quite different, but mainly damage to tissues located near the heels, elbows, shoulders, knees and hip joints are noted.
There are bursitis, capsulitis, osteitis. Bone destruction occurs with further ossification of soft tissues, which complicates the function of periarticular formations. And the following signs appear in the clinical picture:
- Local pain.
- Swelling of soft tissues.
- Restriction of certain movements.
Some enthesitis occurs with rather sparse symptoms, which is typical for damage to the tendons of the iliac region and interspinous ligaments of the spine.
Uveitis
Damage to the spine and peripheral joints is not the only thing that characterizes spondyloarthritis. Systemic inflammation in many cases reaches the organ of vision. In this case, a pathology of the choroid is observed - anterior uveitis (iridocyclitis). It is characterized by the following symptoms:
- Pain in the eyeball.
- Tearing.
- Photophobia.
During the examination, precipitates (deposits) are found on the back of the cornea, a change in the pattern of the iris, and a narrowing of the pupil. Uveitis is complicated by the formation of adhesions in the posterior chamber, opacification of the vitreous, and swelling of the optic nerve. This often leads to decreased vision.
Uveitis sometimes becomes the initial sign of ankylosing spondylitis, many years ahead of other manifestations.
Damage to the heart and aorta
With a long course of the disease, the risk of damage to the cardiovascular system increases. In such cases, inflammatory reactions are found in the aorta (aortitis) or valves (valvulitis). Subsequently, fibrous tissue forms in these places. This is how valve disorders are formed, which can lead to heart failure. The conduction system also suffers - patients often experience atrioventricular blockades, which are manifested by the following symptoms:
- Slowing heart rate.
- Interruptions in the functioning of the heart.
- Dizziness.
- Loss of consciousness.
Severe symptoms are observed in individual patients with rapid development of the inflammatory process in the cardiovascular system. And in most cases, cardiovascular disorders do not have clinical manifestations at all.
Renal dysfunction
Ankylosing spondylitis is also characterized by kidney damage, although it develops much less frequently than other disorders. As a rule, nephropathy occurs associated with the deposition of immune complexes consisting of type A immunoglobulins. Most often, it has a benign course, without long-term impairment of renal function. But the opposite is also possible - a rapid increase in the following symptoms:
- Proteinuria (protein in urine).
- Macrohematuria (blood content).
- Increased blood pressure.
- Kidney failure.
Approximately 1% of patients develop renal amyloidosis, which is a late complication of spondyloarthritis.
If spondyloarthritis develops, the symptoms cover not only the musculoskeletal system, but also the internal organs, indicating the systemic nature of the lesion.
Diagnostics
To confirm ankylosing spondylitis, in addition to a clinical examination of the patient, it is necessary to conduct a number of additional studies. They include laboratory and instrumental procedures that identify inflammatory processes in tissues and their consequences. Patients are shown the following diagnostic program:
- General blood and urine tests.
- Blood biochemistry (markers of inflammation, rheumatic tests).
- Determination of genetic polymorphism.
- X-ray of the spine and joints.
- Tomography (magnetic resonance or computer).
- Electrocardiography.
- Ultrasound of the heart and kidneys.
Radiological criteria for sacroiliitis are important. But in some cases they appear with a delay - about a year after the onset of the clinical picture. These signs are necessary to establish the severity of morphological disorders:
- Stage 1 – doubtful signs.
- Stage 2 – minimal changes (local erosion and sclerosis).
- Stage 3 – unconditional changes (erosions, sclerosis, narrowing of the joint space, possible ankylosis).
- Stage 4 – advanced changes (complete ankylosis).
If ankylosing spondylitis is suspected, consultation with a rheumatologist, vertebrologist, ophthalmologist, or cardiologist is necessary.
The diagnostic program for spondyloarthritis must necessarily include an assessment of structural changes in the musculoskeletal system and analysis of accompanying biochemical changes.
Treatment
Ankylosing spondylitis is a disease that cannot be completely cured. Therefore, the main goal of therapy will be to reduce the severity of inflammatory processes and pain, prevent the development and progression of functional disorders in the spine and joints. Treatment methods for ankylosing spondylitis continue to improve, which gives hope for overcoming this problem in the future.
Drug treatment
Drugs are of decisive importance in achieving the main goals of treatment. They help reduce signs of inflammation in tissues and the corresponding clinical symptoms. But much greater importance is given to the long-term effects that are observed when using modern means that block the mechanisms of pathological effects. The most common prescriptions for the following medications are:
- Non-steroidal anti-inflammatory drugs (diclofenac, nimesulide).
- Corticosteroids (methylprednisolone,).
- Cytostatics (methotrexate, leflunomide).
- Anticytokine drugs (infliximab, rituximab).
It is the latter of these drugs that have the most promising effect, suppressing systemic inflammation in ankylosing spondylitis even in cases resistant to conventional treatment.
Non-drug treatment
With spondyloarthritis, a certain modification of the patient's lifestyle and physical activity is required. Special exercises are especially important for the lumbar and other parts of the spine, as well as articular groups involved in the pathological process. This allows you to maintain and improve the mobility of the structures of the skeletal system, which is an important aspect of quality of life. They should be performed daily, avoiding overloading the back muscles. Swimming helps a lot.
You need to sleep on a hard mattress and small pillows, it is better to maintain the physiological curves in the parts of the spinal column. It is necessary to ensure correct posture, avoiding slouching. It is not recommended to wear corsets for a long time, as they weaken the back muscles.
In addition to gymnastics, physiotherapeutic methods and massage are used in the treatment of spondyloarthritis. This helps fight inflammation and improve biochemical processes in affected tissues.
The optimal set of therapeutic procedures for spondyloarthritis consists of a competent combination of medicinal and non-medicinal methods.
Surgery
In some cases, treatment of ankylosing spondylitis requires surgery. Most often, this is observed in advanced cases, when conservative therapy cannot eliminate the consequences of chronic inflammation. The following operations are carried out:
- upon its destruction.
- Spondylodesis for instability of individual vertebrae and severe kyphosis.
- Installation of an artificial pacemaker for severe heart block.
The prognosis for spondyloarthritis depends on many factors: the time of onset of the first symptoms, damage to internal organs, the degree of structural disorders in the musculoskeletal system, and individual response to therapy. But in any case, treatment should be carried out immediately as soon as alarming signs indicating the development of the disease become noticeable.
There are many diseases known in medicine today that contribute to the destruction and deformation of human bones, in particular the spine.
The spinal column is one of the main organs in the human body, as it performs a supporting and motor function, houses the spinal cord, and is also an attachment for all internal organs. Any disorder in the spine entails painful consequences.
One of the slowly progressive ones is spondyloarthritis. As a result of the development of this disease, a person suffers from back pain, limited motor function, and impaired joint structure.
In this article we will look at what spondyloarthritis is, how the disease manifests itself, why it is dangerous and what measures should be taken.
Spondyloarthritis of the spine is a degenerative-inflammatory disease of the musculoskeletal system, in which destruction occurs and causes its curvature.
The pathology develops slowly, gradually acquiring a chronic form.
The spine becomes inactive and brings discomfort to the person during any movement.
Spondyloarthritis in the chronic stage can cause disability due to severe changes in the structure of the vertebral body. The degree of danger is determined by the stages of development of the disease:
- The first stage of the disease is characterized by the presence of gaps or cracks in the vertebrae, slight limitation of motor ability, and barely noticeable curvature.
- At the second stage, the natural gaps between the joints narrow, which greatly limits a person’s movement. Possible loss of ability to work.
- At the final stage of the disease, the mobility of the spine and joints is reduced to a minimum or absent altogether. A person loses his ability to work and becomes disabled due to health reasons.
Classification
In modern medicine, two types of this disease are distinguished: ankylosing spondyloarthritis, also called ankylosing spondylitis and seronegative spondyloarthritis.
Let's look at what it is in more detail. Ankylosing and seronegative spondylitis are varieties of the same disease, differing in the nature of the development of inflammation.
Ankylosing is characterized by a chronic course with slow progression of joint immobility and fusion of the vertebrae.
This type of disease spreads to the joints of the spine, completely reducing the spaces between them, immobilizing the human body, provoking prolonged attacks of pain.
Moreover, inflammation does not occur in the joint, but at the place where it is attached to other bones - in ligaments and tendons, muscles.
The name ankylosing comes from the phenomenon of ankylosis - the fusion of vertebrae into immobile structures.
The nature of the disease is similar in clinical manifestations to rheumatoid arthritis, which extends not only to bone tissue, but also to connective tissue.
Seronegative spondyloarthritis () are a group of diseases that are similar in clinical manifestations and pathogenic properties.
They have a damaging inflammatory effect on the joints and bones in the area of the spinal column and the vertebrae themselves.
With seronegative spondylitis, prolonged or persistent back pain, changes in posture, impaired support and motor function of the spine, difficulty moving and breathing are observed.
Causes
The causes of inflammatory disease of the joints and spine of a psoriatic nature come down to a disruption in the functioning of the body’s immune system, which perceives the body’s own tissues as foreign and aggressively affects them.
This phenomenon is explained by hereditary pathology - the presence of the HLA B27 antigen, which sends a signal to the brain about the presence of a foreign body in the human body (in this case, joints or spine), then the body tries in every possible way to reject its own tissues.
The consequences can be very disastrous: complete immobilization of the spine due to fusion of the vertebrae, loss of flexibility, decreased functional volume of the lungs (impossibility of expanding the chest during breathing), decreased quality of life and loss of ability to work.Also, among the causes of spondyloarthritis, severe diseases of the genitourinary and digestive systems are identified.
Symptoms
If the cause of the disease is a genetic predisposition to rejection of the body’s own tissues, then the clinical picture will be based on the fusion of the vertebrae and joints of the sacrolumbar, thoracic, intercostal space near the spinal column.
You should pay attention to such manifestations as inflammation of tendons, ligaments and joints (,) for no apparent reason.
In the final stages, the disease affects internal organs, causing disruption of their function.
Symptoms of spondyloarthritis do not appear immediately: in the first stages, the disease may not manifest itself at all, or may cause discomfort with mild periodic pain in the lower back, without attracting the patient’s special attention to this symptom.
A person may not contact a specialist for a long time with such a problem, believing that the cause of such sensations is physical overstrain.In the final stages, the doctor notes that the patient has the following symptoms:
- damage to internal organs;
- vertebral fusion;
- deterioration of respiratory function;
- weakness and weight loss;
- temperature increase;
- other signs of the body's anti-inflammatory response.
Treatment
Spondyloarthritis can be cured in the early stages of the disease, but in the case of a prolonged course, it is only possible to reduce the severity of symptoms, but it will not be possible to completely restore the functions of the spine.
The main danger is that the disease can be asymptomatic for a long time, as mentioned above. Therefore, it is not always possible to prevent its consequences.
The goal of treatment: restoration of motor activity of the spine, elimination of pain, prevention of further fusion of ankylosis.
An integrated approach to the treatment of spondyloarthritis includes drug therapy, physiotherapy, exercise therapy, massage, and surgery.
To eliminate the autoimmune nature of spondyloarthritis, the following are used:
- non-steroidal drugs (ortofen, nimesil, voltaren, etc.);
- antirheumatic drugs for the treatment of joint inflammation;
- corticosteroid drugs are used to reduce inflammation in the last stages of the disease;
- anti-inflammatory drugs;
- muscle relaxants;
- hormonal drugs;
- drugs that improve microcirculation.
Physiotherapeutic methods must be included in the treatment of spondyloarthritis:
- reflexology;
- treatment with ultrasound and laser;
- magnetic procedures;
- inductometry;
- procedures of plasmasorption, plasmapheresis, phonophoresis.
If there is significant limitation in movement due to fusion of ankylosis, the patient may be referred for surgery to restore spinal mobility. This usually means joint replacement, as well as surgical treatment of spinal inflammation.
Exercise therapy and massage for spondyloarthritis
Therapeutic physical activity is necessary in the treatment of diseases of the musculoskeletal system to eliminate problems such as:
- reducing the rate of progression of spinal deformity;
- prevention of vertebral fusion;
- restoration of the functions of internal organs that have undergone changes.
For a patient diagnosed with spondylitis, swimming, on a mat, and joint gymnastics are prescribed.
prescribed as an additional treatment measure should only be performed by qualified specialists to avoid injury to joints and vertebrae.Massage is necessary to restore joint mobility, tone and strengthen muscles, and relieve pain.
Prevention
To prevent the terrible consequences of the disease spondyloarthritis, patients are advised to observe: a hard surface for sleeping, no pillow, room temperature 16 degrees Celsius, duration 6-9 hours.
In everyday life, it is important to adhere to a healthy lifestyle: active recreation, sports, proper nutrition, which includes all the necessary micro- and macronutrients, and correct posture.
Attention! The main risk factor for developing diseases of the musculoskeletal system is excess body weight. Avoid weight gain.
Sanatorium-resort treatment is recommended as a preventive measure for patients with a predisposition to spondyloarthritis or the initial stage of the disease. Prevention includes mud therapy procedures, hydrogen sulfide and radon baths.