Bekhterev’s disease, also known as ankylosing spondylitis (AS), is a chronic inflammatory disease that primarily affects the spine and the sacroiliac joints (where the spine meets the pelvis). It can lead to the fusion of the spine, resulting in a rigid spine. This condition is part of a group of arthritis-related diseases known as spondyloarthropathies. AS typically starts in the late teens to early thirties and is more common in men than in women.
Causes
The exact cause of ankylosing spondylitis is unknown, but several factors are believed to contribute to its development:
- Genetic Factors: A strong link exists between AS and the HLA-B27 gene. While not everyone with the gene develops AS, a significant majority of AS patients are HLA-B27 positive.
- Immune System Dysfunction: AS is considered an autoimmune disease, where the immune system mistakenly attacks healthy joints in the spine and other areas, leading to inflammation.
- Environmental Factors: Some theories suggest that certain infections could trigger the immune system to react in a way that starts the disease process in genetically susceptible individuals.
Symptoms
Ankylosing spondylitis symptoms vary but typically progress slowly over years:
- Back Pain and Stiffness: Chronic pain and stiffness in the lower back, hips, and buttocks that is usually worse in the morning or after periods of inactivity.
- Bony Fusion: Ankylosis, or the fusion of the spine bones, can lead to a permanent stooped posture.
- Pain in Ligaments and Tendons: Particularly the Achilles tendon and the chest wall, can also be affected.
- Fatigue: A common symptom due to chronic inflammation.
- Inflammation in Other Joints: Shoulders, ribs, hips, knees, and feet can also be involved.
- Eye Inflammation: Known as uveitis, presenting as redness, pain, and blurred vision.
- Reduced Flexibility: AS can cause a reduced range of motion in the spine and sometimes the chest, affecting breathing.
Early recognition and treatment of ankylosing spondylitis are crucial to managing symptoms effectively and preventing or minimizing long-term disabilities.
Diagnostics
Diagnosing Bekhterev’s disease, or ankylosing spondylitis (AS), involves several steps to distinguish it from other forms of arthritis and back pain:
- Medical History and Physical Examination: Key to identifying the typical symptoms such as chronic back pain and stiffness that improve with exercise but not with rest.
- Blood Tests: These can detect inflammation with markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Genetic testing for the HLA-B27 gene may also be conducted, which is found in many but not all AS patients.
- Imaging Tests:
- X-rays: Used to look for changes in the joints and bones of the spine and pelvis.
- MRI (Magnetic Resonance Imaging): More sensitive than X-rays for detecting inflammation and early signs of AS before structural changes become apparent.
Treatment
Treatment for Bekhterev’s disease is aimed at managing symptoms, reducing inflammation, maintaining mobility, and preventing spinal deformity. The treatment plan typically includes:
- Medications:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These are the first line of treatment to reduce inflammation and relieve pain.
- Disease-Modifying Antirheumatic Drugs (DMARDs): For patients who don’t respond to NSAIDs, drugs like sulfasalazine may be used.
- Biologic Agents: TNF inhibitors (e.g., infliximab, etanercept) and IL-17 inhibitors (e.g., secukinumab) are effective for reducing pain, stiffness, and inflammation and can prevent further damage in more severe cases.
- Physical Therapy:
- A tailored exercise program is crucial for maintaining joint flexibility and spinal mobility. Exercises often focus on stretching and strengthening the back and abdominal muscles.
- Posture training is also essential to help prevent or manage spinal curvature.
- Lifestyle Modifications:
- Regular exercise, including swimming and walking, can help maintain flexibility and manage symptoms.
- Smoking cessation is particularly important, as smoking can worsen the progression of AS.
- Applying heat/cold to relieve pain and stiffness can also be beneficial.
- Surgical Intervention:
- In severe cases, especially when there is significant joint damage or deformity, surgical options such as joint replacement or spinal surgery may be considered.
- Regular Monitoring and Follow-Up:
- Ongoing assessment by a rheumatologist is needed to monitor disease progression and adjust treatment as necessary.
- Regular eye examinations are recommended due to the risk of uveitis associated with AS.
Managing Bekhterev’s disease effectively requires a comprehensive and proactive approach, involving both medical treatments and lifestyle adjustments to reduce symptoms, maintain function, and improve quality of life.
Prevention
Preventing Bekhterev’s disease, or ankylosing spondylitis (AS), is not currently possible due to its unclear etiology involving genetic factors and immune system dysfunction. However, individuals diagnosed with AS can take steps to prevent the disease from worsening and reduce the risk of complications:
- Regular Exercise: Maintaining a routine that includes stretching and strengthening exercises to preserve joint function and prevent stiffness.
- Good Posture Practices: Engaging in activities and exercises that promote good posture to help manage pain and prevent spinal deformity.
- Quit Smoking: Smoking can accelerate the progression of AS and worsen symptoms, particularly in the lungs.
- Healthy Weight Maintenance: Keeping a healthy weight to reduce stress on the joints, particularly those that support weight like the hips and knees.
Complications
If not properly managed, AS can lead to several serious complications:
- Spinal Fusion: One of the most severe outcomes is ankylosis, where new bone forms on the spine, causing sections of the spine to fuse in a fixed, immobile position. This can significantly limit movement and may lead to a permanent stooped posture.
- Eye Inflammation: Uveitis, an inflammation of the eye, occurs in about 30% of people with AS. Symptoms include pain, redness, and blurred vision, which can lead to more severe eye problems if not treated promptly.
- Cardiovascular Problems: AS can increase the risk of heart problems, including aortic valve inflammation and heart disease.
- Lung Problems: Reduced chest wall expansion due to spinal and rib joint involvement can affect lung capacity and function.
- Osteoporosis: People with AS are at an increased risk of developing osteoporosis, potentially leading to fractures.
Conclusion
Bekhterev’s disease is a lifelong condition that requires ongoing management to mitigate symptoms and prevent severe complications. There is no cure for AS, but with an effective treatment plan that includes medication, physical therapy, and lifestyle modifications, many individuals can lead active, fulfilling lives. Regular medical follow-ups are essential to monitor the disease progression and adjust treatments as necessary to maintain the best possible quality of life. Awareness and education about the disease can also help patients manage their condition more effectively and advocate for appropriate care.