Chronic disruption in the musculoskeletal system, called ankylosing spondylitis of the spine, has been known to mankind since ancient times. To such conclusion scientists engaged in anatomical study of mummies of ancient Egyptian pharaohs. However, the first mention of this disease appeared in the medical literature only in the middle of the XVI century.
Italian anatomist Matteo Colombo Realdo in his famous work De re anatomica (1559) described two human skeletons, which had characteristic pathological changes. A complete characterization of the disease was given in the end of XIX century in the writings of Vladimir Mikhailovich Bekhterev (Russia), Adolf von strumpell’s (Germany) and Pierre Marie (France).
So what is ankylosing spondylitis (spondylitis)? In modern medical practice the so-called pathology that is characterized by inflammation of the intervertebral joints, progressive loss of their mobility, ossification of the ligaments that support the spine, and the formation of ankylosis (lots of adhesions). Over time the spine loses its original flexibility and transformered into a solid bone.
The reasons for the development of pathology
The exact cause of ankylosing spondylitis of the spine is unknown. However, there is a presumption that the basis for the development of the pathological process are immune disorders. Protective mechanisms to recognize and neutralize tumor cells and pathogens, suddenly turn its effect on autogenous structures of the body – intervertebral and ankle joints, knees and elbows, sacroiliac, rib-sternum, and sternoclavicular joints, extra-articular tissue. Inadequate immune response triggers the development of inflammatory process in the affected areas.
Among the factors that increase the risk of appearance of the described disorders include:
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- genetic predisposition, a marker which is the presence in the patient of the antigen HLA-B27;
- results active life some strains of enterobacteria;
- the weakening of protective forces, due to hypothermia, allergic reaction, infections, hormonal disruptions, injuries of joints and spine, chronic inflammatory lesions of the digestive or urinary system.
Statistics indicate that such disruption in the musculoskeletal system, as ankylosing spondylitis is detected mainly in the able-bodied men at the age of 23-37 years. Women face manifestations of this disease is 5-6 times less frequently.
The types of ankylosing spondylitis
The classification of ankylosing spondylitis is the involvement in the pathological process of certain joints and extra-articular tissues. More information about the forms of this pathology are presented in table 1.
Table 1. Forms of ankylosing spondylitis.
|Form of the disease||Name the structures of the body involved in the pathological process|
|Central||The spine or certain departments|
|Peripheral||The spine, ankle joints, elbows, knees|
|Rhizomelic||Spine, shoulder and (or) hip joints|
|Scandinavian||The spine, small joint structures of the hands and feet|
Many scholars further distinguish visceral ankylosing spondylitis. This form of pathology combines the lesions of the spine, the articular structures, visual system, kidney, cardiovascular and urinary systems.
The symptoms of ankylosing spondylitis
In its development of ankylosing spondylitis takes several successive stages. The first signs of pathology are:
- irritability, nervousness;
- somnological disorders (difficulty falling asleep, restless sleep, daytime drowsiness);
- mild discomfort in the joints and muscles.
Further development of the clinical picture of the disease depends on the spread of the pathological process (that is, from the involvement of certain sections of the spinal cord, the articular structures, organs and systems of the human body).
Signs of lesions of the spine
The defeat of the spine is manifested by stiffness and intense pain in the lumbar area. Unpleasant sensations appear in the night and intensified in the morning, become less pronounced after charging and warm the soul. Day pain syndrome occurs with a long stay in the same position, disappears or is attenuated during movement.
If untreated, the condition of the person suffering from ankylosing spondylitis gradually worsens.
The development of the pathology is accompanied by:
- the spread of pain up the spine;
- limitation of motion of the spine (patients are experiencing difficulties when trying to perform forward bends or twists the body sideways, bend the back);
- deformation of the spine (flatten the natural curve of the spine in the lower back becomes more prominent kyphosis in the thoracic spine);
- constant tension the back muscles.
Often patients complain of a weakness in the chest, entailing the occurrence of malfunctions of the respiratory system.
Symptoms of lesions of joints, ligaments
In spondylarthritis, accompanied by ankylosis of the spine, most often affects the large joints of the feet and hands, as well as the tendons and ligaments in the area of fixation on the bone. Small bone joints are involved in the pathological process is much less. The development of inflammation accompanied by pain, independent of motor activity of the sick person, the gradual ossification of tendons and ligaments, disorders of mobility of the articular structures.
Extra-articular signs of disease
Description of the symptoms characteristic of visceral ankylosing spondylitis are presented in table 2.
Table 2. Extra-articular symptoms of ankylosing spondylitis of the spine.
|Internal organs and systems affected by pathological process||Signs of damage|
|Eyes||The development of inflammatory processes in the structures of the visual apparatus, blurred vision, severe tearing, feeling cramps or “sand” in his eyes.|
|The heart and blood vessels||Inflammation of the myocardium, heart valves, aorta, development of aortic insufficiency, cardiac arrhythmias.|
|Nervous system||Nausea, dizziness, migraine, urinary incontinence, violation of potency.|
|Kidney||The development of kidney stones, disruption in the kidney caused by the deposition in the tissues of specific polysaccharide-protein compounds amyloid, the occurrence of glomerulonephritis (involvement of the renal glomeruli).|
In some cases, the pathology is accompanied by dysfunction of the lungs and the fibrotic change in the lung tissue.
Diagnosis of the disease
To Refine the preliminary diagnosis of the patient, use the following methods: a study of the medical history and patient’s complaints, examination of the patient (palpation of the joints and the spine, assessment of their mobility and the extent of damage), the General analysis of blood and evaluation of the results (signs of disease are increased erythrocyte sedimentation rate and anemia in the absence of rheumatoid factor), x-ray, CT scan and MRI of the spine.
In controversial clinical cases, the patient is directed to the delivery of a specific analysis allowing to identify the antigen HLA-B27.
How to treat ankylosis of the spine
Modern medicine has no methods and tools that enable you to fully recover from ankylosing spondylitis. So priorities of treatment are blocking the inflammatory process, the pain, maintaining natural mobility of the spine and affected joints.
The standard regimen includes:
- the use of nonsteroidal anti-inflammatory drugs and glucocorticoid drugs;
- the purpose of immunosuppressants;
- the use of biological modifiers of the immune response (drugs of the directed action, blocking development;
- the pathological process, and allow for the natural protective mechanisms of the body);
- physiotherapy (magnetotherapy, reflexology);
- breathing exercises;
- manual impact;
- therapeutic baths (nitrogen, radon, hydrogen sulfide);
- hardening of the patient;
- physiotherapy (physical therapy).
Patients are advised to sleep on a flat and sufficiently hard bed, avoid high physical stress and stressful situations, to give up Smoking.
When physical therapy ankylosis of the spine
The main objectives of exercise therapy ankylosis in the vertebral column are:
- slowing the process of ossification of the tendons and ligaments of the spine;
- the prevention of deformation of the spinal column;
- maintaining natural mobility of the spine and joints;
- strengthening muscles, removing them spasm;
- the weakening of the pain syndrome;
- correction of disorders in the respiratory system.
The scheme develops physical therapy physician individually for each patient. Table 3 presents a description of the most simple and effective exercises that can be included in the program of fight against the considered pathology.
Table 3. Exercise in ankylosis of the spine.
|Original position||A description of the exercise|
|Sitting on a stool with a hard seat||Turn head right, then left. To repeat 7 times.|
|Tilt your head to the right and touch ear to shoulder, then switch sides. Do the exercise 7 times.|
|Stretch the chin to the center of the left clavicle, and then to change sides. Repeat 5 times.|
|Squeeze hands into fists, raise arms out to the side. To reduce shoulder and press your chin to your neck. To stay in this position for 6-7 seconds. Do the exercise 7 times.|
|Lying on the hard and smooth surface on the back||Bend your elbows, rest them on the floor and inhaling tear Breasts off the floor. On the exhale return to its original position. Repeat 8 times.|
|Bend legs in knee joints, have your hands behind your head, raise and then lower the pelvis. Exercise 17 times.|
|Bring your feet together, hands to raise the body, stretch the fingertips to the feet and to lie down again. Repeat 6 times.|
|To sum up bent at the knee joints of the legs to the chest and 6 to make rotatory movements of the pelvis. Repeat the exercise 3 times.|
|To bring your knees to your chest, clasp their hands, rocking back and try to sit down. To carry out 3 times.|
|Lying on the floor on his side||To straighten the leg and do 10 swings forward and backward. To change the side and again perform the exercise.|
|To straighten the leg and do 10 swings up. Repeat lying on other side.|
|Bend the leg at the knee and perform 7 circular motion in the air. Change sides and repeat the exercise.|
|Lift up both legs, to hold them in this position for 5 seconds. Perform the exercise 5 times and repeat the complex, lying on the other side.|
|Lying on hard surface on belly||Put the hands under the forehead and 15-20 times to stretch the gluteal muscles.|
|Put hands on lower back, slightly lift the body and to expand it to the left, then to lie down again. Repeat 6 times and switch sides.|
|Straighten your legs and lift them up as much as possible. To stay in this position for 3-4 seconds. Repeat 6 times.|
|Dilute hand in hand, clench hands into fists, bend the body back, shoulder blades and try to reach the chin to the chest. Do the exercise 8 times.|
|Standing on the floor on all fours||Lower the pelvis on your heels and stretch forward. Repeat 3-4 times.|
|Arch your back upwards, lowering your head down and stay is 7 seconds. Then bend the back down, throwing his head back, and hold for 10 seconds.|
|Standing||Put the hands on the lower back and perform 10-12 circular movements of the body counterclockwise. Repeat in the other direction.|
|Perform 20 swings hands up and down, then sideways.|
|Straighten your left leg and take 7 swings to the side. Repeat for the second leg.|
Along with physical therapy, patients are advised to regularly engage in swimming and other sports that strengthen the back muscles.
The prognosis of ankylosing spondylitis
Ankylosing spondylitis is an incurable pathology, invariably leading to disability of the patient. However, patients persistently following medical recommendations, responsible host assigned drugs and regularly involved in physical therapy for a long time remain active, ability to work and lead a normal lifestyle.