Treatment of Ankylosing Spondylitis (Bechterew’s Disease)

Ankylosing spondylitis, or Bekhterev's disease — is a chronic inflammatory disease that mainly affects the joints of the spine and the sacroiliac joints. Over time, inflammation can lead to limited mobility of the back, chronic pain and impaired posture. The best treatment results can be achieved if the disease is detected at an early stage.

The first manifestations are often prolonged lower back pain, morning stiffness and discomfort, which decrease after motor activity. That is why these symptoms are often mistakenly associated with overfatigue, because of which seeing a doctor is postponed.

At the «Oxford Medical» clinic, patients with suspected Bekhterev's disease are consulted by a rheumatologist, who conducts comprehensive diagnostics, determines the activity of the disease and selects an individual treatment plan. Timely started therapy helps reduce pain, preserve spinal mobility and reduce the risk of developing complications.

According to National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the exact cause of the development of Bekhterev's disease has not been definitively established. It is believed that the disease occurs as a result of a combination of hereditary predisposition and disruption of the immune system, because of which the inflammatory process develops in the joints and ligaments of the spine.

Factors that may be associated with the development of the disease include:

• hereditary predisposition, in particular the presence of the genetic marker HLA-B27;
• disruption of immune regulation;
• previous infections that can trigger an immune response;
• male sex and young age, because the disease is most often diagnosed in people aged 20 to 40 years.

At the same time, the presence of the HLA-B27 gene does not mean that the disease will necessarily develop. In many people, this gene does not lead to the appearance of symptoms, therefore the combination of several factors plays an important role in the development of the disease.

The most characteristic symptom is prolonged inflammatory pain in the lower back, which intensifies after rest and decreases during movement. As the disease progresses, the inflammatory process may spread to the hip, shoulder and other joints, as well as the places where tendons attach to bones. In some patients, chest pain occurs during a deep inhalation due to decreased mobility of the chest.

Doctors of «Oxford Medical» recommend not ignoring back pain that lasts more than three months, intensifies at night or after rest. Early consultation with a rheumatologist makes it possible to start treatment in a timely manner and preserve spinal mobility.

The course of Bekhterev's disease is usually gradual. The activity of inflammation and the rate of progression differ in different patients, but several stages of the disease development can be conditionally distinguished.

• Early stage. Pain in the lower back, morning stiffness and discomfort after staying in one position for a long time appear. Structural changes may still be insignificant or not detected during standard radiography.

• Stage of progression. The pain becomes more constant, spinal mobility is gradually limited, and the inflammatory process may spread to the hip, shoulder and other joints.

• Late stage. In some patients, prolonged inflammation leads to the formation of persistent structural changes, significant limitation of spinal mobility and decreased mobility of the chest.

Treatment started in a timely manner helps control the activity of inflammation, slow the progression of the disease and preserve mobility and quality of life for as long as possible.

Diagnosis of Bekhterev's disease begins with a consultation with a rheumatologist. The doctor clarifies the nature of the pain, the duration of symptoms, the presence of morning stiffness, family history and assesses the mobility of the spine and chest.

To clarify the diagnosis, the following may be prescribed:

• complete blood count and inflammation indicators (ESR, C-reactive protein);

• testing for the genetic marker HLA-B27 according to indications;

• X-ray of the spine and sacroiliac joints;

• magnetic resonance imaging to detect early inflammatory changes if radiography is not yet informative.

During the examination, the doctor also conducts differential diagnosis with other diseases that may be accompanied by chronic back pain. In particular, it is important to distinguish Bekhterev's disease from reactive arthritis, psoriatic arthritis, degenerative diseases of the spine and other forms of spondyloarthritis.

The diagnosis is established on the basis of the combination of clinical symptoms, results of laboratory tests and instrumental studies. The earlier the disease is confirmed, the faster treatment can be started and its progression can be slowed.

According to the recommendations of Assessment of SpondyloArthritis international Society (ASAS) and EULAR, treatment of ankylosing spondyloarthritis should be comprehensive and combine medication therapy and regular physical activity. The main goal of treatment is to reduce pain and inflammation, preserve spinal mobility, slow the progression of the disease and improve quality of life.

Treatment may include:

• nonsteroidal anti-inflammatory drugs — to reduce pain and the activity of inflammation;

• biological therapy or targeted drugs — if standard treatment is not sufficiently effective;

• therapeutic physical training and individually selected exercises to maintain spinal mobility;

• physiotherapeutic methods according to indications;

• kinesio taping as an auxiliary method to reduce muscle overstrain and improve comfort during movements in individual patients.

Doctors of «Oxford Medical» recommend maintaining regular physical activity even during periods of improved well-being. It is the systematic performance of exercises in combination with correctly selected therapy that helps preserve spinal mobility longer and control the course of the disease.

Without timely treatment, the inflammatory process may gradually lead to irreversible changes in the spine and other organs. The risk of complications depends on the activity of the disease, the duration of its course and the timeliness of the started therapy.

Possible complications of ankylosing spondylitis:

• persistent limitation of spinal mobility;

• posture disorder and formation of pronounced stooping;

• decreased mobility of the chest, which may make breathing difficult;

• damage to the hip joints with worsening of gait;

• inflammation of the eyes (uveitis);

• increased risk of vertebral fractures due to changes in their structure.

With a prolonged course of the disease, the cardiovascular system, lungs and other organs may also be affected in individual patients. That is why it is important to regularly undergo follow-up examinations and follow the doctor's recommendations even during periods of remission. Timely treatment helps reduce the activity of inflammation, slow the progression of the disease and reduce the risk of developing most complications.

It is impossible to completely prevent the development of Bekhterev's disease, since hereditary predisposition plays a significant role in its occurrence. At the same time, timely detection of the disease and following the doctor's recommendations help slow its progression.

For prevention, it is recommended to:

• regularly perform a set of therapeutic exercises;

• maintain daily physical activity;

• not interrupt the prescribed treatment without consulting a doctor;

• control body weight;

• quit smoking;

• regularly undergo follow-up examinations with a rheumatologist.

Doctors of «Oxford Medical» recommend not waiting for symptoms to intensify or for a pronounced limitation of mobility to develop. Regular follow-up, timely correction of treatment and performance of an individual exercise program help maintain an active lifestyle longer and reduce the risk of complications.

The cost of treatment for Bekhterev's disease depends on the activity of the disease, the necessary scope of examinations and the individually selected therapy program. In some cases, a consultation with a rheumatologist, laboratory tests and regular follow-up are sufficient, in others additional studies and long-term treatment may be needed.

You can preliminarily familiarize yourself with the prices for doctors' consultations here. During the consultation, the doctor will assess the examination results, determine the optimal treatment tactics and orient you regarding the cost of medical services. To make an appointment at a time convenient for you, contact the contact center or use the online appointment form on the website.

The information is for informational purposes and does not replace a doctor's consultation.

Sources:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases
• ASAS-EULAR Recommendations
• US National Library of Medicine