Ankylosing spondylitis, as Bechterew's disease is also known, belongs to the group of spondyloarthritides, i.e. inflammatory diseases of the skeletal system. The disease occurs more frequently in young men between the ages of 20 and 40. The spine and the transition to the pelvis, the so-called sacroiliac joint, are predominantly affected. In some cases, symptoms are also found in the area of the knee joint and the tendon insertions.
In the course of the disease, the bones and joints are destroyed and broken down by the inflammation, while new bone cones are formed elsewhere. These have no anatomical function and severely restrict the mobility of the affected person's skeleton.
In Western Europe, it is estimated that around 0.5 percent of people develop ankylosing spondylitis.
Ankylosing spondylitis is a chronic disease and progresses in phases. Back pain and restricted movement can increase with each flare-up. Adhesions and stiffness occur in the joints and ligaments, but the heart, eyes and other organs can also be affected by changes.
The following symptoms indicate ankylosing spondylitis:
- The main symptom is deep-seated back pain, morning stiffness and pain at night
- Other common symptoms are Hip, knee and shoulder pain
- Pain in the heel
- Tennis elbow and tendon disorders
- fatigue
- weight loss
- Pain when sneezing and coughing
After years and several relapses, ankylosing spondylitis noticeably changes posture. The pelvis flattens and the thoracic spine becomes more and more curved, resulting in a hump. The joints of the body are then usually additionally restricted in their movement due to severe pain.
Important complications can include changes to the eyes, heart or kidneys, which require intensive clarification by experts. Otherwise there is a risk of permanent damage to the affected organ systems.
The exact reasons why and in whom ankylosing spondylitis develops are still unclear. Genetics may play an important role, but autoimmune reactions are also suspected. However, the presence of HLA-B27 in the blood of those affected is also very striking. This is a surface protein that helps the immune system to recognize pathogens and threats. In some cases, however, HLA-B27 triggers strong immune reactions that are suspected of attacking bones and joints in an inflammatory manner. This eventually develops into chronic inflammation of the spine and pelvis, ankylosing spondylitis. However, it is not known which pathogen ultimately triggers this overreaction.
In order to be able to recognize the disease, the patient's cooperation in the anamnesis interview is very important. Characteristic back pain usually opens the discussion with the doctor. Other signs also point to ankylosing spondylitis:
- Low back pain lasting more than three months
- Complaints before the age of 45
- Morning stiffness lasting longer than half an hour
- Improvement in back pain with movement, but not at rest
- Frequent waking up at night in the second half of the night due to severe low back pain
- alternating buttock pain.
The doctor uses various methods to confirm the suspected diagnosis. One is the Mennell test, in which the leg is raised backwards in a prone position. This causes the ankylosing spondylitis patient to feel pain in the sacrum area. The Schober-Ott sign, on the other hand, helps to assess the mobility of the spine. A spodylitis patient will no longer be able to reach the floor with their fingertips when bending their body forwards.
The determination of inflammatory parameters (e.g. CRP or erythrocyte sedimentation rate), MRI scans of the back or the determination of rheumatoid factors such as HLA-B27 are also helpful.
Treatment for ankylosing spondylitis is based on three main pillars:
- Remedies for pain and inflammation,
- agents to dampen the immune system and finally
- Exercise and diet.
The painkillers of choice are primarily non-steroidal anti-inflammatory drugs (NSAIDs). However, as these can damage the stomach if taken long-term, they are often given in combination with stomach-friendly medication. Cortisone injections can also be used during acute flare-ups.
Physiotherapy and light exercise have proven to be effective in addition to medication. When eating, fat and too much meat should be avoided, as the arachidonic acids (= special fatty acids) they contain have an inflammatory effect.
Dampening the immune system (= immunosuppression) is only carried out if all other therapies have been exhausted without results. This is because a suppressed immune system always means a higher risk of developing infections or cancer.
Ankylosing spondylitis is an intermittent, chronic disease that develops over a period of years. The disease cannot be cured with current treatments. However, its course and prognosis can be favorably influenced. An active lifestyle is recommended, as is a healthy diet with plenty of fruit and vegetables. In addition to medically supervised pain treatment, patients should complete special training programs that are put together for them by physiotherapists and physiotherapists alike.
However, it is particularly important to attend check-ups to assess changes in the skeleton. If complications also occur in the cardiovascular system, eyes or kidneys, vision, kidney function (using glomerular filtration rate = eGFR) and heart function (e.g. using ECG) should be checked regularly by the relevant specialist(ophthalmologist, nephrologist, cardiologist). The prognosis can then be positive even with progressive spondylitis and the course of the disease can be slowed down.
