Autoimmune spondyloarthritis. Causes, symptoms and treatment of spondyloarthritis. Early signs of the disease

With seronegative spondyloarthritis, the treatment of which takes a long time, inflammatory and degenerative processes are observed in the joints and spine, leading to various serious pathologies. It is necessary to consider in detail the reasons for the formation of this disease, its symptoms, and modern methods of treatment.

Concept and causes of seronegative spondyloarthritis

Seronegative spondyloarthritis implies a special group of interrelated chronic diseases with similar etiological, pathogenetic and clinical signs. The main feature that unites them is damage to the joints and spinal column. The group includes arthritis classified according to ICD 10:

• psoriatic;
• acute anterior uveitis;
• enteropathic;
• idiopathic ankylosing (Bechterew's disease), etc.

In 1970, seronegative spondyloarthritis (SSAP) was isolated from the general group of rheumatoid arthritis. This was associated with the detection of the common histocompatibility antigen HLA-B27. Other features of the development of this group of diseases are the following identical signs:

• absence of rheumatic factor;
• asymmetrical development;
• heredity;
• absence of subcutaneous nodules;
• manifestations of ankylosing SA or on a radiograph;
• clinical crossovers, etc.

In most cases, doctors consider the beginning of the development of pathology to be an inflammatory process at the site of the sacroiliac joints, which gradually spreads throughout the entire spinal column and covers almost all other articular groups. The disease may have periods of exacerbation and remission. It develops for quite a long time, during which the spinal column gradually turns into a solid curved bone - ossification of the ligaments occurs, fusion of the vertebrae with each other. The spine becomes painful and stiff, loses its mobility. In advanced forms of the disease, it is impossible to completely restore motor activity to the spine and joints. The person becomes disabled.

The reasons for the formation of SSAP are under study. Scientists have established the active influence of infectious agents on the development of this pathology. At the moment, the following causes of diseases can be named:

• genetic predisposition (the presence of the HLA-B27 antigen in everyone);
• genitourinary and intestinal infections;
• penetration of bacteria.

The impetus for the development of SSAP can be severe stress or serious injury.

More often than others, the pathology affects young and middle-aged men.

Symptoms of seronegative spondyloarthritis

With a wide variety of diseases included in the group of seronegative spondyloarthritis, a number of common symptoms can be identified, namely:

• inflammatory pain in the back or joints;
• damage to the sacroiliac joints;
• curvature of the spinal column in the thoracic and other parts;
• psoriatic plaques on the skin;
• disturbances in the functioning of many important organs: cardiovascular system, kidneys, intestines, vision organs
• ulcerative lesions of the oral mucosa;
• Possible subfebrile body temperature.

The extensive inflammatory process gradually involves intervertebral discs, vertebral bodies, ligament attachment points, iliosacral joints, and facet joints. First, pain occurs when moving, and then at rest. On the part of the cardiovascular system, aortritis and impaired AV conduction occur, and heart valve disease can form.

With SSAP, kidney diseases are not excluded: nephrotic syndrome, microhematuria, etc. The patient may experience damage to the optic nerve, cataracts, uveitis, glaucoma and other eye pathologies. Ulcers, erythema, and keratoderma often appear on the mucous membranes. Sometimes the disease manifests itself as inflammatory processes in the intestines.

With seronegative spondyloarthritis, the symptoms are very varied, which makes it difficult to make a correct diagnosis.

Diagnosis of seronegative spondyloarthritis

Currently, modern diagnosis of SSAP is based on careful consideration of the following criteria:

• clinical manifestations;
• genetic predisposition;
• X-ray studies;
• effectiveness of treatment.

Only a qualified specialist can make a correct diagnosis of this pathology. Seronegative spondyloarthritis may have a polymorphic clinical picture that does not fit into the framework of the diseases included in this group. In this case, it is necessary to approach other types of research more carefully.

To obtain an objective picture of the disease, in addition to a rheumatologist, the patient should be examined by a cardiologist, ophthalmologist, gastroenterologist, dermatologist, urologist and other specialists. Specialized doctors will help create a holistic picture of the disease. If necessary, they carry out the following activities:

• aortorrhaphy;
• EchoCS;
• Ultrasound of the kidneys;
• colonoscopy, etc.

When conducting an X-ray examination in patients with SSAP, signs of sacroiliitis are revealed, i.e. lesions of the sacroiliac joints. To determine the specified disease factor, the following can be used:

• radiography;

Laboratory tests of blood and urine, which are carried out on the basis of general, immunological and biochemical tests of the patient, are important for diagnosing the disease. Based on the results of the research, we can conclude:

• about the presence of the genetic marker HLA-B27;
• about an increase in the level of C-reactive protein;
• about the absence of rheumatoid factor.

During diagnostic measures, seronegative spondyloarthritis should be differentiated from diseases with similar symptoms - rheumatoid arthritis, rheumatism, hydroxyapatite arthropathy, etc.

Modern treatment of seronegative spondyloarthritis

The modern method of treating seronegative spondyloarthritis includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The effectiveness of this treatment is determined by a decrease in pain after 2-3 days from the start of taking medications.

It is worth noting that today there are no methods for completely getting rid of this systemic disease. The goal of treatment for SSAP is:

• slowing down or stopping the development of the disease;
• elimination of the main symptoms;
• improving the patient's quality of life.

The effectiveness of treatment will be ensured by an integrated approach, including:

• a course of non-steroidal anti-inflammatory drugs;
• taking immunological drugs;
• proper nutrition;
• complex of therapeutic exercises;
• physiotherapeutic procedures;
• massage;
• traditional medicine.

Basic therapy for SSAP is considered to be a course of non-steroidal anti-inflammatory drugs, which are aimed at relieving pain, inflammation, and swelling. Common representatives of NSAIDs are: "Voltaren", "Diclofenac", "Ibuprofen", "Indomethacin", "Phenylbutazone", a new drug - "Aceclofenac". These medications should be taken under the supervision of the attending physician due to the high likelihood of serious complications in the form of erosive and ulcerative lesions of the gastrointestinal tract.

Such modern immunological drugs as Imunofan and Infliximab have shown their effectiveness in the treatment of seronegative spondyloarthritis. The action of the drugs is aimed at producing antibodies that can eliminate the main structural elements of this pathology.

During periods of remission of the disease, physiotherapy, manual therapy, breathing exercises, certain physical exercises and massages are indicated. Types of physical activity such as walking, swimming, etc. are recommended. A diet developed by a specialist, taking into account the stage of development of the disease and the individual characteristics of the patient, is a necessary component of effective treatment of SSAP.

Additional treatment with folk remedies may be carried out strictly in consultation with the attending physician. These include long-term use of decoctions, tinctures of medicinal plants, and warm compresses.

Possible complications and prevention of seronegative spondyloarthritis

Lack of treatment and/or incorrectly selected drug therapy can lead to irreversible serious consequences:

• degenerative changes in the joints and spine;
• circulatory disorders;
• development of heart valve disease;
• a sharp decrease in visual acuity and blindness;
• severe skin lesions;
• renal failure, etc.

To exclude relapses in seronegative spondyloarthritis or avoid encountering them, you must follow some simple recommendations from doctors. These include:

• emotional comfort without stressful situations, overwork;
• maintaining personal hygiene (washing hands, cleaning premises);
• proper nutrition (eating only fresh and well-cooked food);
• exclusion of questionable sexual relations;
• following a daily routine;
• good sleep;
• increasing immunity;
• eliminating bad habits;
• healthy lifestyle;
• timely treatment of infectious diseases: tonsillitis, ARVI, pharyngitis, etc.;
• undergoing medical examinations to identify any pathologies.

Conclusion on the topic

Thus, seronegative spondyloarthritis is considered a difficult disease to define and treat. Only a responsible attitude towards your health will help you avoid the occurrence of disease.

Comprehensive treatment of ankylosing spondylitis at the Yusupov Hospital helps relieve the patient of pain and other symptoms, improve mobility in the spinal column, and improve the quality of life.

Our experienced rheumatologists carry out accurate diagnostics using special tests, assess the condition of the spinal column, its mobility, and the excursion of the chest. The diagnosis is confirmed by x-ray.

All medications for the treatment of ankylosing spondylitis are available at the Yusupov Hospital. The doctor prepares treatment individually, taking into account the form and severity of the disease. At the same time, our doctors always try to minimize the risk of side effects and prescribe powerful drugs only in cases where they are really necessary. A course of rehabilitation treatment helps improve the condition of the spinal column and return the patient to an active, fulfilling life.

Our specialists

Prices for services *

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, defined by the provisions of Art. 437 Civil Code of the Russian Federation. For accurate information, please contact the clinic staff or visit our clinic.

Ankylosing spondylitis is a chronic inflammatory disease of the spine and sacroiliac joints, which often involves peripheral joints, tendon-bone junctions, the heart, and the organ of vision. Seronegative spondyloarthritis is represented by a group of inflammatory diseases that occur with damage to the spine and joints, which have etiological, pathogenetic and clinical similarities. Primary idiopathic spondyloarthritis is called ankylosing spondylitis. The average duration between the appearance of the first signs of ankylosing arthritis and diagnosis in Russia is 8.7 years, in Moscow – 8 years. To diagnose spondyloarthritis, rheumatologists at the Yusupov Hospital use modern research methods using the latest devices from leading American and European manufacturers. Doctors at the therapy clinic quickly establish an accurate diagnosis if the patient applies in a timely manner.

Spondyloarthritis is treated with the most effective medications that have minimal side effects. Specialists at the rehabilitation clinic widely use innovative methods of physiotherapeutic treatment and kinesitherapy. Severe cases of spondyloarthritis are discussed at a meeting of the Expert Council with the participation of professors and doctors of the highest category. A multidisciplinary approach to the treatment of patients suffering from spondyloarthritis allows one to quickly stabilize the patient’s condition, reverse the development of symptoms of the disease and cause long-term remission.

Causes of spondyloarthritis

The main cause of spondyloarthritis is considered to be the aggressiveness of the immune system towards its own tissues of ligaments and joints. This is due to a genetic predisposition in people who are carriers of the HLA-B 27 antigen. Thanks to this antigen, ligaments and joints are perceived not as their own, but as foreign bodies that the body seeks to reject. The target for spondyloarthritis is the articulation of the spine, sacrum, and costovertebral joints. The disease develops under the influence of the following risk factors:

• Engaging in heavy physical labor or sports in which the main load falls on the spine;
• Overweight;
• Physical inactivity, weakness of the muscular corset, work with prolonged stay in a static position;
• Poor posture, spinal curvature, flat feet;
• A number of dysplasias and developmental anomalies of the spine, including lumbarization (the presence of an additional sixth lumbar vertebra) and sacralization (congenital anomaly of the spine, in which the fifth lumbar vertebra completely or partially fuses with the sacrum) with the formation of a false joint;
• Reducing the height of the intervertebral disc with osteochondrosis;
• Injuries of the spine, limbs, shortening of one leg;
• Natural wear and tear of joints in the elderly;
• Metabolic disorders, hormonal disorders.

Ankylosing spondylitis develops in people who have a specific hereditary predisposition and certain genetic characteristics of the immune system. Chronic urinary tract and intestinal infections play a certain role.

Symptoms of spondyloarthritis

Spondyloarthritis is characterized by a gradual development of symptoms, which in the early stages rarely forces the patient to see a doctor. The disease progresses slowly. Over time, pain spreads to other parts of the spine. The pain syndrome is persistent. In some cases, pain occurs sporadically. Pain with spondyloarthritis has features:

• Increases at rest;
• Decreases when performing active movements or after taking a hot shower;
• The intensity of the pain syndrome is noticeably reduced under the influence of anti-inflammatory drugs.

In some cases, pain may be completely absent. The only complaint of patients is limited mobility of the spine. Changes in the spine develop from bottom to top, so in the upper parts of the spinal column they can be observed only several years after the onset of the disease. If the pathological process affects the upper parts of the spine at the onset of the disease, the course of spondyloarthritis is unfavorable.

Considering the fact that with spondyloarthritis, mobility in the joints that connect the thoracic vertebrae and ribs is limited, patients have impaired respiratory movements. For this reason, weakening of lung ventilation develops, which leads to the development of chronic pulmonary diseases. Additional symptoms of spondyloarthritis are pain in other joints:

• Hip;
• Shoulder;
• Temporomandibular.

Pain in the sternum and swelling of the joints of the upper and lower extremities are quite rare. Spondyloarthritis is characterized by a number of extra-articular manifestations: inflammation of the tissues of the heart, eyes, kidneys and lower urinary tract. Patients suffering from spondyloarthritis note pain in the muscles of the back and buttocks. Atrophy of the gluteal muscles is noted. Pain in the back muscles is a response of the body that occurs when they are tense.

At the onset of the disease, an increase in body temperature may be observed, which accompanies damage to peripheral joints. Patients complain of general weakness and loss of appetite. Weight loss is noted.

Diagnosis of spondyloarthritis

The diagnosis of ankylosing spondylitis is made by rheumatologists at the Yusupov Hospital in accordance with the modified New York criteria, which were published in 1984. They include one radiological and three clinical signs. A radiological sign of spondyloarthritis is bilateral sacroiliitis of at least the third stage or unilateral sacroiliitis of stages 3–4.

Rheumatologists quantify spinal mobility limitations. To assess spinal mobility, easy-to-implement and dynamic assessment methods are used that objectively reflect changes in all parts of the spine: Thomayer's symptom and the modified Schober test. Then the limitation of mobility of the lumbar spine in the frontal plane is assessed. To do this, use the measurement of lateral flexion in this department.

The criterion for diagnosis is the limitation of respiratory excursion. It is defined as the difference between its circumference during inhalation and exhalation. Limitation of chest excursion may indicate involvement of the costovertebral and costosternal joints in the pathological process. Using expert-class devices, X-ray computed tomography and scintigraphy are performed. These research methods allow doctors at the Yusupov Hospital to identify spondyloarthritis at the inflammatory stage of the pathological process.

Treatment of spondyloarthritis

The primary goal of treating a patient with ankylosing spondylitis (ankylosing spondylitis) is to preserve the quality of life for as long as possible through the following measures:

• Controlling symptoms of inflammation;
• Preventing the progression of structural damage;
• Preservation of motor function and social status of the patient.

This is achieved by the use of non-pharmacological and medicinal treatment methods by doctors at the Yusupov Hospital. Rheumatologists use the following medications:

• Non-steroidal anti-inflammatory drugs (diclofenac, nimesulide and meloxicam);
• Analgesics;
• Glucocorticoids;
• Basic anti-inflammatory drugs in case of development of peripheral arthritis (sulfasalazine, methotrexate, tumor necrosis factor inhibitors).

In severe cases of the disease, patients in the therapy clinic receive high-dose pulse therapy with glucocorticoids and undergo plasmapheresis.

Physical exercise is an essential part of treatment. Rehabilitators individually select a physical therapy program. Various exercises are aimed at improving flexibility, strength, stability and range of motion. The patient is explained how to avoid positions that aggravate pain.

In the rehabilitation clinic, patients are treated with modern physiotherapeutic procedures (galvanization or electrophoresis, diadynamic therapy, amplipulse therapy, laser therapy and magnetic laser, magnetotherapy). Reflexologists use acupuncture to relieve pain and muscle spasms. Massage therapists use various techniques aimed at eliminating spasms and chronic muscle tension that form as a result of daily stress. Using manual manipulation, rehabilitation therapists manage to relieve tension in soft tissues (ligaments, tendons, muscles). If you have pain or stiffness in your spine, make an appointment with our specialists.

Bibliography

• ICD-10 (International Classification of Diseases)
• Yusupov Hospital
• Rheumatology. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96.
• Bagirova, G.G. Selected lectures on rheumatology / G.G. Bagirova. - M.: Medicine, 2011. - 256 p.
• Sigidin, Ya. A. Biological therapy in rheumatology / Ya. A. Sigidin, G.V. Lukina. - M.: Practical Medicine, 2015. - 304 p.

The development of spondyloarthritis is associated with a hereditary predisposition. This group of diseases manifests itself in characteristic syndromes: articular, skin, eye, cardiac, intestinal and renal. Diagnosis is carried out according to characteristic clinical criteria, after which anti-inflammatory therapy is prescribed. Recovery is impossible, but the disease must be treated in order to slow down the general damage to the body.

What is spondyloarthritis?

According to statistics, about 1% of people on Earth suffer from spondyloarthritis. Epidemiologists note that we are talking about 80 million people across the planet, most of whom are mature and older men. Previously, it was believed that only old people were susceptible to the disease.

However, today the peak incidence of the disease is observed in people of working age, namely 25-45 years. Spondyloarthritis is a complex term that includes a whole group of inflammatory diseases.

Thus, spondyloarthritis includes:

• ankylosis of the sacroiliac joint (Bechterew's disease);
• reactive and juvenile arthritis;
• and Behçet's syndrome;
• for psoriasis and pathologies of the intestinal tract (Crohn's disease, etc.);
• acute iridocyclitis.

These diseases have similar causative factors, development mechanisms and clinical features. Ailments occur with characteristic damage to the joints of the limbs and spinal column, intestinal tract, skin, eyes, heart and kidneys.

Why does spondyloarthritis appear?

Today, clinicians distinguish two main types of spondyloarthritis: primary (forming on a healthy joint) and secondary (arising as a consequence of early pathology). Rheumatologists are still arguing about the causes of primary spondyloarthritis, while the etiology of the secondary one is already known:

1. Genetic predisposition associated with the presence of special antigens that provoke self-aggression in the body;
2. Damage to the articular surfaces of the vertebrae (osteochondrosis, spondylolisthesis, etc.) or necrosis (necrosis) of cartilage tissue;
3. Epiphyseal dysplasia, accompanied by ossification disorders and joint stiffness;
4. Traumatization of the spinal column (vertebral fractures, subluxations, etc.);
5. Endocrine disorders (chondrocalcinosis or “pseudogout”);
6. Infections of the intestines or urinary system (dysentery, yersiniosis, shigellosis, chlamydia, salmonellosis, etc.).

One of these factors (heredity, infection or injury) activates the body's immune system. The latter inexplicably begins to perceive its own cartilage tissue as foreign. Special protein agents are produced - antibodies - which attack the cartilage of the body, provoking the clinical picture of joint damage.

For this reason, spondyloarthritis is classified as an autoimmune disease associated with self-aggression of the immune system towards the body’s own tissues.

Symptoms

As noted above, diseases classified as spondyloarthritis have common not only causes, but also symptoms. The latter includes the following symptom complexes.

Joint syndrome

Joint syndrome in spondyloarthritis is characterized by pain in the joints of the spine or limbs. Soreness often has a “starting” character: it appears or intensifies when movements begin, after which it disappears.

In ankylosing spondylitis, the process is localized mainly in the sacroiliac and intervertebral joints. Often there is a curvature of the spine in the form of an arch, stoop. In such a deformed state, the spinal column immobilizes, as a result of which a person cannot straighten up.

Arthritis in psoriasis is associated with an inflammatory reaction of the phalangeal joints of the fingers, while damage to the spine develops extremely rarely. appears a week or two after an infectious or viral disease. Usually the joints of the lower extremities become inflamed: the knee, ankle and small joints of the feet.

Cutaneous

Skin manifestations of spondyloarthritis may be accompanied by psoriatic plaques (extensive itchy and flaky formations that sometimes crack and suppurate) or erythema nodosum (dense red nodules under the skin from 0.5-5 centimeters). In some cases, keratoderma (excessive keratinization of the skin), damage to the nail plates, and the formation of ulcerations (ulcerations) on the oral mucosa are observed.

Ophthalmic

Ophthalmological disorders in spondyloarthritis are manifested by inflammation of the iris and choroid (uveitis, iritis), damage to the cornea (keratitis), increased intraocular pressure (glaucoma), as well as optic nerve conduction disorders. Such manifestations often lead to deterioration or complete loss of vision.

Do not destroy sore joints with ointments and injections! Arthritis and arthrosis are treated...

Orthopedist: “If your hip joint and knees ache, immediately get rid of the habit...

Cardiac

Disturbances in the functioning of the heart muscle are usually not associated with the severity of articular syndrome. Often, interruptions in heart rhythm with spondyloarthritis are the first and only complaint of the patient. Thus, patients are often worried about weakness, shortness of breath, dizziness and fainting associated with impaired conduction of nerve impulses in the heart. Sometimes inflammation develops in the walls of the aorta (aortitis), accompanied by angina-type chest pain, hypertension, fever, and circulatory disorders in the upper and lower extremities.

Intestinal

Occurs in 20% of patients and correlates with the activity of the articular syndrome. Thus, intestinal disorders are often accompanied by pain and appear before the activation of spondyloarthritis symptoms. This is usually a long-lasting diarrhea that lasts for a month or more.

Renal

Damage to the urinary system is combined with the accumulation of a specific protein – amyloid – in the kidneys. Blood and protein often appear in the urine, which can be determined with a routine analysis. Clinical manifestations such as pain are rare. The course of such disorders is usually benign and does not lead to renal failure.

Diagnostic criteria

The diagnosis of spondyloarthritis is valid if:

• The patient notes lower back pain, symmetrical arthritis, tenderness in the buttocks, thickening of the fingers like “sausage”, eye damage, genitourinary tract infections (except gonorrhea!), diarrhea before the onset of arthritis or the presence of psoriasis.
• The X-ray shows signs of inflammation of the sacroiliac region (sacroiliitis).
• Blood relatives have previously been diagnosed with psoriasis, spondyloarthritis, or a specific antigen has been identified in the patient.
• When anti-inflammatory therapy is prescribed, the patient's condition improves within two days.

The presence of 3 or more of these symptoms is the basis for a diagnosis of spondyloarthritis. In this case, the greatest weight is given to changes in the radiograph, the determination of a specific antigen in the blood, as well as characteristic lesions of the joints, eyes and intestines.

To confirm the diagnosis of spondyloarthritis and exclude concomitant pathologies, a puncture (puncture) of the joints with examination of their contents, a cardiogram, ultrasound, CT, MRI, as well as a number of laboratory tests of blood, urine and feces are often performed.

How is spondyloarthritis treated?

A complete cure for spondyloarthritis is impossible, so the goal of therapy is to relieve inflammation and pain in order to improve the lives of patients.

Medicines

Thus, patients are prescribed anti-inflammatory drugs by their own doctors (Diclofenac, Phenylbutazone, Nimesulide). If they are ineffective, corticosteroids (Metypred) or immunosuppressants (Sulfalazine, Methotrexate) are used.

Modern drugs include biological agents aimed at modifying the immune response (Infliximab, Rituximab), as well as immunomodulators (Imunofan).

Adjuvant therapy

Patients are provided with a healthy sleep on a hard bed with a low pillow. Stressful situations and emotional tension are excluded, feasible physical activity is introduced, and sanitation of foci of chronic infection (caries, sore throat, otitis, etc.) is prescribed.

During periods of remission (weakening of the disease), patients are recommended physical treatment (darsonvalization, magnetic and cryotherapy), therapeutic and breathing exercises, as well as gentle massage. The goal of such therapy is to get rid of muscle spasms and lightly warm the affected joints.

Prevention

Preventive measures for spondyloarthritis are aimed at monitoring the general condition of people at risk with:

• genetic predisposition (born in families where psoriasis, Crohn's disease, etc. were previously encountered);
• damage to the articular surfaces of the vertebrae (osteochondrosis, spondylolisthesis, etc.) or necrosis (necrosis) of cartilage tissue;
• epiphyseal dysplasia, accompanied by ossification disorders and joint stiffness;
• trauma to the spinal column (fractures of the vertebrae and their processes, subluxations, etc.);
• endocrine disorders (chondrocalcinosis or “pseudogout”);
• infections of the intestines or genitourinary system (dysentery, yersiniosis, shigellosis, chlamydia, salmonellosis, etc.).

Considering that the occurrence of the disease largely depends on genetic burden, its manifestation is a matter of time. Therefore, special attention must be paid to combined damage to the joints, inflammation of the membranes of the eyes, as well as damage to the intestines, heart and urinary system.

Spondyloarthritis is an incurable disease that often leads to disability and disability in patients. Therefore, in order to maintain an adequate standard of living, patients need timely diagnosis and comprehensive treatment.

If the joints of your arms and legs begin to hurt, immediately remove them from your diet...

Orthopedist: “If your knees and lower back start to hurt, remember, never touch...

Hello, friends!

How is your spine, is it normal? It's good if everything is under control. But there are diseases where changes occur that cannot be predicted. Spondyloarthritis of the lumbar spine, also called ankylosing spondylitis, is one of these types of pathologies.

In the article I will tell you what the essence and main danger of this disease is, we will find out the causes, get acquainted with the classification and their symptoms, and find out how this disease is treated.

A little about the disease: what is spondyloarthritis? In fact, this disease provokes uncontrolled inflammation, which can be observed in almost all structures of the axial skeleton - synovial membranes, tendons, ligaments and joints. Later, as it progresses, changes begin in the bone tissue of the vertebrae and subsequent calcification of the tissue (which is the reason for the development of limitation of movements).

According to statistics, ankylosing spondylitis affects mainly the strong half of humanity - usually men over 35 years of age, although cases of ankylosing processes have also been identified from the age of 15. Women get sick approximately 5 times less often.

Also, spondyloarthritis is seronegative, that is, the examination does not reveal bodies to the rheumatoid factor, which is characteristic of similar inflammatory processes.

Causes

There is no reliable information about the true etiology of the disease. There are guesses and theories, which mainly come down to autoimmune processes, when the body’s own immune cells show aggression on the joints and ligaments of the body.

In addition to scientific assumptions, there is also a group of provoking factors that can serve as an impetus for the development of spinal spondyloarthritis:

• stress;
• inflammatory infections of the oral cavity, genitourinary system, gastrointestinal tract, especially their chronic forms;
• spinal column injuries.

Classification

The division is needed to determine the severity of the process, as well as clinical assessment. There are 3 stages spondyloarthritis– initial, moderate and late. Their differences are in how pronounced the restrictions in mobility and changes in ligaments are.

1. Slowly progressive.
2. Slowly developing, but with periods of exacerbation included.
3. Rapidly progressing (feature in the extremely rapid development of vertebral immobility).
4. Septic – arthritis with a sharp onset, fever, profuse sweats and a significant increase in ESR.

The activity of symptoms and the severity of the increase in ESR and C-reactive protein are also taken into account. According to these criteria, minimal, moderate and severe stages are distinguished.

Symptoms

Spondyloarthritis of the lumbar spine develops extremely slowly. Signs and unpleasant feeling for the most part they are simply ignored, many do not even ask the question “what is wrong with me?” At the very beginning, lumbar spondyloarthritis can only manifest itself as weakness, increased fatigue and weight loss.

Soon the patient begins to experience pain in the lower back, which can radiate to the gluteal region. The pain is constant and aching, especially intensifying at night. At this stage, the illness is often equated with standard folk diagnoses - “blown back” or “pulled back”. This is the danger, since therapy should begin as early as possible in order to maintain motor functions and physical activity.

Watch a short video about ankylosing spondylitis.

The initial symptoms of ankylosing spondylitis include:

1. pain – aching in nature, with an accent of activity at night;
2. a feeling of stiffness in the lumbar region - expressed especially often after waking up. The patient can relieve such tension by relaxing or taking a hot bath;
3. swelling and pain in the joints of the lower extremities - if the disease also affects other parts musculoskeletal apparatus.

With the development of spondyloarthritis, smoothing of the lumbar region becomes noticeable, movement, bend over becomes It's getting more and more difficult. With severe progression, the spine may completely lose its bends, taking the so-called “asking pose” - the physiological protrusion in the chest area also smoothes out. This occurs due to an ascending inflammatory process, which subsequently affects almost all parts of the spine.

Spondyloarthritis can involve the joints of the limbs, causing the phenomenon of arthritis. A characteristic feature is damage to the shoulder and hip joints.

Sometimes internal organs can be affected. First, eye diseases occur in the form of uveitis (inflammation of the choroid) and iridocyclitis (involvement of the iris in inflammation). Later, the addition of cardiovascular pathologies is possible - myocarditis, pericarditis, as well as the pulmonary system in the form of emphysema and fibrous changes.

An important clinical manifestation is the appearance of pain in the heel bone, which does not go away over time (taking into account the initial signs).

Ankylosing spondylitis and pregnancy

Often motherhood is the impetus for the launch of inflammatory processes. Unpleasant pain spreads not only to the lower back, but also to the pelvis. Insomnia appears due to discomfort. Spondyloarthritis of the lower back is not dangerous for the course of pregnancy itself and for the baby, just as childbirth through the birth canal is not prohibited.

How to diagnose spondyloarthritis of the lumbar spine

A correct diagnosis is very important to determine in the early stages of spondyloarthritis. When structural changes have occurred in the spine, identifying the disease is not difficult. Only clinical signs are enough.

Video of disease diagnosis

In addition to complaints, you need to pay attention to a general blood test. If the ESR is increased by more than 30 mmol/hour, then in combination with symptoms, you should immediately consult a doctor and find out the cause.

Which doctor treats this disease and who should I refer to for consultation?

• Therapist - he will help you carry out general tests, and also give you a referral to a specialist.
• A rheumatologist is the main doctor who will make an accurate diagnosis, conduct all the necessary accurate studies and prescribe treatment.

The disease is detected in most cases through a clinical examination and evaluation of complaints. Instrumental methods in the form of x-ray diagnostics do not help detect the disease. To distinguish lumbar spondyloarthritis from other inflammatory processes in the spine, blood is donated to determine:

1. rheumatoid factor (it is negative);
2. C-reactive protein (increases depending on the stage of activity).

How to treat spondyloarthritis of the spine?

Consultation on how to treat should definitely be obtained only from a specialist, since the pathology has a tendency to progress.

Therapy includes not only taking pills, it must be comprehensive and long-term. It is also necessary to include rehabilitation measures in the form of sanatoriums and systemic control in the hospital.

Main stages:

1. Anti-inflammatory drugs - include both hormonal drugs. So are non-steroidal anti-inflammatory drugs.
2. Physiotherapy.
3. Exercise therapy should be carried out not only to develop the spine, but also to prevent chest immobility.

Remember that timely treatment of spondyloarthritis in the lumbar spine can slow down the progression and avoid disability.

This is where I end the article. If the material was useful, leave a comment and subscribe to blog updates.

Take care of yourself and your spine!

Content

Inattention to health when the first signs of disease appear can cause serious consequences. An advanced state of spondyloarthritis leads the patient to limited mobility and the appearance of serious complications. How the disease develops, what symptoms it has, methods of diagnosis and treatment - this is discussed in the review of the pathology of the spine and joints.

The danger of the disease lies in its slow development - the patient notices irreversible consequences late. Spondyloarthritis - what is it, what is its danger? The chronic disease is systemic in nature; degenerative changes occur in the spine, accompanied by inflammation. As the:

• Ankyloses are formed - areas of vertebral fusion.
• Rigidity of the spinal column occurs - immobility, the formation of a solid bone joint.
• Curvature of the spine develops in the thoracic region - kyphosis. In the lumbar region - lordosis - convexity of the bend forward.

Spondyloarthritis is a disease that, according to statistics, affects men more often. The pathology covers 1.5% of the population; the disease occurs in children in 8% of the total cases. There are 2 types of disease:

• ankylosing spondylitis - affects ligaments, tendons, muscles, in places of attachment to bones;
• seronegative spondyloarthropathy – joints in the spinal region and vertebrae are susceptible to inflammation.

A famous scientist studied ankylosing spondylitis, so it bears his name - ankylosing spondylitis. The pathology is characterized by:

• gradual progression to all parts of the spinal column;
• persistence of pain that worsens at rest;
• lesions of the ankle, knee joints, sacroiliac, costosternal joints;
• stiffness of the back and pectoral muscles;
• transformation of a flexible spine into an immobile bone.

Causes

Doctors are inclined to believe that ankylosing, seronegative spondylitis develops as a result of the aggressiveness of the immune system, which attacks the tissues, ligaments, and joints of its own body. This is explained by genetic predisposition. In carriers of the HLA-B 27 antigen:

• own tissues are perceived as hostile;
• the body makes efforts to reject them;
• inflammation of soft tissues, tendons, hip and knee joints begins;
• The main lesion is the costovertebral joint, sacrum, and spine.

The etiology of ankylosing spondylitis is under study. It is believed that the development of degenerative lesions of the spine and joints can cause a change in immune status, provoked by:

To accurately describe all conditions associated with ankylosing spondylitis, a classification is used. It includes divisions according to the stages of pathology development and laboratory data. According to functional insufficiency, the following are noted:

Based on the results of laboratory studies, the stages of process activity are distinguished:

	Symptoms	Stiffness in the spine, joints	ESR, mm/hour	C-reactive protein
(minimum)	Limited mobility
(moderate)	Persistent joint pain	Duration up to three hours
(progressive)	Persistent painful syndrome, damage to internal organs, development of ankylosis	All day

According to the phases of development, the inflammatory process is divided into exacerbation and remission. There is a primary type of ankylosing spondylitis - idiopathic, occurring without previous diseases, secondary - as a result of complications after inflammatory and infectious pathologies. According to the degree of damage, the following forms of pathology are distinguished:

• central – spinal disease;
• rhizomelic - damage to the hip and shoulder joints is added;
• peripheral – the elbow and knee joints are additionally covered;
• Scandinavian - in addition to the spine, small joints of the foot and hands hurt.

The stages of ankylosing spondylitis are classified according to the nature of the course:

• slow progression of the disease;
• periods of exacerbation are added to the slight development of pathology;
• rapid progression of ankylosis in a short period of time;
• septic development - an acute onset with increased temperature, fever, and the appearance of visceritis.

Symptoms of spondyloarthritis

The disease has many common symptoms with other pathologies characterized by a degenerative-inflammatory course. Spondyloarthritis is characterized by a slow development of processes from the lumbosacral region to the cervical spine. Distinctive symptoms of ankylosing spondylitis:

• inflammation of the iliosacral joint – sacroiliitis;
• problems with flexion and extension of the spine;
• disease of the iris - iritis.

The inflammatory process is characterized by:

• development of the disease in young men;
• severe pain at rest, decreasing with movement;
• increased muscle tension followed by atrophy;
• limited mobility of the spine, ending in an irreversible stage, disability;
• change in gait;
• difficulty turning the head;
• respiratory dysfunction;
• increased temperature;
• chills;
• sweating;
• weakness.

The symptoms of ankylosing spondylitis manifest themselves differently in women and children. Characteristic features of the inflammatory process:

• in boys, most often between the ages of 9 and 16 years, at the onset of the disease, peripheral spondyloarthritis is observed with damage to the hip and knee joints, inflammation of the ligaments develops in acute form, and uveitis is an eye disease;
• in women, exacerbations alternate with long-term remission; aortic valve insufficiency, unilateral damage to the sacroiliac joint, and hypochromic anemia are more common.

First signs

The danger of the disease is that patients take the appearance of problems in the lumbar spine lightly. They become worried when symptoms of stiffness occur. The first signs of pathology are:

• the appearance of pain in the lower back;
• damage to peripheral joints, accompanied by an increase in temperature;
• pain in the chest area;
• decreased appetite;
• weight loss;
• general weakness;
• swelling of the joints in the upper and lower extremities;
• a feeling of hardness in the hips and lumbar spine in the morning.

The inflammatory process continues for a long time, which complicates its diagnosis. The patient turns to specialists late, with the active development of the disease, when the following are observed:

• increased pain;
• discomfort in other parts of the spine;
• inflammatory processes in the membrane of the eyes;
• slouch;
• decreased mobility of the spine;
• back muscle tension.

Pain syndrome

Ankylosing spondylitis is characterized by the breadth and variety of pain manifestations. A distinctive sign of the disease is increased sensations during sleep, in the morning, and at rest. The painful syndrome appears:

• first in the lumbosacral spine;
• extends to the thoracic and pelvic joints;
• in the gluteal muscles, radiating to the thigh;
• in the cervical region, accompanied by dizziness, loss of coordination as a result of compression of blood vessels when the vertebrae are damaged;
• when chewing, when inflammation has reached the maxillofacial joints.

With the development of the disease, a painful syndrome:

• worsens when bending, turning, coughing;
• is episodic in nature or is constant, aching;
• from the lumbar region radiates to the legs;
• decreases from the action of analgesic, anti-inflammatory drugs;
• subsides with active movement, from the use of hot water in the bath, shower;
• manifests itself in spasmodic muscles of the back and chest;
• covers the heart - when aortic valve insufficiency occurs;
• observed in the kidney area when they are damaged during the illness.

Non-vertebral symptoms

With ankylosing spondylitis, extra-articular manifestations are often observed. Among the first signs are tension and spasms in the muscles of the back, neck, and chest. Non-vertebral symptoms of the disease are noted:

• kidney inflammation;
• pathologies of the genitourinary system – urethritis, cervicitis develops;
• changes in the skin and nails when psoriatic spondylitis is diagnosed;
• eye lesions accompanied by photophobia, lacrimation, redness, pain, and blurred vision.

Extra-articular symptoms include the results of damage to other body systems caused by the disease:

• inflammatory processes in the tissues of the heart - myocarditis, valve defects;
• fever as a reaction to joint disease;
• atrophy of the buttock muscles;
• general malaise;
• sudden weight loss;
• shortness of breath as a result of deterioration in breathing caused by chest tightness;
• myocardial dysfunction;
• fibrosis of the upper lungs;
• urinary problems;
• neurological manifestations.

Diagnosis of spondyloarthritis

When a patient consults a doctor, it is important to conduct a proper examination to accurately identify this disease. Diagnosis includes examining the patient and collecting anamnesis. The doctor prescribes:

• physical examination - inspection, palpation, percussion;
• functional tests for the presence of sacroiliitis - the main sign of the inflammatory process;
• X-ray of the lungs, sacroiliac joint;
• laboratory research;
• Ultrasound of the kidneys;
• electrocardiogram;
• consultations with a cardiologist, ophthalmologist, traumatologist, therapist;
• differential studies.

Functional

Functional tests are used to diagnose the disease. They bear the names of the doctors who first examined them. Therapist B.P. Kushelevsky, who described the symptoms of the disease, made a great contribution to the study. Tests for the presence of inflammation bear his name:

The third Kushelevsky symptom is determined in the supine position:

• the patient bends his right leg at the knee;
• takes her aside;
• the doctor rests his hand on his bent knee;
• with the other hand presses the pelvic bones on the opposite side of the body;
• with spondyloarthritis, sharp pain appears in the sacrum - evidence of ankylosing spondylitis;
• the diagnosis is repeated for the other side.

To detect inflammation in the sacroiliac joint, special tests are used. These symptoms include:

• Zatsepina – pain when pressing on the place of attachment to the vertebrae of the X-XII ribs.
• Forstier - determination of the shape of posture. The patient touches the wall with his heels, torso, and head. Lack of contact at one of the points is evidence of spondyloarthritis.

Frequently used tests to detect the inflammatory process:

• Makarova I – pain when tapping the sacrolumbar joint with a hammer;
• Makarova II – pain in the sacroiliac region with sharp contraction and separation of the legs in a supine position;
• bowstring symptom - when the body bends back and forth on the flexion side, the rectus dorsi muscles do not relax.

Laboratory

Important components of diagnosing the disease are laboratory tests. Of great importance is a general blood test, which determines the activity of the process in terms of ESR. Biochemical research reveals:

• elevated C-reactive protein;
• alpha 1, alpha 2, gamma globulins;
• direct and total bilirubin;
• protein, its fractions;
• seromucoid;
• febrinogen;
• thymol test;
• alkaline phosphatase;
• creatine;
• urea

To determine the severity of the disease, additional laboratory tests are carried out. Diagnosis of spondyloarthritis includes:

• determination of blood glucose levels;
• general urine analysis;
• rheumatological tests - fibrinogen, rheumatoid factor, C-reactive protein;
• determination of immunoglobulins of classes M, G, and HLA-B 27 antigen in blood serum.

The earliest changes begin in the joints of the sacroiliac joint. They are detected at an early stage using scintigraphy. X-ray examination gives accurate results. The stages of damage are noted:

• I – the articular surfaces have an unclear contour, the joint gap is widened, moderate subchondral sclerosis is determined;
• Stage II – sclerotic lesions of cartilage, narrowing of the interarticular space;
• III – partial ankylosis;
• Stage IV – complete immobility of the sacroiliac joint, a symptom of squaring of the vertebrae.

Differential

To successfully stop the inflammatory process, it is necessary to distinguish spondyloarthritis from many other diseases that have similar symptoms. For this purpose, special diagnostic measures are carried out. Distinctive characteristics of ankylosing spondylitis:

• the presence of a symptom of vertebral quadratization;
• symmetry of the manifestation of symptoms in the sacroiliac joint;
• uniformity of damage to all parts of the spinal column.

Characteristic features of diseases with a similar clinical course are noted:

Among the diseases that need to be differentiated when diagnosing spondyloarthritis:

Treatment of spondyloarthritis

The task set by vertebrologists when diagnosing the disease is to stop the progression, alleviate symptoms, and reduce the inflammatory process. There are non-drug and medicinal treatment methods. The first include:

• daily morning exercises;
• regular physical exercise;
• sleeping on a hard surface, without a pillow;
• body weight control – weight gain is not allowed;
• breathing exercises – stops chest deformation;
• hardening procedures;
• maintaining correct posture.

To improve the condition of patients, effective treatment is prescribed:

• drugs that relieve inflammation and pain;
• immunocorrective agents;
• medications that improve microcirculation in tissues;
• glucocorticoids – for severe disease;
• muscle relaxants that relieve spasms;
• hardware physiotherapy;
• mud therapy;
• baths;
• treatment in sanatoriums;
• surgery to correct the deformity if the diagnosis is axial spondyloarthritis with severe joint changes;
• if the hip joint is damaged, prosthetics are used to restore mobility.

Drug therapy

In the treatment of spondyloarthritis, an important role is played by medications. Groups of drugs have different effects. Vertebrologists prescribe:

	Drugs	Action
Immunocorrectors	Wobenzym	Reduces the development of autoimmune conditions
Immunosuppressants	Diprospan Azathioprine	Reduce immune activity that causes disease
	Methotrexate	Cytostatic, non-hormonal immunosuppressant
Anti-inflammatory	Sulfasalazine	Has an antibacterial, antiphlogistic effect
	Indomethacin	Non-steroidal anti-inflammatory drug – reduces swelling, pain

The effectiveness in the treatment of spondyloarthritis is:

	Drugs	Action
Glucocorticoids (hormonal agents)	Metipred Prednisolone	Treat inflammation in severe stages of the disease, have an immunosuppressive effect
Muscle relaxants	Mydocalm Baclofen	Relieves spasms, reduces strain on muscles
Chondroprotectors	Structum	Slow down the deformation of cartilage tissue, accelerate the formation of synovial fluid
Vascular agents	A nicotinic acid Pentoxifylline	Stimulate microcirculation, metabolic processes, improve tissue nutrition

Physiotherapy

Physiotherapeutic procedures help alleviate the patient’s condition at any stage of spondyloarthritis. Sessions help stop the progression of the disease. The course of treatment promotes:

• activation of blood circulation;
• acceleration of metabolic processes;
• normalization of tissue nutrition;
• elimination of painful symptoms;
• acceleration of immunological reactions.

Doctors prescribe for the treatment of spondyloarthritis:

• ultraviolet irradiation – has an analgesic, anti-inflammatory effect;
• phonophoresis with hydrocortisone – relieves pain, reduces swelling;
• reflexology – affects acupuncture points;
• mud therapy – reduces inflammation, activates blood circulation, accelerates metabolic processes;
• ultrasound treatment – ​​increases range of motion;
• Magnetic therapy – improves microcirculation and trophism in tissues.

The inactive stage of the disease requires the use of balneotherapy. Turpentine, iodine-bromine, radon, sulfite baths reduce the inflammatory process and stop the progression of ankylosis. Helps eliminate pain symptoms:

• electrophoresis with Lidaza, Novocaine;
• transcranial electrical stimulation - exposure of the brain to a current of a certain frequency;
• magnetotherapy.

Spondyloarthritis of the lumbar spine is treated with physiotherapy that strengthens the muscle corset, improves tissue nutrition, and increases mobility. Highly efficient:

• laser therapy;
• inductothermy;
• decimeter therapy on the adrenal glands;
• paraffin treatment;
• ozokerite therapy;
• diadynamic currents;
• cryotherapy.

Exercise therapy and massage

If a patient has been diagnosed with spondyloarthritis, his morning should begin with exercise. This will help maintain range of motion, create a positive mood for the whole day, and eliminate stiffness. In addition, you need to regularly conduct exercise therapy classes. Constant moderate loads:

• stop the progression of the disease;
• will prevent deformities;
• activate blood circulation;
• restore weakened muscles;
• normalize breathing.

Ankylosis will progress in the absence of constant exercise. Physical exercise will help:

• treat emerging deformities;
• increase muscle mass;
• reduce pain;
• relieve spasms;
• strengthen posture and muscle corset;
• increase the performance of joints;
• eliminate stoop;
• restore coordination of movements;
• activate the gastrointestinal tract and cardiovascular system.

The doctor selects a set of exercises for the patient individually, taking into account the stage of the disease and well-being. Classes should be done every day for 30 minutes. Physical education includes exercises on:

• neck muscles, spinal erectors;
• coordination of movements;
• strengthening the extension muscles of the spine and back;
• equilibrium;
• development of the hip joint, limbs;
• increase in inhalation volume.

Therapeutic massage plays an equally important role in stopping the progression of spondyloarthritis. The procedure is carried out in a course of 10 sessions during a period when there are no exacerbations or severe pain. Massage helps:

• reduce muscle tension;
• relieve spasms;
• activate blood flow;
• improve nutrition of joints and spine;
• deliver oxygen to tissues;
• stop the process of ankylosis;
• protect joints from toxins.

The patient is prescribed a classic massage of the back, chest, cervical, and lumbar areas. In this case, there is an effect on muscles, skin, and fatty tissue. In addition, underwater, acupressure, and segmental massage are used. The procedures take place in a gentle manner, eliminating pressure, vibration, and patting. Recommended movements:

• stroking;
• trituration;
• squeezing;
• kneading.

Complications

It is impossible to completely cure ankylosing spondylitis. It is only possible to stop the progression of the disease and reduce the symptoms. If treatment is not treated in time, serious complications may occur. In addition to damage to the joints and spine, the disease affects the organs of vision. Developing:

• episcleritis;
• iridocyclitis;
• iritis;
• uveitis;
• glaucoma;
• cataract;
• complete loss of vision.

A serious disease affects other systems, causing the development of:

• pulmonary dysfunction, fibrosis;
• secondary amyloidosis, nephropathy – kidney pathologies;
• diseases of the heart, blood vessels - conduction disorders, valve defects, myocarditis;
• respiratory system problems;
• compression fracture;
• spinal cord damage;
• heart attack;
• stroke;
• hemodynamic disorders;
• atlantoaxillary subluxation;
• a condition that guarantees disability.

Prevention

To avoid such a serious disease as spondyloarthritis, careful attention to your health is required. If symptoms of spinal pathology appear, you need to seek help from specialists and undergo an examination. Early diagnosis:

• helps stop the inflammatory process;
• relieves symptoms;
• improves quality of life.

Since the exact cause of spondioarthropathy is unknown, it is advisable to exclude factors that may affect the functioning of the immune system. Among them:

The following will help prevent the progression of diseases of the spine and joints:

• daily exercise;
• absence of stress, neuroses;
• moderate physical activity;
• counteracting nervous tension;
• normalization of rest - elimination of overloads;
• swimming lessons;
• hardening;
• limiting stress on the spine during work and sports;
• safe sex life.

Video

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.