Monday, April 21, 2014

Bechterew's Disease (Ankylosing spondylitis)

Definition

Bechterew's disease is also called Marie Strumpell disease, rheumatoid spondylitis, and ankylosing spondylitis.

Ankylosing is a term meaning rigid or stiff. Spondyl refers to the spine, while itis means inflammation. Ankylosing spondylitis causes inflammation of the spine and affects young males predominantly, producing pain and stiffness as a result of inflammation of the sacroiliac, intervertebral, and costovertebral joints. It may progress to cause complete spinal and thoracic rigidity. It can also affect hip and shoulder joints, and infrequently the peripheral joints.

Description

Ankylosing spondylitis is a serious ailment that affects males almost exclusively, with the first appearance of the signs or symptoms usually occurring between the ages of 15 and 45. There is stiffening of the spinal joints and ligaments, so that movement becomes increasingly painful and difficult. When it runs its full course, it results in bony ankylosis of the vertebral joint. The stiffening may extend to the ribs and limit the flexibility of the rib cage, so that breathing is impaired.

Causes

A familial tendency has been strongly suggested by recent evidence. Immunologic activity is suggested by the presence of histocompatibility antigen HLA-B27 (in more than 90 percent of patients with this disease) and circulating immune complexes.

Symptoms

The presence of symptoms other than back pain depends on the disease stage. These symptoms may include:

  • Intermittent low back pain, usually most severe in the morning or after a period of inactivity
  • Stiffness and limited motion of the lumbar spine
  • Pain and limited expansion of the chest due to involvement of the costovertebral joints
  • Peripheral arthritis involving shoulders, hips and knees
  • Hip deformity and associated limited range of motion
  • Tenderness over sites of inflammation
  • Mild fatigue, fever, anorexia, or weight loss
  • Occasional iritis
  • Aortic regurgitation and cardiomegaly
  • Upper lobe pulmonary fibrosis (mimicking tuberculosis)

Diagnosis

This problem is diagnosed through a combination of clinical history and x-rays. While blood tests for HLAB27 can be positive in ankylosing spondylitis, many males without ankylosing spondylitis also test positive for HLAB27; thus, HLAB27 testing should not be used as a substitute for a thorough examination.

Treatment

Most patients respond well to medications given to reduce pain and inflammation, combined with exercises to improve posture and strengthen muscle groups to counteract possible deformity. This is particularly true for patients who contract it early in life and for whom treatment begins early in the course of the disease.

Nonsteroidal anti-inflammatory drugs are effective in treating patients; the most effective appear to be indomethacin and related compounds. Other nonsteroidal anti-inflammatory drugs may also be helpful. Narcotic and systemic corticosteroids are to be avoided.

Exercises should emphasize back movements, especially extension, straightening of the thoracic vertebrae, and deep breathing. Swimming is an excellent exercise.

The patient should get ample rest, sleeping on his or her back on a firm mattress with a flat pillow or none at all. Posture management is extremely important.

Some persons benefit from back braces.

Therapeutic measures usually eliminate the need for surgery to straighten the spine.

The injectable “biologic” agents, Enbrel, Humira, and Remicade, are all indicated for and helpful in the treatment of ankylosing spondylitis.

Questions

What is the stage of the disease?

What are the treatment options?

Do you recommend anti-inflammatory drugs?

Do you recommend Enbrel, Humira or Remicade?

Do these have serious side effects?

Would planned exercise help?

What are good coping methods?

Should I undergo regular eye examinations to look for eye inflammation?