Bechterew’s disease, also known as ankylosing spondylitis or Bechterew’s disease, is a chronic rheumatic disease. In Bechterew’s disease, the joints are mostly affected, especially the spinal joints.
What is Bechterew’s disease?
Bechterew’s disease, also known as ankylosing spondylitis and Bechterew’s disease, is a chronic, inflammatory, rheumatic disease that mainly affects the joints.
The spinal joints are particularly affected, which become increasingly stiff as the disease progresses. See lawfaqs for Definitions of Hashimoto’s Thyroiditis.
In addition, inflammatory changes occur in the tendons, eyes, in the large joints and in the heart muscle, since there are no rheumatoid factors in the blood. Internal organs are rarely affected.
The cause of Morbus Bechterew is a disturbed interplay between environmental influences and hereditary factors. About 95 percent of those affected have the hereditary trait HLA-B27, which leads to a faulty immune reaction and thus promotes the development of chronic inflammation.
This genetic trait indicates that the cause of the disease is partly hereditary. In addition, the genetic trait HLA-B27 can cause the human immune system to deal with the normal germs in the intestinal flora in such a way that this also leads to chronic inflammation.
Symptoms, Ailments & Signs
The main symptoms of ankylosing spondylitis are deep back pain, morning stiffness and nocturnal pain. If these symptoms persist for at least three months, this is an unmistakable sign that Bechterew’s disease is present. During the day, the body becomes more flexible again. The symptoms improve especially with movement.
When resting, on the other hand, the pain and stiffness increase again. The pain is mostly in the lower part of the spine and radiates to the buttocks and thighs. Early signs of ankylosing spondylitis can be such uncharacteristic symptoms as occasional heel, hip, knee or shoulder pain.
In the early stages, there can also be increased fatigue, pain when sneezing or coughing, and weight loss. Bursitis and other tendon disorders are also possible. Bechterew’s disease occurs in episodes. The patient is almost symptom-free between the attacks. The posture of those affected typically changes over time, with the thoracic spine arching (hump) and the lumbar spine flattening at the same time.
Over time, the hip and knee joints as well as the shoulder and elbow can also be affected by painful movement restrictions. A smaller proportion of patients develop cardiac arrhythmia, visual disturbances or renal insufficiency. Inflammation of the aorta or other cardiovascular diseases are less common. It is also assumed that some intestinal or urinary tract infections are related to Bechterew’s disease.
Course of the disease
The course of Bechterew’s disease is very inconsistent. In some cases, internal organs, joints or limbs can also be affected and sometimes the disease only manifests itself in the spine.
The inflammatory pain is predominant in some cases, which occur in episodes over many years. In other cases, however, the focus is on the stiffening of the spine, which progresses increasingly in the first 30 years. However, complete spinal rigidity and disability as a result of the disease are rare.
However, if the disease takes a severe course, damage to organs and joints can occur and thus permanent restriction of movement. For example, arthritis in the hip joint can destroy the joint and require a hip replacement. Morbus Bechterew is currently not curable, but the course can be influenced by appropriate therapy.
Patients with Bechterew’s disease primarily experience severe back pain. This pain can also continue to spread to other areas of the body, causing severe pain. Especially at night, rest pain can lead to severe sleep disorders or sleep disorders. They impair the quality of life enormously and lead to irritability in the patient.
In general, persistent pain can lead to psychological problems and depression. The patient’s back also stiffens, resulting in restrictions in movement and in the performance of various sports. It is also not uncommon for heart problems and a racing heart to occur.
The heart problems usually have a negative effect on the life expectancy of the patient and can significantly reduce it. The hips can also be irreversibly damaged without treatment. Bechterew’s disease is treated by taking various medications and performing physiotherapy. Complications usually do not arise. However, not all complaints can be limited in every case.
When should you go to the doctor?
Back pain or joint discomfort should be reported to a doctor as soon as it increases in intensity or persists for several days. If the symptoms are not caused by physical exertion, there is cause for concern.
If the daily requirements or usual sporting activities can no longer be met, a doctor should be consulted. Weight loss, flu-like symptoms such as a cough or runny nose and increased tiredness should be examined by a doctor. If mobility is restricted, morning stiffness occurs, or if the person concerned wakes up at night due to existing pain, a doctor is needed.
An inner restlessness, a feeling of heaviness or a reduced well-being indicate a health impairment. A doctor’s visit is necessary so that a diagnosis can be made and a treatment plan can be designed. Pain in the heels, knees or hips is characteristic of Bechterew’s disease.
Irregularities along the spine up to the shoulder should be treated by a doctor. If the affected person experiences an improvement in symptoms when moving and an increase in pain when resting, a doctor’s visit is advisable. A hunched posture, vision disorders and cardiac rhythm are warning signs of the organism. If there are problems with urination, if there is inflammation and inner restlessness, a doctor’s visit is necessary.
Treatment & Therapy
The first clue for the diagnosis of Bechterew’s disease is the typical back pain. Additional symptoms, such as inflammation of the anterior chamber of the eye and the iris can support this suspicion.
Above all, it is important for the diagnosis to demonstrate inflammation of the sacroiliac joints. For this purpose, a doctor tests the “Menell’s sign”, which indicates inflamed sacroiliac joints. X-rays and magnetic resonance imaging can also confirm the diagnosis of Bechterew’s disease.
Therapy for Bechterew’s disease is mainly aimed at fighting the pain and maintaining the mobility of the spine. Regular physical therapy is essential. Inpatient treatment in an appropriate rheumatism clinic can also be helpful. Drug therapy with non-steroidal anti- inflammatory drugs is also used. In addition, sulfasalazine or methotrexate is added as a basic drug to influence the course of the disease.
In a very active form of Bechteres’ disease, drug treatment with the inflammatory messenger TNF-alpha can be used. This biological inhibitor can reduce the activity of the disease and thus delay or even prevent its progression. On the other hand, an operation is rarely used and only when a hip joint is also affected by inflammation and an artificial hip joint is necessary.
Outlook & Forecast
The prognosis can be very different for those affected, because there are significant differences in the severity of Bechterew’s disease. However, active cooperation on the part of the patient can have a very positive influence on the course. Around 80 percent of patients are still able to work despite their illness, even if their mobility is often somewhat restricted. On average, however, the course is so severe in 10 to 20 percent of patients that progressive stiffening occurs. This can eventually lead to severe long-term disabilities.
However, Bechterew’s disease can also come to a complete standstill at any time. If the disease occurs early in those affected, i.e. before the age of 18, the overall prognosis for these patients is significantly poorer. Also unfavorable is the ineffectiveness of NSAID preparations and the severe stiffening of the diseased spine in an unfavorable position as well as the involvement of the hip joint.
In general, the disease is often milder in affected women. The stiffening of the spine is also less common in them. The influence of the disease on life expectancy has not been clarified. However, according to some studies, there is a reduction in life expectancy. Death occurs from aortic insufficiency, respiratory insufficiency, spinal cord injury, or from side effects of therapy.
The follow-up care of those affected is directly correlated to the factors of pain, mobility and inflammation. Therefore, lifelong aftercare is based on the pillars of medication compliance, lifestyle adjustment and physiotherapy. While the readiness is usually very high in flare-free intervals, this often decreases in the case of an acute inflammation. Therefore, follow-up care between flare-ups is particularly important.
The drug therapy in the aftercare consists mainly of non-steroidal anti-inflammatory drugs that relieve the pain, maintain mobility and thus improve the attitude towards life. But many NSAIDs can cause gastrointestinal distress, necessitating re-medication. In advanced stages, doctors also use sulfasalazine or TNF alpha blockers to alleviate the symptoms of the disease. All of these medications need to be taken separately and at different times of the day. Medication compliance is extremely important and essential for the progression of the disease.
A healthy lifestyle can also have a huge impact on the course of Bechterew’s disease. Various studies have shown that sports such as walking, yoga, cycling or gymnastics are beneficial for well-being. Because not only the muscles and tendons of those affected are strengthened.
These gentle and even movements gently stretch the joints, enrich them with sonovial mucus and help to straighten the spine. In order to prevent the rapid progression of the disease, those affected should also change their diet in addition to exercise. Because arachidonic acid in particular, which accumulates in meat, promotes inflammation and promotes flare-ups.
You can do that yourself
People suffering from Bechterew’s disease can counteract the development of the disease through their own behavior. This includes everyday efforts to keep your posture as upright as possible. A positive, self-confident attitude towards life promotes the attitude of “not wanting to bend”. With this awareness, constant helpful corrections of the posture can be made.
Muscle training and gymnastic stretching exercises are beneficial for improving movement and posture. Endurance sports are also recommended to strengthen your condition and breathing capacity. A hunched back should also be avoided when sitting during working hours or during leisure time, even if it involves exertion. Soft, low armchairs should be avoided. A seat wedge or a suitable cushion in the back area can support the desired posture while driving.
The limited elasticity of the spine can cause problems when walking on a hard surface such as tar, stone or concrete. Wearing shoes with springy soles or cushioning inserts and elastic heels reduces the symptoms. The bed should definitely not be equipped with a soft mattress.
If you can, relax your spine when you lie down in the middle of the day and straighten it out again. Even when lying down, care should be taken to ensure that the spine is as straight as possible. Restraints should be avoided in all areas of everyday life. A sensible lifestyle with a healthy, balanced diet is also useful.