Ankylosing spondylitis

 

Ankylosing spondylitis

Ankylosing spondylitis is also recognized as "Bechterew's disease."

Ankylosing spondylitis (Bechterew's disease) is an inflammatory disease of the small vertebral joints. In addition, all joints, large and small, can be affected by this immunologically mediated inflammation. Eye involvement in the form of iris inflammation (iritis) is possible. Internal organs are very rarely involved. The mistakes the immune system makes are similar to those in psoriatic arthritis.

causes

The cause or trigger of the disease is currently unknown. The disease is associated with a specific gene, HLA B27. Very many patients carry this gene. However, since 8-10% of the total population also have this gene, the determination of this genetic factor is only of importance in those patients who also have the related symptoms of the disease. It is central to point out that it is not a hereditary disease.

 

complaints

Spine: The disease often begins at a young age (usually between the ages of 20 and 40). The patients complain of deep back pain. The pain increases when you are at rest and is supposed as uncomfortable, especially at night. Many patients wake up from back pain at night. Many wounded complain of back toughness in the morning, which improves with movement. The symptoms can also radiate into the gluteal muscles. As seen in a herniated disc, leg pain typically does not occur.

 

·        Joints: Joint inflammation can affect large and small joints. The joints swell, are limited in mobility, and lead to pain.

 

·        Tendons: Many patients experience persistent, persistent tendinitis, e. B. in the sense of a "tennis elbow" or the form of Achilles tendon complaints.

 

·        Eye: An inflammation of the eye's anterior segment (iris inflammation) leads to severe pain, reddening, and photophobia in one eye. In some patients, this is the only manifestation of the disease. Irritation of the iris can be very persistent and may also recur.

 

·        Heart: Heart involvement is infrequent and affects the heart valves. An ultrasound scan of the heart can quickly clarify the situation.

 

·        Lungs: Due to the inflammation, the spine becomes stiff. This restricts the chest's mobility and makes the patient feel as though they are getting less air.

 

·        Osteoporosis: The risk of osteoporosis is increased in patients with ankylosing spondylitis. The reduced mobility of the spine, combined with general immobility and cortisone therapy, supports the development of osteoporosis, which, however, by no means always occurs.

Therapy in rehabilitation

Without therapy, the small vertebral joints' inflammation leads to reduced elasticity and ultimately to a stiffening of the affected spinal column sections. The disease usually arises from the lumbar spine upwards. The therapy aims to counteract this stiffening through targeted measures.

 

·        Spine: The small vertebral joints' inflammation can be reduced through active, properly dosed training. With active exercise treatment, the small ligaments and tendons can regain their elasticity. This therapy must be started early before the tendons and ligaments are converted into bone braces. The spine's limited mobility leads to the shortening of various tendon attachments, including those on the hips and knee joints. Targeted physiotherapeutic treatment is crucial and is combined with back training and functional gymnastics tailored to the clinical picture. Sports therapy is an essential building block for successful treatment.

 

·        Joints: The joint inflammation can be relieved by local measures. Physiotherapy and occupational therapy techniques can be beneficial. In the acute stage, the use of cold is helpful.

 

·        Nutrition: As part of rheumatological rehabilitation, patients receive specific suggestions for a modern diet that focuses on the correct ratio of carbohydrates (sugar), fats, and proteins. 

·        Information/training/exchange: In training courses, the patients receive information from specialized rheumatologists based on scientific studies of recent years. It is vital to understand how exercise and nutrition work and why these therapies are so important. The exchange with other patients helps to cope with the disease.

 

·        Targeted drug therapy: In addition to the aforementioned therapeutic measures, continuous drug therapy plays a significant role. It has been possible to develop therapy guidelines worldwide that can very successfully stop the inflammatory process in many patients. The use and selection of the drug depend on the stage of the disease and the exact manifestations of the disease. In rehabilitation, patients are taught how to use the medication. The mechanisms of action and possible side effects are discussed in detail.

 

·        Job: The job situation assessment is a critical issue for many patients. In a multidisciplinary rehabilitation team, solutions are worked out together with the patient, which ideally helps to ensure earning capacity over a long time.

 

·        Follow-up care/self-help: An inpatient rheumatological rehabilitation measure should always be continued with a medium-term outpatient program to achieve long-term effects. The pension and health insurance programs allow a seamless continuation of the therapies after the rehabilitation. Self-help groups such as the German Bechterew Disease Association ( DVMB ) and the German Rheumatism League are important, competent partners.