Definition
Rigidness means changes in joints after a long period of inflammation, slowing joint movement, and spondylitis means inflammation of the spine. Therefore, literally transferring ankylosing spondylitis can be said to be a disease that causes inflammation of the spine and slows movement. ankylosing spondylitis is the most common disease in the group of diseases called “blood-negative spondylosis,” which has a negative rheumatoid factor, and is a chronic inflammatory disease that characteristically invades the ceiling joint and spine joint of the hip.
It is characterized by osteoarthritis, which causes inflammation in areas where ligaments or tendons attach to bones, such as heels and front chest bones, and can invade other organs such as eyes, stomach, lungs, heart, kidneys, and prostate in addition to joints. In the past, this disease was known to occur mainly in men, but recently, the proportion of female patients is also increasing.
Cause
The cause of ankylosing spondylitis is not yet known, but it has long been known that it is deeply related to the gene HLA-B27. HLA-B27 appears to be positive in more than 90% of patients with ankylosing spondylitis, and if there are patients with ankylosing spondylitis in their families and HLA-B27 is positive, the incidence is high at 10% to 30%. However, given that HLA-B27 is also found in 5% of healthy people, the cause of ankylosing spondylitis cannot be explained only by genetic factors, and environmental factors such as bacterial infection, trauma, and overwork are thought to affect it.
Symptom
Symptoms of ankylosing spondylitis mainly appear as pain in the waist, hips, peripheral joints, heels, soles of feet, and anterior breastbone, and other extra-joint symptoms.
1) Back pain: Spondylitis is the most characteristic along with hip ceiling arthritis, and appears as an aspect of inflammatory back pain. It is characterized by a pattern that mainly occurs in the 20s and 40s, and the symptoms gradually progress and persist for a long time for more than 3 months. Inflammatory back pain is clearly distinguished from back pain caused by back sprain and intervertebral disc herniation because it is accompanied by severe and stiff stiffness in the morning and tends to improve after exercise.
2) Hip pain: Ceiling arthritis can cause symmetrical hip pain.
3) Peripheral joint pain: The main symptom of ankylosing spondylitis is spinal symptoms, but arthritis also appears in the limbs in more than half of patients. Usually, in young people in their teens, the disease often begins with symptoms of limbs joints. Unlike rheumatoid arthritis, peripheral joint invasion appears asymmetric, and it is characterized by invading knee or ankle joints well.
4) Pain in the heel, soles, and anterior chest bone: Pain is caused by osteoarthritis, which causes inflammation in the area where ligaments or tendons attach to the bone. It may appear as the first symptom without symptoms of spondylitis in the early stages.
5) Extraarticular symptoms: It can invade various organs such as staphylitis, chronic prostatitis, pulmonary fibrosis, amyloidosis, aortic valve dysfunction, electrocardiogram disorder, and inflammatory bowel disease.
diagnosis/examination
Inflammatory back pain, a characteristic spinal symptom of ankylosing spondylitis, can be suspected of the disease, and it is evaluated through several tests that objectively measure the range of motion of the joint, such as the Schober’s test. In addition, pelvic X-rays can identify and diagnose signs corresponding to ceiling arthritis, and simple X-rays may not find abnormalities in the early stages of the disease. Recently, with the introduction of imaging tests such as CT and MRI, diagnosis has become possible much earlier. Genetic testing (HLA-B27) can be performed if the diagnosis is ambiguous and referred to for diagnosis, but is not essential. Red blood cell sedimentation rate (ESR) and C protein reaction (CRP), which are blood tests that evaluate the degree of inflammation, can also be performed, and their levels are often increased.
Therapy
- Medication
There are no drugs yet to cure ankylosing spondylitis. However, drug therapy is known to have a synergistic effect when implemented in conjunction with exercise therapy, and constant treatment can be used to ensure that there is no major problem in normal life.
Drugs used for ankylosing spondylitis include nonsteroidal anti-inflammatory drugs, antirheumatic drugs, and TNF blockers.
1) Non-steroidal anti-inflammatory drugs: Anti-inflammatory drugs such as indomethacin, naproxen, and diclofenac improve pain and stiffness, enabling a normal life and preventing spinal deformation. It is important that nonsteroidal anti-inflammatory drugs are not just painkillers, but drugs that reduce inflammation. Long-term administration may cause gastrointestinal side effects, but anti-inflammatory drugs have recently been developed to reduce these side effects.
2) Antirheumatic drugs: drugs such as sulfasalazine and methotrexate, which are used in addition to nonsteroidal anti-inflammatory drugs in patients who do not respond well. It can cause various side effects, including gastrointestinal side effects, so it must be taken under the supervision of a specialist.
3) TNF Blocker: A drug that can be used for intractable ankylosing spondylitis that does not respond to existing drugs. It blocks TNF, a substance that plays an important role in inflammatory reactions, and is effective in treating other arthritis such as rheumatoid arthritis. Medical insurance coverage is only applied to some patients who are still suffering from severe symptoms of ankylosing spondylitis due to high prices and who are not responding to existing drugs. Since TNF blockers inject drugs under the skin or into blood vessels as injections, medical treatment and help are required, and side effects such as side effects at the injection site, upper respiratory infections, and the expression of latent tuberculosis must be consulted with a specialist.
- Exercise therapy
Exercise is a basic way to maintain patient flexibility and prevent spinal deformation. You can maintain posture and reduce stiffness through gymnastics and stretching to maintain flexibility in your waist joints and exercises that strengthen your waist and neck. Aerobic exercise is necessary to keep the thoracic exercise flexible, so you need to do it consistently. Among them, it is recommended to swim regularly, and it is recommended to avoid extreme exercise with physical contact. If it is difficult to exercise due to stiffness, it is also a good idea to take a warm shower to relax your joints and muscles and then exercise. If symptoms worsen or spinal stiffness increases, special physical therapy is required.
- Surgery
Rigid spondylitis is a systemic inflammatory disease, so surgery cannot cure it. However, surgery can be considered if there is a major inconvenience in life due to severe deformation of the spine or other joints. However, spinal surgery is very dangerous, so an evaluation by a surgeon who is well aware of the surgery and complications must be made first.
progress/complexity
If ankylosing spondylitis is left untreated, it can lead to stiffness in which the spine is connected like bamboo (Bamboo spin). As a result, spinal movement in all directions becomes difficult, the back bends forward, and the neck becomes difficult to move. If the sternum of the breastbone comes, the chest does not expand, so you will be out of breath even for light exercise.
Rigid spondylitis can cause inflammation throughout the body in addition to the spine and limbs joints. Typically, there is Uveitis, which causes inflammation of the eye’s grape membrane, causing eye pain and visual impairment. Staphylococcus easily, and if repeated, it can lead to serious consequences such as glaucoma or loss of vision. In addition, complications of the lungs, heart, and nervous system may occur.