Ankylosing spondylitis (ankylosing spondylitis) is a chronic inflammatory disease of the spine and joints. The cause of ankylosing spondylitis is the aggressiveness of the immune system towards the tissue of one’s own joints and ligaments (inadequate immune response). The reason is a genetic predisposition in people who are carriers of a certain antigen (HLA-B 27); in this case, the immune system mistakenly perceives some tissues of the body as foreign, which is the cause of aggression.
- Ankylosing spondylitis. Why and how joints, ligaments and spine suffer.
- Symptoms, examination and diagnosis of ankylosing spondylitis
- How to relieve pain and maintain mobility of the spine and joints with ankylosing spondylitis
- Gymnastics for ankylosing spondylitis
- Diet for ankylosing spondylitis
- Ankylosing spondylitis and infections
- Ankylosing spondylitis and mental stress
- What is useful and what is harmful in ankylosing spondylitis
- Treatment of ankylosing spondylitis (ankylosing spondylitis) at the Echinacea clinic
Ankylosing spondylitis. Why and how joints, ligaments and spine suffer
Favorite targets of ankylosing spondylitis are the joints and joints of the sacrum and spine, costovertebral joints. Inflammation of the joints of the extremities and peripheral enthesopathies (inflammation of the sites of attachment of tendons to the bone) are also often observed; less often – symptoms of damage to internal organs.
The basis of the disease is inflammation of the joints, tendons and ligaments. In addition, inflammatory changes occur in the synovial membrane of the joints and changes in bone tissue. Long-term uncontrolled inflammation of the articulations and joints of the spine leads to calcification and the development of ankylosis - immobility. Therefore, we strive to reduce the aggressiveness of the immune system and relieve inflammation as quickly as possible - this is the only way to maintain mobility and relieve pain in the back and joints.
Shoulder stiffness
In the shoulder joint, stiffness is manifested by severe pain and a sharp limitation of motor activity. Contracture of the shoulder joints is classified depending on the underlying cause of the pathology:
- adhesive capsulitis;
- postoperative stiffness;
- post-traumatic contracture.
Post-traumatic stiffness is caused by fractures, dislocations, ruptures of the joint capsule and tendons. Fractures always entail erosion of bone tissue and subsequent limitations.
Adhesive capsulitis forms against the background of inflammatory processes. The disease often becomes chronic and leads to the formation of fibrous scar changes.
During operations on the upper limb girdle with the installation of metal structures, the limb is preserved, but the appearance of contracture is inevitable. Stiffness in the shoulder joint appears in women after a mastectomy.
Operating technique and the scale of intervention affect the functioning of the ligamentous apparatus, the level of skin sensitivity, and the innervation of the upper limb.
Symptoms, examination and diagnosis of ankylosing spondylitis
Diagnosis of ankylosing spondylitis
We often see patients with an “experience” of ankylosing spondylitis of 10 years or more, with an unknown diagnosis, and therefore who have not received the correct treatment. In the early stages, it is indeed difficult to recognize ankylosing spondylitis: early radiological signs are familiar only to specialists. In any case, if you have been experiencing morning pain and stiffness in the lower back and back for a long time, you should rule out ankylosing spondylitis. For early diagnosis of ankylosing spondylitis, we perform x-rays in special projections and laboratory tests, including genetic ones.
Symptoms of spinal damage:
- An important early symptom is pain and stiffness in the lumbar spine; often occurring at night and worsening in the morning, it can last more than 2 hours after waking up and decreases after exercise and a hot shower. During the day, pain and stiffness in the spine with ankylosing spondylitis are observed at rest, in the morning and decrease with movement, sometimes disappearing in the afternoon. Spinal damage is a mandatory symptom.
- As the disease progresses, the inflammatory process with pain and stiffness spreads to the overlying parts of the spine.
- The physiological curves of the spine are gradually smoothed out and pathological kyphosis (stooping) of the thoracic region is formed, so that in some cases the correct diagnosis can be made “at a distance”, based on the characteristic posture of the patient. The course of this form of the disease is usually slow, many years, with periods of exacerbations and improvements.
- As a reaction to the inflammatory process in the spine, painful tension in the back muscles occurs.
- In the later stages, in the absence of treatment, the limitation of mobility in the spine is aggravated due to fusion of the vertebral joints and ossification of the intervertebral discs, with the formation of intervertebral “bridges”, clearly visible on x-rays.
Symptoms of joint damage:
- An important manifestation of ankylosing spondylitis is inflammation of the joints of the sacrum - sacroiliitis. In this case, pain can be felt deep in the buttocks. Pain is often mistaken for a symptom of radiculitis or herniated disc, inflammation of the sciatic nerve.
- More than half of patients with ankylosing spondylitis have damage to the joints of the extremities, most often the hip and shoulder. Pain and stiffness in the joints, as well as in the spine, are more intense in the first half of the day.
- Less common is inflammation and swelling of the small joints of the hands and feet. The period of inflammation of the joints of the extremities with Ankylosing spondylitis is most often short-lived (1 – 2 months), but sometimes it can drag on for a long time. Even in these cases, unlike rheumatoid arthritis, destruction and deformation of the joints does not occur (with the exception of the hip joints in advanced cases without adequate therapy).
Non-articular symptoms of ankylosing spondylitis
About a third of cases of ankylosing spondylitis are accompanied by non-articular symptoms. With ankylosing spondylitis, inflammation of the eye tissue (uveitis, iridocyclitis), inflammation of the heart tissue (myocarditis, possible formation of valvular heart defects), aorta (aortitis), lungs, kidneys, and lower urinary tract occurs.
Ankylosing spondylitis usually begins at the end of the second, beginning of the third decade of life, but recently it has become increasingly common in adolescence.
In childhood or adolescence, the disease most often begins with damage to peripheral joints and is accompanied by a slight increase in body temperature.
Stiffness in the joints of the fingers
Restrictions in finger mobility appear as a result of progressive arthritis, a chronic inflammatory process. The causes of stiff finger joints are:
- age-related processes associated with hormonal changes, slowing metabolism, menopausal processes;
- injuries;
- professional conditions: sewing, working with small parts, machines;
- hereditary predisposition;
- immune disorder;
- diabetes mellitus, gout;
- systemic pathologies: rheumatism, systemic lupus erythematosus;
- psoriasis.
The first symptoms of the disease do not cause concern in a person, since they are not accompanied by painful sensations. Morning stiffness is replaced by constant moderate pain. Over time, the joints become deformed and contractures form.
How to relieve pain and maintain mobility of the spine and joints with ankylosing spondylitis
How to relieve pain and maintain mobility with ankylosing spondylitis?
The treatment tactics are logical and quite feasible. The following is required:
- Reduce the aggressiveness of the immune system , and as soon as possible, because inflammation of the joints and ligaments leads to decreased mobility of the spine and joints (ankylosis);
- Control possible risks of exacerbation (infections, intoxications, and other factors that increase the aggressiveness of the immune system);
- Perform gymnastics to restore and maintain mobility;
- Avoid weight gain (overload your joints!); if necessary, we will help you lose weight.
3.Diagnosis of the disease
The diagnosis of osteoarthritis is made after analyzing the symptoms of the disease, information about the location and nature of the pain, and a medical examination. Special methods may be used to diagnose arthritis:
- X-ray
, which will show joint damage and help rule out other types of arthritis; - MRI, the need for which arises if the x-ray turned out to be insufficiently informative.
- Blood tests
are done to rule out other forms of arthritis. - If fluid builds up in your joints, your doctor may remove some of it and examine it under a microscope to rule out other conditions.
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Gymnastics for ankylosing spondylitis
Physical activity is the main condition for proper treatment, so we teach gymnastics to each of our patients . Exercises are selected individually, after assessing mobility impairments. We recommend performing the exercises daily, and if pain occurs, we adjust the gymnastics regimen.
Sometimes you have to develop mobility through the sensation of pain. With irregular exercises, when in the interval between training there is time for a change in the ligamentous apparatus with the formation of dense, sedentary areas in the ligaments and muscles. In these cases, massage helps well. Massage requires quite a long time and frequent courses, so we teach patients and their loved ones massage and self-massage techniques.
Objectives of exercise therapy for ankylosing spondylitis:
- Reducing the progression of ankylosis (if the patient is immobilized, ankylosis occurs quickly)
- Prevention of deformities
- Treatment of existing deformities
- Increasing muscle strength in weakened muscle groups
- Reducing muscle spasm and muscle pain
- Development of correct compensation, correct functional stereotype
- Increased respiratory capacity of the lungs.
Diet for ankylosing spondylitis
As with any chronic inflammatory disease, nutrition must be balanced and compensate for the body's costs. Nutrition should not lead to weight gain, which can increase the load on the spine and joints of the lower extremities. Sufficient consumption of protein foods is mandatory, with preference given to fish dishes and dairy products.
Since patients often have to be prescribed NSAIDs (non-steroidal anti-inflammatory drugs), which have undesirable effects on the mucous membrane of the stomach and intestines, to relieve pain and inflammation, a more gentle diet should be followed.
Your doctor will recommend certain types and caloric intakes of food based on your age, gender, weight, and other important factors.
Stiffness of the jaw joints after dislocation
The temporomandibular joint is susceptible to dislocation due to rough mechanical impacts on the lower jaw. In some cases, unpleasant consequences lead to:
- yawn;
- scream;
- vomit;
- laughter;
- tooth extraction;
- taking dental impressions;
- gastroscopy;
- bronchoscopy;
- intubation;
- bad habits of chewing hard food with teeth, tearing packaging or opening bottles
- falling on the chin;
- direct blows to the lower jaw or temporal joint.
Stiffness of the jaw joints is observed with osteomyelitis, arthritis, and malocclusion. The condition is accompanied by increased salivation, impaired swallowing, changes in facial symmetry, and tension in the masticatory muscles.
Ankylosing spondylitis and infections
In the development of ankylosing spondylitis, the aggressiveness of the immune system against the tissue of one’s own joints and ligaments plays a role (a genetically predisposed perverted immune response to a certain microbial agent). The aggressiveness of the immune system can be maintained at a high level by various types of chronic infections , and this is a common cause of prolonged exacerbations and difficulties in treatment. Pathogenic microbes may not cause any symptoms, but their very presence in the body irritates the immune system.
In case of ankylosing spondylitis , we identify and treat chronic infections , which allows us to reduce the activity of the disease with minimal doses of medications.
Frequent cases of hidden infections:
- Chronic tonsillitis and pharyngitis (inflammation of the tonsils and pharyngeal mucosa);
- Chronic inflammation of the paranasal sinuses;
- Herpes (recurrent rashes on the lips and/or genitals);
- Intestinal dysbiosis and intestinal parasites;
- Infections of the genitourinary system (prostatitis, urethritis, cystitis, etc.);
- Inflammatory cysts in the area of tooth roots.
Seasonal viral infections can also cause arthritis to worsen.
2. Causes of arthritis (osteoarthritis)
There are several factors that increase your chance of developing arthritis:
- Heredity
. Some people have an inherited defect in one of the genes responsible for the formation of cartilage. This can cause rapid wear and tear on the joints. Those who were born with spinal curvature or scoliosis are prone to developing spinal osteoarthritis. - Obesity
. Obesity increases the risk of developing arthritis in the knee, hip and spine due to the excess stress of body weight on the joints. - Injuries
. Injuries can also affect the development of the disease. For example, athletes who have had a knee injury often develop knee arthritis. People who have had serious back injuries may be predisposed to developing osteoarthritis of the spine. A bone fracture can cause arthritis in the joint near the fracture site. - Excessive load on the joint
. Increased stress on a joint increases the risk of arthritis. For example, people whose jobs require constant bending of the knee are more likely to suffer from osteoarthritis of the knee. - Other diseases
. People with rheumatoid arthritis, the second most common form of the disease, are also prone to developing osteoarthritis. In addition, certain conditions, such as too much iron in the body or excess growth hormones, contribute to the development of osteoarthritis.
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What is useful and what is harmful in ankylosing spondylitis
Useful for ankylosing spondylitis:
- Swimming (swimming – work of the spine and joints without gravitational load);
- Regular gymnastics, slow exercises - “toffees”;
- Massage (out of exacerbation);
- Dosed and systematic implementation of hardening procedures.
Harmful for ankylosing spondylitis:
- It is contraindicated to engage in traumatic sports; running, jumping, and sudden movements are not recommended;
- Hypothermia is contraindicated, so we recommend conducting rehabilitation exercises in comfortable conditions;
- Physiotherapy and massage are not recommended during an exacerbation; massage (not sports, but therapeutic) is prescribed when the inflammatory activity of the disease subsides; It is recommended to conduct courses at least 4 times a year;
- Treatment with immunostimulants (leads to exacerbation);
- Nervous and physical fatigue.
Treatment of joint pain with osteopathy
Treatment of joint pain with classical methods includes regimen, diet, physical therapy, massage, physiotherapy and drug therapy. Acute arthralgia is usually relieved by taking non-steroidal anti-inflammatory drugs (NSAIDs). In case of a severe attack of pain, blockades are made. Unfortunately, therapy often eliminates only the symptoms, but not the cause of the disease. Moreover, often the inflammatory process that causes pain is a compensatory mechanism aimed at increasing blood supply when it is insufficient. And anti-inflammatory drugs, especially steroid ones (diprospan, kenalog) interfere with the body and thereby aggravate tissue hypoxia, leading to atrophy and even necrosis. Thanks to this “treatment,” arthrosis often gradually moves from mild to severe, despite temporary relief.
Osteopathy works in a completely different way. It evaluates the structural and anatomical relationships between organs and systems of the body, allowing you to accurately determine why joints hurt. The technique is absolutely safe and painless for the patient, as it does not involve brute force. It can be used for therapeutic and prophylactic purposes at any age. Osteopathy in children makes it possible to identify damage to the musculoskeletal system that has formed in utero and during childbirth, and to prevent complications associated with them.
An osteopathic doctor uses his hands to diagnose and treat joint pain. It affects the affected anatomical area (bones, cartilage, ligaments, muscles, blood vessels, nerves), causing a complex effect. During the session, arthralgia, edema, and organ dysfunction are reduced or even eliminated, and blood supply and innervation are restored. The person feels relief and improved well-being.
For joint pain, osteopathy can be used as an independent method or combined with other types of treatment (physiotherapy, pharmacotherapy, local invasive manipulations). Taking into account the etiology of arthralgia, doctors prescribe painkillers, hormonal agents, antibiotics, xanthine oxidase inhibitors, chondroprotectors and vitamin-mineral complexes. If the oncological diagnosis is confirmed, osteopathic treatment of the affected joints is not carried out. In this case, special treatment is prescribed, for example, radiation therapy, chemotherapy with cytostatics.
Regardless of the cause of arthralgia, osteopathy always gives good results. However, like any treatment for joint pain, it has limitations in its use. Absolute contraindications are:
- malignant tumors beyond the stage of stable remission (if pain in the area of the tumor is bothersome);
- acute infectious processes in the articular surfaces, spinal column, brain and spinal cord;
- recent musculoskeletal injuries;
- postoperative rehabilitation period;
- focal spinal symptoms;
- Klippel-Feil syndrome (anomaly of the structure of the cervical spine);
- fragments of intervertebral hernia;
- pronounced displacement of the vertebrae relative to each other (spondylolisthesis);
- osteoporosis grade 3-4;
- acute circulatory disorder of the brain and heart;
- recent heart attack;
- severe mental disorders;
- serious diseases of internal organs in the active phase.
Therefore, it is necessary to treat joint pain with osteopathy after eliminating all possible contraindications. To protect yourself as much as possible and get rid of arthralgia, the patient should contact a competent and experienced osteopathic doctor.
