Understanding Ankylosing Spondylitis: Causes, Symptoms, and Management Strategies

Understanding Ankylosing Spondylitis: Causes, Symptoms, and Management Strategies

Morbus Bechterew belongs to the group of inflammatory rheumatic diseases of the spine. In medical circles, Bechterew’s disease is also known as ankylosing spondylitis. Spondylitis means the vertebral bodies are inflamed while ankylosing describes the tendency to stiffen. Those affected often report chronic back pain, which is particularly severe in the morning. The course of this incurable disease is very variable. Various treatment options can alleviate the symptoms of those affected and slow the progression of the disease.

What is Bechterew’s disease?

Bechterew’s disease (M. Bechterew) represents the so-called spondyloarthritides. These diseases fall within the field of rheumatology. For reasons that have not yet been fully clarified, inflammation occurs in the area of ​​the vertebral bodies. Over the years, these inflammations cause bones to be remodelled and the joints to stiffen. The spine is most commonly affected, but other joints can also be affected.

These spondyloarthritides have a genetic component in common. A change in the HLA-B27 protein can be detected in 90 to 95 per cent of all those affected by Bechterew’s disease. HLA is English and stands for “human leukocyte antigen”. HLA-B27 is a protein mainly found in leukocytes (white blood cells). Since the leukocytes are responsible for our immune response, one theory on the development of Bechterew’s disease says that if there is a defect in the HLA-B27 protein, the leukocytes do not function properly, leading to inflammatory processes in the spinal column.

The change in the HLA-B27 protein is hereditary; thus, there is a risk of developing Bechterew’s disease.


How does ankylosing spondylitis begin?

The disease often begins between the ages of 20 and 30. Men are affected about twice as much as women. According to current studies, it is assumed that around 0.5 per cent of all people in Central Europe will develop Bechterew’s disease in their lifetime. However, only about 50 per cent of the cases are diagnosed because the symptoms are mild in some, and the disease is mild in many cases.

The most common early symptom is back pain, lasting several weeks. The pain is primarily localized in the lower back and occurs at night. The pain improves after movement, which is typical of back pain in Bechterew’s disease.

Pain in the area of ​​the tendon insertions (enteropathies) can also occur.

What are the symptoms of Bechterew’s disease?

Since Bechterew’s disease is a so-called systemic disease, there are several other symptoms and concomitant diseases in addition to the typical back pain. These include:

  • fatigue
  • Pain in various joints, for example, in the hip, shoulder or knee
  • Fever
  • very painful
  • weight loss
  • Skin changes such as psoriasis vulgaris
  • Reduced bone density and thus higher fracture risk
  • Pain in the sacroiliac joint (sacrum-iliac joint)
  • Inflammation of the eyes (anterior uveitis)
  • inflammatory changes in the gastrointestinal tract
  • Inflammation of the prostate gland in men ( prostatitis )


How do you diagnose ankylosing spondylitis?

If Bechterew’s disease is suspected, the doctor has various methods available to diagnose the disease.

MRI  is the best way to see the inflammatory processes in the joints. For this reason, this method is well-suited for early diagnosis.

In examining the blood values, some inflammatory parameters such as the CRP (C-reactive protein) or the ESR (erythrocyte sedimentation rate) can indicate Bechterew’s disease. Much more accurate is the determination of the already mentioned antigen HLA-B27.

The classic X-ray is well suited to show changes later in the spine. In the final stage, the inflammatory changes can lead to a so-called “bamboo stick spine”. Over the years, the body forms small, bony attachments (syndesmophytes) that connect the individual facet joints of the spine. Due to this connection, the spine can hardly move, and those affected will stiffen.

What other tests are carried out for Bechterew’s disease?

Doctors need to know how flexible the spine of a person with Bechterew’s disease is. There are different ways to do this. One way is using a tape measure to evaluate how far someone can bend forward or backwards.

If the disease progresses untreated, sufferers of Bechterew’s disease develop a typical attitude. The spine tends to curve forward and thus stiffen. This makes it increasingly difficult for those affected to sit up straight. In the final stage, people with ankylosing spondylitis walk in a hunched, bent-over posture, which can be so pronounced that those affected can no longer make eye contact with the person opposite.

What treatments are there for ankylosing spondylitis?

There are various treatment approaches to counteract the progression of the disease. Physiotherapy is the most important. People with ankylosing spondylitis need physiotherapeutic treatment throughout their lives, on the one hand, to maintain the mobility of the spine and, on the other hand, to improve the pain. Most of the exercises can be done at home. Regular meetings with the physiotherapist ensure that the exercises are carried out correctly.

Another critical pillar of therapy is pain medication, such as ibuprofen. This drug belongs to the group of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) and has both anti-inflammatory and pain-relieving effects. If an acute disease attack occurs, ibuprofen may be given for several weeks.

Other drugs and measures used in the therapy of Bechterew’s disease are:

  • Corticosteroids for inflammation
  • Biologics to reverse the faulty immune response
  • heat and cold applications
  • massages
  • Electrotherapy
  • posture training
  • Operations in exceptional cases (to straighten the spine)


How does Bechterew’s disease affect work?

Due to the increasing stiffening of the spine and the chronic pain, those affected can be restricted in their professional activities, up to and including being unable to work. To capture this, sufferers are assessed according to the International Classification of Functioning, Disability and Health (ICF). Depending on the severity of the complaints, they can be classified as severely disabled.

If everyday work becomes increasingly difficult for those affected, a pension can be applied due to reduced earning capacity. More detailed information can be obtained from the Deutsche Rentenversicherung.

How dangerous is Bechterew’s disease?

Although Bechterew’s disease is incurable, life expectancy is not limited. The disease can progress differently in everyone. There are cases in which severe attacks lead to a rapid deterioration in mobility and other instances in which those affected hardly notice anything about their illness.

Those affected must engage in regular physical activity. Physiotherapy exercises can help you live an active life for as long as possible. About nutrition, there is no special “Bechterew diet” that can be proven to improve the course. However, a healthy and balanced diet combined with physical activity can positively affect the disease.


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