The Diagnosis Of Ankylosing Spondylitis’s Disease.

I often see patients with the «experience» Ankylosing Spondylitis's disease in more than 10 years. With an unknown diagnosis, and therefore did not receive proper treatment.

Ankylosing Spondylitis Pathogenesis

Symptoms, Examination And Diagnosis Of Ankylosing Spondylitis’s Disease
Symptoms, Examination And Diagnosis Of Ankylosing Spondylitis’s Disease

In the early stages to identify Ankylosing Spondylitis really difficult. Early radiological signs known only by a narrow specialist. In any case, if you're a long time feel the morning pain and stiffness in the lower back and spine, should be deleted Ankylosing Spondylitis. For the early diagnosis of Ankylosing Spondylitis's disease, X-rays in special projections and laboratory studies, including genetic.

Symptoms Of Spine Injury:

1.     An important early symptom is a pain and stiffness in the lumbar spine. Often originating at night and becomes stronger in the morning. It may take longer than 2 hours after waking and decreased after exercise, hot shower. Day of pain and stiffness in the spine in Ankylosing Spondylitis's disease observed at rest, in the morning and decreases during the motion, sometimes disappearing in the afternoon. The defeat of the spine - an obligatory symptom.

2.     In the course of inflammatory disease with pain and stiffness extends to the overlying spine.

3.     Gradually smooths the physiological curves of the spine and the formation of pathological kyphosis (stoop), thoracic, so that in some cases the correct diagnosis was possible «distance», in a characteristic pose of the patient. During this form of the disease is usually slow, long-term, with periods of exacerbations and improvement.

4.    As a reaction to inflammation in the spine, there is a painful back muscle strain.

5.    In later stages, if untreated, restriction of mobility in the spine exacerbated by the seam joints and vertebrae ossification of intervertebral discs, with the formation of intervertebral "bridges" are visible on radiographs.

Symptoms Of Joint Damage:

1.     An important manifestation of Ankylosing Spondylitis's disease is an inflammation of the joints of the sacrum - sacroiliac disease. This pain can be felt deep in the buttocks. The pain is often mistaken for a symptom of sciatica or a herniated disc, sciatica.

2.   More than half of patients with Ankylosing Spondylitis's disease marked the defeat of limb joints, most commonly the hip and shoulder. Pain and stiffness in the joints, as well as in the spine, more intense in the morning.

3. Rarely encountered inflammation and swelling of small joints of hands and feet. Period of inflammation of the joints of extremities with ankylosing spondylitis usually of short duration (1 - 2 months.), But sometimes can drag on for a long time. Even in these cases, unlike rheumatoid arthritis, fracture and deformation of joints does not occur (with the exception of the hip joints in advanced cases without adequate therapy).
Nesustavnye Ankylosing Spondylitis Symptoms.
About a third of cases of ankylosing spondylarthritis accompanied nesustavnymi symptoms. Ankylosing Spondylitis  's disease occur when inflammation of the tissues of the eye (uveitis, iridocyclitis), inflammation of the tissues of the heart (myocarditis, possibly the formation of valvular heart defects), aorta (aortitis), lungs, kidneys, lower urinary tract.

Ankylosing Spondylitis usually begins in the late second and early third decade of life, but recently more and more common in adolescence. In childhood or adolescence, the disease often starts with damage to peripheral joints and is accompanied by a slight increase in body temperature.
Symptoms Of Early Stage

  1. Pain in the lumbar spine and in the sacroiliac joints of a continuing nature, amplifying mainly in the second half of the night and morning, decreasing during movements and in the afternoon (inflammation «nature» of pain).
  2. Pain in the gluteal area due to the defeat of sacroiliac joints with irradiation in the thigh, arising from the right, then left.
  3. The feeling of tightness and stiffness in the lumbar spine, typically reinforced in the morning and decreases after exercise, hot shower.
  4. Pain in the chest (when involved in the pathological process costovertebral joints) on the type of intercostal neuralgia or myositis of intercostal muscles, reinforced by coughing, sneezing, deep breaths.
  5. Stiffness and tension lines back muscles.
  6. Flattening of lumbar lordosis (especially noticeable when the patient is tilted forward).
  7. Clinical and radiographic signs of bilateral sakroileita; to identify pain in the sacroiliac joint, indicating the presence in them of the inflammatory process, the following tests:
    • test Makarova (effleurage the sacrum);
    • Test-Kushelevskogo-1 (pressure on the upper front spine of the ilium in the position of the patient on his back);
    • test Kushelevskogo-II (pressure on the wing of the ilium in the position of the patient on his side);
    • Test-III (in the position of the patient on his back is the simultaneous pressure on the inner surface is bent at an angle of 90 ° and allocated to the knee joint and the upper front barb of the opposite wing of the ilium).
  8. Enthesiopathies manifest pain in the fibrous structures attach to the bones, in particular, the iliac crest, greater trochanter of the thigh bones, spinous processes of vertebrae, sternum, rib joints, buttocks. In the development of bursitis there is swelling.
  9. Eye in the form of anterior uveitis (iritis, iridotsiklita), usually bilateral, characterized by acute onset, lasts 1-2 months, may take a prolonged relapsing nature; pathology of the eye occurs in 25-30% of patients.

Symptoms Of Late Stage

  1. Pain in various parts of the spine.
  2. Violation of posture, straightening the physiological curves of the spine ( «doskoobraznaya back») or «pose asylum». Pronounced kyphosis of the thoracic spine, down the slope and bending the legs at the knee joints. Which compensates for the movement of the center of gravity forward.
  3. Atrophy of the muscles of the back straight.
  4. Sharp decrease in chest excursion, many patients with breathing is carried out only through the motions of the diaphragm.
  5. Restriction of mobility in the spine in 3-4 planes: sagittal (flexion, extension), frontal (tilt), vertical (rotation).
  6. Ankylosis of sacroiliac and intervertebral joints.
  7. The defeat of the «root» (shoulder and hip) or peripheral joints. The hip joints are affected more frequently in patients whose disease began in childhood or adolescence. Peripheral joints are involved in 10-15% of patients.  With affected mainly large and medium-sized joints of the lower limbs of type mono-or. May occur sternoclavicular arthritis (usually asymmetrical), acromion-clavicular, mandibular and synchondrosis handle sternum. Peripheral arthritis may be at 20-25% of patients take their toll.
  8. The defeat of the cardiovascular system - the aorta, aortic valve insufficiency, pericarditis, myocarditis with varying degrees of violations atrioventikulyarnoy conductivity. The frequency of aortita and violations of the atrioventricular conduction is significantly higher in the longer duration of disease and the presence of peripheral arthritis.
  9. Pulmonary disease in the form of slowly progressive fibrosis of the apical segments of the lungs.
  10. Renal disease is rare, about 5% of cases in the form of amyloidosis, or IgA-nephropathy. And in contrast to idiopathic IgA-nephritis is rarely expressed hematuria.