ankylosing spondylitis

Bechterew's disease or ankylosing spondylitis

Bechterew's disease is a chronic, inflammator rheumatic disease that can be very painful (in phases). It mainly affects the joints of the spine and the posterior pelvis, the sacrum. Bechterew's disease is one of the rheumatic diseases that affect the axial skeleton (technical term: axial spondylarthritis, axSpA for short). If left untreated, the spine becomes increasingly deformed and stiffened (ossified) in the course of the previously incurable autoimmune disease, which impairs mobility .

The correct medical name for Bechterew's disease is ankylosing spondylitis (AS; ankylosing spondylitis), which means something like "bending and stiffening inflammation of the vertebral bodies". Ankylosing spondylitis can affect people of any age, especially younger people (under 30 years of age) are often affected. The earlier ankylosing spondylitis is diagnosed and treated, the better the prognosis for the course of the disease.

The name Bechterew's disease, which is commonly used colloquially for ankylosing spondylitis, is derived from the name of the Russian neurologist and psychiatrist Vladimir Bechterew (1857-1927). Bechterew carried out various studies on the structure and function of the central nervous system. In 1892 he also described Bechterew's disease, an inflammatory arthritis (joint inflammation) of the spine, which - as far as he was aware - only occurs in men. 

Symptoms of ankylosing spondylitis

According to expert estimates, Bechterew's disease affects around one percent of people in Central Europe. Contrary to previous assumptions, new research suggests that women and men get the same disease. Most sources, however, assume that men are affected about two to three times as often.

Pain in ankylosing spondylitis

Typical signs of Bechterew's disease (ankylosing spondylitis) are long-lasting, deep-seated pain in the back, buttocks or hips, which are particularly pronounced in the morning hours . Morning stiffness also often occurs. In many ankylosing spondylitis sufferers, the pain is so great that they have to wake up and move around in the second half of the night. If the pain slowly subsides through movement, this is an indication of inflammatory back pain. The pain is consider chronic if it persists for more than twelve weeks.

In addition to the back, other joints can be affected by inflammation (arthritis) in ankylosing spondylitis, sometimes also tendons (enthesitis). Then pain in the heel is typical. In some patients, entire fingers or toes become inflamed in the jet (dactylitis). In the long term, the inflammatory changes in the joints and on the skeleton impair the upright posture, lead to painful muscle tension and restrict mobility, especially in the area of ​​the spine.

The inflammation progresses in an episode

During an acute inflammatory phase, the flare-up, patients suffer from particularly severe pain and restricted mobility, and their backs can bend significantly. However, if ankylosing spondylitis is detected and treated early enough, many sufferers almost regain their normal posture outside of the flare-ups. However, there is often a reduced bone density (osteopenia), sometimes bone loss ( osteoporosis ).

In addition to the impairment of the musculoskeletal system, about half of ankylosing spondylitis patients suffer from complaints in other tissues and organs . Especially often the eyes are affected, in which the iris inflamed (uveitis), or the skin by a psoriasis ( psoriasis developed). The intestine can also develop chronic inflammatory diseases in ankylosing spondylitis, such as Crohn's disease or ulcerative colitis. As the disease progress, you may experience difficulty breathing.

Bechterew's disease in women

Ankylosing spondylitis usually manifests itself in women with different symptoms than in men, especially at the beginning. Therefore, ankylosing spondylitis is usually recognized much later in women. This could also contribute to the fact that of the 340,000 registered ankylosing spondylitis patients in Germany only about a quarter are women.

This is what distinguishes ankylosing spondylitis in women:

• first symptoms more often on joints outside the body axis
• at the beginning more often the cervical vertebrae are affected instead of the lower back
• Inflammation of tendon attachments and bursae in areas of the body that are untypical for ankylosing spondylitis
• apparently slower progression of the disease
• Stiffening and ossification usually only appear in later stages than in men
• the pain burden is by no means less

Diagnosis of ankylosing spondylitis

In most patients, ankylosing spondylitis is diagnosed years after the first symptoms appear. Back pain is widespread and a very unspecific indication of a disease. They can have many causes. Often those affected only go to the doctor if further symptoms arise or the pain becomes unbearable.

Treatment of ankylosing spondylitis

Ankylosing spondylitis should be treated with a comprehensive therapeutic concept. Which component is in the foreground depends on the stage of the disease and the patient's state of pain. In the case of an acute episode, pain relief and anti-inflammatory measures are the top priority, outside of the episodes a lot of movement with mobilizing and stabilizing exercises. A good concept for ankylosing spondylitis consists on the one hand of informing and training the person concerned about what is going on in his body and how he can best cope with his everyday life with the disease in the future. On the other hand, the symptoms are treated with a combination of physiotherapy or physiotherapy and medication. Ankylosing spondylitis may also require injections and, less often, surgery.

Ankylosing spondylitis exercises

Ankylosing spondylitis therapy is based on regular exercise. Depending on the pain and the inflammation, the doctor will also prescribe medication. It may be necessary to take non-steroidal anti-inflammatory drugs (NSAIDs) on a permanent basis. If a patient does not respond to the standard therapy, he can be treated with so-called TNF-alpha blockers.

The exercise therapy maintains or even improves the mobility of the patient and thus facilitates everyday life with ankylosing spondylitis. Medicines alone cannot do this. With the right physiotherapy and intensive training, the symptoms can be alleviated to such an extent that some sufferers can reduce their medication dose.

In spite of ankylosing spondylitis, regular exercise therapy not only maintains physical functionality, it also significantly alleviates pain during the course of the exercises. In the long term, the training stabilizes the body, improves posture, coordination and prevents falls. Which exercises work best differs from patient to patient with ankylosing spondylitis. Different areas of the body are affected in everyone.

In addition to physiotherapy or physiotherapy prescribed by a doctor, the German Association of Bechterew's Disease (DVMB) organizes various exercise offers in many places. Including weekly functional therapy and courses with sports suitable for ankylosing spondylitis patients. These offers can also be prescribed and the contribution paid by the health insurers. The German Association of Bechterew's Disease (DVMB) also offers support through self-help groups.