Ankylosing Spondylitis Ankylosing spondylitis (AS) (rheumatoid spondylitis, Strumpell Marie disease) - a systemic inflammatory disease of connective tissue with a primary lesion of the articular ligaments, spine and peripheral joints and the involvement of internal organs (heart, aorta, kidney).
Distinguish it from the seasonal meteozavisimost sharp increase in the risk of exacerbations in the cold wet weather.
Archaeological excavations have uncovered the remains of a skeleton spine Egyptian mummy, which is over 5,000 years old, with evidence of babmukovoy stick. First speaker described the anatomist and surgeon Realdo Colombo in 1559 in his treatise The Anatomy. In 1691, Bernard Connor gave a description of the human skeleton with signs of scoliosis in which the sacrum, pelvis, lumbar vertebrae and 10 thoracic vertebrae with ribs were fused into a single bone.
The disease is called stiffness with the curvature of the spine, first described by VM Bechterev in 1892 A.Strumpell gave a definition of chronic inflammation of the spine and ankylosing sacroiliac joint, and P. Marie in 1898, described a form of the disease - the defeat of the spine with involvement in the process of the hip and shoulder joints, giving it the name rizomielichesky spondylosis.
Epidemiology
The prevalence of AS is 0.01 - 6% of the population. It affects more men (90%) aged 20-40 years. There is a point of view, the incidence of female understated due to less severe symptoms.
Social significance of the AU is due to its development in the young working age, and progressive course with the development of disability.
Risk factors, etiology, pathogenesis
Risk factors include genetic predisposition speaker, gender (more common in males), age (20-40 years), hypothermia, the presence in the body of foci of chronic infection.
In 90% of patients revealed histocompatibility antigen HLA-B27 and 70% - and ARTS1 genes IL23R, the existence of which, however, does not necessarily mean that a person is sick or ill speakers.
There are three hypotheses of the pathogenesis of AC6
- Molecular mimicry between the amino acid sequences of infectious agents and HLA-B27 (not confirmed)
- receptor (HLA-B27 antigens and viral form circulating immune complexes which can cause abnormal reactions causing AU Clinic)
- modified HLA-B27 (some microorganisms can change the molecular structure of HLA-B27, which activates T-killer cells to destroy it.)
The inflammation usually begins in the sacroiliac joints and extends to the overlying spine. Subsequently, there is a reflex spasm of paravertebral muscles, which increases the pain and causes circulatory disorders. Inflammation in the intervertebral joints eventually lead to the development of ankylosis with ossification of the ligaments and degenerative changes of hyaline plates and vertebral bodies.
Classification
ICD-10
M45 Ankylosing Spondylitis
M45.1 Ankylosing spondylitis: Localization - the neck, the first and second cervical vertebrae
M45.2 Ankylosing spondylitis: Localization - Neck area
M45.3 Ankylosing spondylitis: Localization - cervicothoracic
M45.4 Ankylosing spondylitis: Localization - Thoracic
M45.5 Ankylosing spondylitis: Localization - Lumbar-thoracic
M45.6 Ankylosing spondylitis: Localization - Lumbar
M45.7 Ankylosing spondylitis: Localization - the lumbosacral
M45.8 Ankylosing spondylitis: Localization - sacral and sacrococcygeal department
M45.9 Ankylosing spondylitis: Localization - Unspecified localization
Clinical classification
Adrift:
- slowly progressing
- slowly progressive with periods of exacerbation
- rapidly progressive
- septic option.
By steps:
- minimal signs of sacroiliitis - small areas of sclerosis and erozirovaniya without changing the width of the joint space
- signs step 1, but in combination with the narrowing of the joint space
- some signs of sacroiliitis: moderate-to-severe sacroiliitis, manifested erosions expressed sclerosis, expansion, contraction or partial ankylosis of the joint gaps
- complete ankylosis.
According to the degree of inflammatory activity:
- Minimal - small stiffness and pain of the spine in the mornings ESR - 20 mm / h, DRR than 6 g / l
- moderate - constant pain in the spine and joints, morning stiffness for several hours, ESR - 40 mm / h, CRP of 12 g / l
- severe - severe persistent pain, stiffness throughout the day, low-grade fever, visceral manifestations, ESR - 40 mm / h, CRP of 12 g / l.
According to the degree of functional impairment of the joints (FNS):
- change in the physiological curves of the spine with limited mobility of the spine and joints
- significant limitation of mobility of the spine and joints, so that the patient is forced to change professions
- ankylosis of all parts of the spine and joints, which causes a complete loss of ability to work or self-
The clinical picture
Depending on the localization of the process there are several forms of AC:
- Central - affected only the spine
a) kyphosis of the thoracic spine, cervical hyperlordosis (kifozny view)
b) the lack of lumbar lordosis, back takes the form of boards (rigid view)
- rizomielicheskaya - except the spine affects the root (shoulder and hip) joints
- Peripheral - affects the peripheral joints (knee, ankle) and spine.
- Scandinavian - affects the joints of the hands and feet, spine.
In 75% of cases AS begins with pain in the sacrum and spine, 20% - from pain in the peripheral joints, 5% - with the defeat of the eye (iritis, iridocyclitis).
In most cases, the AU begins quietly, with the defeat of the lumbosacral and / or cervical spine. Often coincides with the beginning of hypothermia or acute viral infection.
Identify several options for beginning speakers:
- with primary localization process in the sacroiliac joint AU begins with the gradual emergence of a typical inflammatory type of pain, the pain may be intensified and combined with pain in the joints
- in the primary lesion of the joints (usually at a young age) is observed only in the opening monooligoartrit subacute, often asymmetrical and unstable, later joined by the phenomenon of sacroiliitis
- in children and adolescents may start with the appearance of migratory pain, sometimes with a slight swelling in the peripheral joints, which must be differentiated from acute rheumatic fever
- AC rarely begins with an acute febrile syndrome, arthritis join only after 2-3 weeks
- perhaps beginning with the defeat of the eye (iritis, iridocyclitis) or aortitis or carditis (rarely) in combination with high levels of inflammatory activity, this joint syndrome and sacroiliitis symptoms appear only after a few months.
myVancouver Ankylosing Spondylitis
http://optiklocal.com Andrew Morren has a form of arthritis that many in Canada haven't heard of. At 24, his spinal joints are fusing together, and by his mid-30s he's expected to have "the body of a one hundred year old man." Spend a day with Andrew to see how he overcomes the day-to-day challenges of living with AS, how he stays positive, and the plans he's making for the future. myVancouver #442 Faces & Places. Airing week of May 20th, 2013.
