Ankylosing spondylitis (Bechterew's disease)

Contain the inflammation, relieve the pain

The source of the pain is deep inside the back. It is particularly severe when resting, at night or in the early morning. Try stretching and walking a little — in most cases, patients with ankylosing spondylitis find movement helps. However, the tiredness and feeling of increasing stiffness will remain. 

The specialist consultants at the Schoen Clinic have extensive experience in treating these symptoms. With various effective therapies, we can help you to alleviate your discomfort, avoid severe outcomes, and live better with stiffening vertebral inflammation. And should surgical intervention nevertheless be considered, you will find yourself in highly experienced hands.

Causes & symptoms

Causes: How does ankylosing spondylitis develop?

Ankylosing spondylitis is caused by a pathological immune reaction within the body. The exact reason for this has not yet been explored. However, one thing is certain: the defence cells of the immune system are directed to attack each other. Instead of attacking foreign pathogens, the body attacks its own cells which it recognises as "sick". A never-ending process begins – starting in the joint capsules, joints, bone-tendon transitions and cartilage. This results in chronic inflammation. Tissues such as cartilage and bone are permanently damaged by the patient's own body, in some cases resulting in ossification of the joints. 

The gene HLA-B27 is strongly suspected to be one of the triggers for ankylosing spondylitis. Current research suggests that this gene is directly involved in the inflammatory processes. Also, certain bacteria are believed to act as triggers for ankylosing spondylitis. Susceptibility to ankylosing spondylitis is also inheritable to a certain degree – a genetic contributory factor has been established in the form of the HLA-B27 antigen. However, the presence of 

HLA-B27 alone does not necessarily indicate the onset of ankylosing spondylitis. Additional triggers must also be present. Certain bacteria, for example, are thought to function as co-triggers for ankylosing spondylitis. In the event of an infection, these bacteria stimulate an excessive auto-immune response from the host's immune system. 

The severity of the disease can be extremely varied — from mild forms with only occasional and changing complaints to severe forms that include chronic inflammation and ossification, which may also extend to other areas of the spine and peripheral joints.

Ankylosing spondylitis: Symptoms of the disorder

Deep-lying back pain and buttock pain are typical symptoms of this disease. Suffers experience spine and chest pain during or after long periods of rest, i.e. especially at night. Starting from the sacroiliac joints in the lower back, the pain radiates into the buttocks and both thighs. Deep inhalation and exhalation can also be painful.

Stretching or a gentle massage can reduce the pain significantly. Nevertheless, patients feel increasingly stiff and immobile as well as tired and emotionally shattered.

Inflammation of the bone-tendon transitions is manifested by, among other things, pain in the pelvis, thighs, lower leg and heel bone. This causes the patient to become increasingly immobile amid worsening stiffness in the mornings.

In the later stage of severe cases, the skeleton also changes. The spine ossifies and bends. The lumbar spine flattens and the thoracic spine forms a hump. At the same time, there may be inflammatory changes to the knees, ankle joints, shoulders and especially the hips. The changes can also affect tendons, eyes and the cardiac muscle. The internal organs may also be affected.

Symptoms involving internal organs:

  • Heart: aortic insufficiency, cardiac arrhythmias
  • Lungs: restrictive lung disease, connective tissue deposits in the upper lobes 
  • Eyes: irritation of the iris / iritis / uveitis
  • Intestine: enteritis

Diagnostics

Ankylosing spondylitis – diagnosis: How we identify the disease

The first signs of ankylosing spondylitis typically include deep-seated back pain or pain in the buttocks which occurs when resting or after periods of rest, as well as bouts of morning stiffness lasting more than 30 minutes. However, given that these symptoms can have numerous possible causes and the expression of the symptoms of ankylosing spondylitis are manifold, and also that the disease can progress in a wide variety of ways, it usually takes several years before the correct diagnosis is made. 

If ankylosing spondylitis is suspected or diagnosed, the next step is to consult a rheumatologist.

Detailed consultation and physical examination

Above all, our initial consultation with you is of critical importance. During this, we ask you about the nature, timing and progression of your pain and stiffness as well as any other symptoms. During the physical examination, we focus in particular on assessing your mobility and investigating the sources of the pain in your spine and joints via clinical tests. For example, we use the so-called Schober test to check the mobility of your lumbar spine. In this process, we mark the first coccygeal vertebra and another point ten centimetres above it. We then ask you to lean forwards while keeping your knees straight. If you are suffering from ankylosing spondylitis, the marked points will not move very much because the mobility of your vertebrae will already be severely limited.

Imaging procedures

If there are already cases of ankylosing spondylitis or other autoimmune diseases in your family, or if specific indicators of ankylosing spondylitis are present, it is especially important to arrange a blood test and diagnostic imaging. The most effective way to visualise the typical changes in the joints (for example, the sacroiliac joints) and the bone-tendon transitions is via magnetic resonance imaging (MRI) or computed tomography (CT). An MRI scan of the sacroiliac joint is currently the preferred method. However, X-ray images can also reveal advanced changes in the affected areas.