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Ankylosing spondylitis


Ankylosing spondylitis (Bekhterev’s disease) is a chronic systemic joint disease characterized by predominant joint involvement of the spine, sacroiliac joints, knees, and shoulders. Ankylosing spondylitis is diagnosed when, in the absence of concomitant pathologies such as psoriasis, inflammatory bowel disease, or infection in the patient’s medical history, the radiograph shows sacrococcygeal disease, which is equivalent to spondyloarthritis. This condition has varying degrees of severity, and early diagnosis and appropriate treatment can reduce the risk of serious deformity. Although the exact causes of the disease have not been determined, it is known to have a genetic predisposition. Of particular importance is the genetic link to the HLA-B27 factor, which is absent in normal individuals but present in patients with ankylosing spondylitis. However, the presence of HLA-B27 is not a determining factor in the development of ankylosing spondylitis – this gene only indicates an increased risk of Bekhterev’s disease.


The symptoms of ankylosing spondylitis vary greatly from person to person. However, the most common initial manifestation of the disease is back pain. Ankylosing spondylitis usually begins in young people between the ages of 10 and 20. The nature of this pain remains quite specific (called “inflammatory back pain”). Symptoms of inflammatory back pain usually appear before the age of 40, and if it persists for more than three months, it can lead to a chronic course of the disease. The pain increases with prolonged inactivity, including sleeping at night, and decreases with physical activity. Patients often feel stiffness in the back, especially in the morning after sleeping. There may also be swelling and pain in the hips, shoulders, heels, and ribs, with pain increasing with pressure on the affected area. In rare cases, symptoms related to the heart, kidneys, or colon may occur.


A physical examination is first performed to assess the patient’s general physical condition. Typical tests include a Schober’s test to determine if there is a decrease in the amplitude of flexion of the lumbar spine; spinal stiffness may also limit the ability of the chest to expand, so a chest expansion test may be performed; a text to measure the distance from the larynx to the wall is performed to diagnose cervical spondylitis. In addition, x-rays, blood tests, or MRI may be performed if ankylosing spondylitis is suspected.

Treatment and course of the disease

Ankylosing spondylitis can be treated with exercise and physical therapy, medication, and surgery. Regular exercise as part of physical therapy can reduce pain, maintain joint mobility, and correct posture by exercising all joints, including the spine. In addition to stretching, aerobic exercise and appropriate strength training should be performed regularly. Medical treatments for ankylosing spondylitis include non-steroidal anti-inflammatory medications (NSAIDs), biologic blockers such as TNF and IL-17, antirheumatic medications, and steroids. If symptoms do not improve with these treatments, surgery may be required.

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