Bechterew's disease
Ankylosing spondylitis, Spondylitis ankylopoetica

Bechterew's disease is a condition in which the joints of the pelvis and spine become inflamed, causing pain and stiffness in the back and other joints.

Bechterew's disease takes its name from a Russian doctor who first described the condition. Other names that are often used are ankylosing spondylitis and spondylitis ankylopoetica.

Description of condition

When we talk about back pain, we make a distinction between two groups of back pain: non-specific back pain and specific back pain.

With non-specific back pain, no obvious damage is found and no disease is responsible for its occurrence. With specific back pain, there is actually a clear diagnosis. Bechterew’s disease falls within this last group.

The disease is characterized by inflammation mainly of the joints in the pelvis and the spine. The inflammation usually starts in the lower back area near the sacroiliac joints and then spreads to the joints of the spine.

This inflammation damages the cartilage and bone. Eventually, the cartilage is converted into bone.Ossification occurs. This results in pain and increasing stiffness being experienced in the back.

Cause and history

The cause of Bechterew's disease is not yet entirely clear. It is common for several members of the same family to have this condition. Heredity therefore seems to play a role. Of all people with Bechterew's disease, 90% are carriers of the so-called HLA-B27 gene.

A possible other cause is previous infections. When the immune system takes action to fight infections, it can become disrupted and attack healthy tissue. This can lead to Bechterew's disease.

It is known that the disease is equally common in men and women. The disease manifests itself at a relatively young age, between the ages of 15 and 35. Bechterew's disease occurs in about 1 in 500 people.

Signs & symptoms

Although the course of Bechterew's disease is different for everyone, there is always pain and stiffness in the back. The first symptoms usually start in the lower back or in the buttocks and may spread upward.

The symptoms worsen after a period of inactivity, i.e. in the morning or after sitting still for a long time. When the symptoms also reach the chest, this can make normal breathing difficult.

Typical symptoms that may accompany Bechterew's disease are:

• Pain and stiffness in the hips, buttocks and (lower) back.
  
• Reduction of symptoms through movement.
  
• Symptoms in other joints.
  
• Inflammation of tendons, intestines, skin or eyes.
  
• Fatigue.
  
• Fusion of the spine causing it to change shape.
  
• Difficulty breathing.

Diagnosis

Initially, the symptoms appear very much like back pain as suffered by many people at one time or another. Therefore, the first signs are often not recognized and it may take some time before a correct diagnosis is made.

In order to make a diagnosis, the doctor has to rely on the patient's story and a subsequent physical examination. Questions need to be asked about the nature and intensity of the symptoms and additional limitations.

The physical examination focuses on the mobility of the hip, pelvis and spine. In addition, other indications that may be associated with Bechterew's disease, such as inflammation of tendons, eyes and skin abnormalities, are reviewed.

If Bechterew’s disease is suspected, a referral to a rheumatologist will follow. The specialist will eventually make a definitive diagnosis.

As the symptoms worsen, and look more and more like Bechterew's disease, blood tests are often conducted first. These tests look for active inflammation and whether the HLA-B27 gene is present. Although this does not provide 100% certainty it can reinforce suspicions.

In a (greatly) advanced stage, clear abnormalities of the spinal column can be seen on an x-ray, including deformities of joints and a typical curvature of the spine. An MRI can detect abnormalities of the joints more quickly and may therefore be very valuable in early detection of the disease.

Treatment

Unfortunately, no cure has yet been found for Bechterew's disease. However, pain and stiffness can be reduced using painkillers and anti-inflammatory drugs.

In order to slow down the disease process as much as possible, it is very important to keep moving and to do exercises regularly. They can be done individually and/or in groups, with or without the guidance of a physiotherapist. The exercise therapy will be aimed at maintaining or increasing mobility and improving posture and quality of life. This needs to be maintained for life. In addition to exercise, getting sufficient rest is important.

Because nowadays Bechterew’s disease is often discovered earlier, and better medication is available, it is rare for the spinal column to become totally rigid. However, the course of the disease will vary. Periods with relatively few symptoms alternate with periods in which more symptoms are experienced. This is why the disease takes a different path for everyone.

Some people will suffer more from pain and stiffness and will deteriorate faster than others. In order to keep problems to a minimum, it is important to recognize the disease as soon as possible and to start the right treatment.

Exercises

The exercises depend on which stage of the disease the patient is in. An exercise program with exercises for Bechterew's disease has been compiled for each stage.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Cleland, J. (2007). Orthopaedic clinical examination. An evidence-based approach for physical therapists. Philadelphia: Saunders. Elsevier.
El, A. van der (2007). Manuele diagnostiek. Wervelkolom. Rotterdam: Uitgeverij Manthel.
Nugteren, K. van & Winkel, D. (2013). Onderzoek en behandeling van de thorax. Houten: Bohn Stafleu van Loghum.
Verhaar, J.A.N. & Linden, A.J. van der (2005). Orthopedie. Houten: Bohn Stafleu van Loghum.