Bechterew’s disease is due to inflammation, especially in the muscles and joints. You get hurt, get tired and stiff. The pain comes and goes for periods, usually more tightly at first. It is not possible to recover completely, but with treatment, the disease can be slowed and relieved.

The cause of the disease is unknown but the risk of getting it increases if you have a close relative with Bechterew’s disease. You usually get sick before you turn 40. Other names for Bechterew’s disease are pelvospondylitis and ankylosing spondylitis.

Symptoms of Bechterew’s Disease

It is common to have the following symptoms of bechterew’s disease:

  • You get a sneaky, dull ache in the lower back and buttocks for several weeks, sometimes months. Many times the pain changes between right and left ham. It can be difficult to determine exactly where it hurts.
  • You get inflammation of the pelvis, hips, shoulders and jaw joints. Sometimes the eyes can also become inflamed. For example, the eyes may become red and hurt at the same time as the eyesight becomes foggy.
  • You feel unusually tired. Having pain at night causes you to sleep poorly, get a disturbed sleep rhythm and get tired. But the fatigue also depends on you have ongoing inflammation in the body.
  • You feel generally ill. You may lose your appetite, lose some weight, feel ill or have a low fever. Such general symptoms are especially common when children get Bechterew’s disease.

When and where should I seek care?

Contact a doctor at a health center if you have had a painful pain in the lower back and buttocks for an extended period of time without any obvious cause.

If needed, the doctor then writes a referral to a rheumatologist who makes a diagnosis and gives advice on treatment. There are often rheumatologic teams available at the hospitals, with doctors, nurses, physical therapists, occupational therapists, and curators.

You can seek care at any healthcare center you want throughout the country. You also have the opportunity to have a regular doctor’s contact at the health center.

You have the right to understand

In order for you to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. You can also ask for information printed so that you can read it peacefully.

Investigations

In order for the doctor to diagnose, it is important that you explain how it hurts when the pain started and whether it has moved between different sides of the body. The doctor asks if it hurts when you sit or lie down and if it gets better if you move. The doctor also examines the back, joints, skin, and eyes.

Blood tests

You may also submit blood samples to measure the value of the sink and CRP. The values ​​reflect the degree of inflammation in the body. If the disease activity is high, the decrease and CRP are usually also higher than it should be. But often these samples show common values ​​even though you have the disease. 

Sometimes the inflammation can cause anemia, ie too little red blood cells in the blood. Therefore, samples are also taken to determine blood value. Anemia or low red blood cell counts are measured as hemoglobin levels in the blood, Hb. You may also submit urine samples and samples for liver and kidney values.

There is no special test that can be taken to find out if you have Bechterew’s disease. The diagnosis is based on the physician’s overall assessment of the problems you have and what the various examinations and tests have shown.

X-ray and imaging examinations

In X-rays, the doctor can see changes in the tendons ‘attachments to the skeleton and on the vertebrae’s body. After some time, bridging bones may form between the vertebrae. Early in the disease, it can be difficult to see such changes.

If you break a vertebra, it is usually because you suffer from osteoporosis. You can, therefore, go through a so-called bone density measurement. You are sitting or lying down during the X-ray examination which takes about 20 minutes. A very weak x-ray is sent through the bone to be examined, for example in the back or hip. The survey is not felt and most people do not feel it as unpleasant.

Magnetic camera examination, MRI, is a more sensitive examination method than regular skeleton X-ray. Therefore, magnetic cameras are sometimes used to find changes in muscle attachments and lead early in the disease.

You can also be examined with ultrasound if you have heart problems.

Important to get a preliminary diagnosis

It may be difficult for the doctor to diagnose Bechterew’s disease early. Often, nothing is seen on X-rays of the back and pelvic joints at the beginning of the disease.

It is important that the doctor makes a preliminary diagnosis if many still indicate that it is Bechterew’s disease. Then you can quickly begin physical exercise to prevent joints and ligaments from being converted to bone.

Wrong diagnosis

Sometimes the symptoms of bechterew’s disease are diffuse and difficult to understand. It can sometimes lead to a misdiagnosis, such as sciatica, spinal cord, rheumatoid arthritis or fibromyalgia.

Getting a sick message

It can feel both nice and hard to know that you have Bechterew’s disease. Nice, because you finally get an explanation for the problems that have often existed for several years. Difficult, because you are told that you have a chronic illness that can worsen over the years. Getting the right diagnosis is important as it is the basis for getting the right treatment.

To gain an understanding of the pain, stiffness and fatigue caused by the disease, it is important to tell relatives, close friends, workmates and managers about the disease, and the decrease in performance that often results. It is different from person to person if you need to be on sick leave.

Treatment of Bechterew’s Disease

When you get Bechterew’s disease, it is important to get started on treatment quickly to counteract the cartilage effect, preferably before it has started at all. With the right diagnosis and advice on exercise, much of the pain and rigidity can be prevented. At the beginning of the disease, you may have the most muscular problems due to muscle cramps or overwork. This means that both medication and exercise can bring great improvements.

You are often given physiotherapy and various medicines that help with the pain and inflammation. You can get Bechterew’s disease in small joints, such as toes or fingers. Especially for Bechterew’s disease is that you can also get inflammation and pain in the so-called sacroiliac joint in the hip bone. A syringe with cortisone in the joint can then provide long-term relief.

If the disease is so severe that a joint has been damaged, it may need to be replaced by an operation.

Important with stable care contact

If you have a stable contact with the care, the possibilities are very good that you can avoid long-term pain and stiffness. But the effects of different treatments of bechterew’s disease vary greatly from person to person.

Exercise helps with pain and stiffness

You can take care of yourself by touching yourself. For example, you can take walks. The best thing is if you can do it every day. Daily exercise helps both against the pain and against the stiffness. Shower or bath warm can also relieve the pain and stiffness.

Keeping your body moving can be difficult when you are in pain, but there are ways that usually work, such as training in a hot water pool, walking, cycling and other types of quiet exercise. Pain-relieving medication can also facilitate exercise. Each should, in consultation with the physiotherapist, find suitable ways of moving.

Physiotherapy to relieve pain and stiffness

It is easier to relieve pain early in the disease than later.

Different types of physical therapy can cause you to feel less pain and become more mobile. This applies, for example, to acupuncture, massage or training in a hot water pool. Also, heat, movement, touch and nerve stimulation provides pain relief.

Physical therapy with physical exercise can also prevent joints and muscle attachments from solidifying and turning into bones.

Treatment with drugs

You may also receive treatment with pain-relieving and anti-inflammatory drugs. If the disease is mild or only moderately active, anti-inflammatory and analgesic drugs are usually sufficient together with physiotherapy and in-house training.

If the disease is more active, stronger drugs are usually used that can curb joint inflammation and contain methotrexate, sulfasalazine, and cortisone.

Drug

Medicines that can be used in Bechterew’s disease:

  • painkillers
  • anti-inflammatory drugs
  • antirheumatic drugs
  • biological drugs
  • cortisone.

Painkillers

What painkillers you receive depends on what kind of pain you have.

Painkillers, ligaments or muscles are used to treat pain. Examples are drugs containing paracetamol, which rarely cause side effects if taken at the right dose.

Prolonged pain, where the disease has caused the body to have injuries that can no longer be repaired, may require more intense pain relief. Then you can, for example, get morphine-like pain-relieving drugs.

Anti-inflammatory drugs

Anti-inflammatory drugs, called cox inhibitors or NSAIDs, are used to reduce pain and inflammation. They are used especially when you have inflammation in, for example, joints or tendon skis. The drugs relieve the symptoms but do not prevent the disease itself.

One side effect of the drugs is that they can irritate the gastric mucosa and cause stomach pain. You can also get stomach ulcers or bleeding ulcers. It can be combined with other drugs that protect the lining of the stomach, such as omeprazole.

If you take a long-acting anti-inflammatory drug in the evening, you usually have less pain at night, better night’s sleep and less morning silence. If you have more periodic and short-term pain, it may be better to take something more rapid.

If you have any heart disease, kidney disease or allergy of any kind, you should be very careful with anti-inflammatory drugs. Consult your doctor before taking any medicines.

You should not use NSAIDs when you are pregnant, especially during the last three months of pregnancy when prostaglandin is important for the development of the fetal heart and blood vessels. You should always consult your doctor and choose a proven drug if you are using NSAIDs in early pregnancy. NSAIDs can also make it more difficult for women to become pregnant.

You should consult a doctor if you need to use NSAIDs when breast-feeding. Most anti-inflammatory pain relievers pass into breast milk, but if you follow the dosing instructions there is little risk of the baby being affected.

Anti-rheumatic drugs

When you have Bechterew’s disease, it is common for you to get medicines that slow the disease, so-called anti-rheumatic drugs.

When you have Bechterew’s disease with inflammation in joints other than your back, such as hip joints, shoulder joints, or knee joints, it is common for you to start with the drug sulfasalazine. The most common side effect is the effect on the gastrointestinal function that causes nausea or stomach pain. Hypersensitivity to the skin also occurs.

If the disease is limited to the spine, there is no reliable evidence that the disease would be curbed by the drug. Then you should primarily use anti-inflammatory drugs and exercise to prevent you from getting stiff in the back.

The drug methotrexate is sometimes used in the treatment of Betcherew’s disease, but there is no evidence that the drug affects the course of the disease.

Biological drugs

In recent years, a new group of drugs has been added. They are often produced in cell cultures and are therefore called biological. The drugs are made from living cells or tissue and are often copies of substances found in the body. You can try biological medicines when other treatments have not worked.

The drugs used to treat Bechterew’s disease are infliximab, etanercept, adalimumab, golimumab, certolizumab pegol, and secukinumab. You can get the medicines in combination with other anti-rheumatic drugs. You get them either as a drip or as a syringe under the skin. For many, these drugs have significantly improved the control of the disease and improved quality of life.

If the disease is limited to the spine, there is no reliable evidence that the disease would be curbed by these drugs.

cortisone

Cortisone has a powerful anti-inflammatory effect and can attenuate inflammation in almost every organ of the body. Since you get side effects of high doses of cortisone, it is good if a low dose is sufficient for a shorter period of time. A short treatment course of one to three weeks can sometimes be what makes you get out of bed and start exercising.

Common side effects of high doses of cortisone over a long period of time include weight gain, thin fragile skin, and osteoporosis.

If you have Bechterew’s disease there is an increased risk of osteoporosis. Therefore, you usually get extra lime and vitamin D when you start a cortisone treatment that is expected to last for a long time. However, if you get osteoporosis, you may be treated with drugs with bisphosphonates that slow down bone breakdown.

Cortisone directly in the joint produces no side effects

An important and gentle method of treating inflammation in an external joint, such as a hip joint, knee joint or shoulder joint, is to get a syringe with cortisone directly into the joint you are suffering from. It provides quick relief of inflammation without affecting the rest of the body.

For example, after having a knee joint treated with a cortisone syringe, you can often go without pain already a day later. It can be a way to get started again with walking and physical therapy.

Various specialists treat

When you have Bechterew’s disease, you are checked by specialists in general medicine, rheumatology, and internal medicine. Who will treat the disease is primarily determined by how severe the disease is and which drugs are needed to gain better control over the disease.

Many times the treatment of bechterew’s disease can be done by a doctor at a health center after the diagnosis is made and the treatment determined.

Care if you get seriously ill

Prolonged pain in which the disease has caused the body to have injuries that can no longer be repaired may require intensive pain-relieving treatment. In many hospitals, you can get help from special pain groups when you have long-term pain. They consist of doctors, nurses, physiotherapists, occupational therapists and curators who are specially trained in pain management.

Such long-term pain may, for example, be caused by the disease-causing a hip injury. Consult your doctor if the joint is so damaged that it should be replaced.

An orthopedic surgeon then determines if a joint prosthesis is possible and if it would provide better function and attenuate the pain. For example, a hip joint surgery can give you back functions that have previously disappeared. In a hip joint operation, a rigid and constantly painful hip joint is replaced by an artificial joint, a so-called prosthesis.

Knee joints and shoulder joints can also be replaced by surgery. The joint is then replaced with a prosthesis. Knee prostheses are somewhat more common than shoulder prostheses.

If you have a severe back position, in some cases you may need back surgery, a so-called corrective osteotomy. This means that a small wedge in the spine is cut out, then the spine is straightened and stabilized with the help of metal bars or a plate with screws.

A stabilizing operation may be needed if you have severe upper back problems.

Alternative treatment

There are many alternative treatments for rheumatic diseases. Some of them are documented, which means that there is scientific support that they can affect the symptoms of rheumatic diseases. Other methods lack scientific evidence and should be considered with some skepticism for the time being.

Bechterew’s disease and pregnancy

Most women with Bechterew’s disease can become pregnant. The risk of childlessness in women with Bechterew’s disease is no greater than in healthy women. Sometimes the symptoms of bechterew’s disease and inflammation can even be alleviated during pregnancy.

In most cases, you can also feed naturally. However, cesarean sections may be necessary, for example, if the pelvic anatomy has changed due to the disease. 

Drugs and pregnancy

You should plan your pregnancy care with your doctor as the drugs you receive in the treatment of bechterew’s disease affect the fetus.

You should be careful about medicines containing sulfasalazine. You should, together with your doctor, make a balance between how important the drug is for the disease and any side effects it can cause during pregnancy.

Anti-inflammatory painkillers, so-called NSAIDs, are not suitable for use during pregnancy. During the first six months of pregnancy, you should not use the medicine without first consulting a doctor. There is a risk that the fetus may be adversely affected. During the last three months, do not use NSAIDs at all. The drugs can seriously affect the fetus, prolong labor, delay delivery and make you bleed more. But if you have taken a single dose during pregnancy, you need not worry. Above all, repeated use should be avoided. All painkillers go into breast milk, but there is no evidence that they harm babies who are breastfeeding.

You sometimes need to take cortisone during pregnancy in order for it to continue as it should and for your own illness not to get worse. The cortisone does is kept as low as possible but is determined by how active the disease is.

What happens in the body?

Bechterew’s disease is a chronic inflammatory disease. You can get the inflammation in various tissues such as ligaments, muscle attachments and joints. The most common thing is that you get Bechterew’s disease in the spine. Then the inflammation is mainly in the longitudinal ligaments but can also sit in the small joints between the vertebrae.

The disease often starts with a stinging pain in the lower back or buttocks, especially in the morning. After a few years of the disease, the pain becomes more persistent and later the inflamed tissues can be converted to bone. It can lead to stiffness and prolonged pain.

It is not possible to recover from the disease, but the pain and the stiffness can both be relieved and prevented with the help of drugs and physical exercise, especially at an early stage. It is therefore important that you get the diagnosis as early as possible.

Bechterew’s disease belongs to a group of rheumatic diseases, spondy arthritis, which you can get in joints and muscle attachments. Spondarthritis group diseases include Bechterew’s disease, psoriatic arthritis, and joint diseases associated with inflammatory bowel diseases, such as Crohn’s disease and reactive arthritis.

The cause is not known

It is an interaction between hereditary ancestry and the environment that determines if you get Bechterew’s disease.

The causes of the disease are not known, but for some reason, inflammation occurs in certain tissues in the body, such as muscle attachments and joints. In the inflamed tissues, large amounts of white blood cells accumulate which form various inflammatory substances. It makes you tired, aches and stiffness. The inflamed tissues can tease or break down.

Smoking is thought to pose an increased risk of getting Bechterew’s disease. Another reason for increased risk is if you are exposed to silicon dust, for example, if you work as a miner or potter.

The disease is often hereditary

You are more likely than you to have the disease yourself if one of your parents has Bechterew’s disease. One in ten children with a sick parent gets the disease.

More common among younger men

Bechterew’s disease is more than twice as common in men as in women, and it is above all younger men who get sick. You usually get sick before you turn 40, but the disease can begin even when you are older. many countries, more than 40,000 have Bechterew’s disease. There is also a special and very unusual form of Bechterew’s disease that children can get.

Smoking increases the risk of getting sick

There is nothing to do to safely avoid the disease, and it is not possible to find out if you will get the disease. But one way to reduce the risk of getting sick is to not smoke.

If the disease becomes more severe

The disease manifests itself very differently in different people. Most often, the course of the illness is mild and most can continue with their usual work and leisure activities.

In unusual cases, the disease can be cumbersome and quickly make it difficult to make everyday movements. This is especially true if you get inflammation of the hips early, if you have poor effects of some anti-inflammatory drugs and if you get poor mobility in the lower back, the so-called lower back.

More information

Bechterew’s disease belongs to a group of rheumatic diseases, which in medical sciences is called spondyloarthritis. Spondyloarthritis is a collective name for a variety of inflammatory conditions that cause pain and stiffness in joints, muscles, muscle attachments, and the spine.

The word spondy arthritis comes from the Greek terms arthritis which means joint inflammation and spondylosis, vertebrae.
Other diseases that are also associated with spondylarthritis are psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel disease.

Psoriatic arthritis is a disease that causes inflammation of the joints as well as psoriasis changes in the skin and on the nails. The joint problems can occur both before and after the skin changes. Reactive arthritis is a joint inflammation that can develop after an infection, for example after a salmonella infection. In connection with an inflammatory disease of the gut, such as ulcerative colitis, inflammation of the joints, arthritis associated with inflammatory bowel disease, can also be experienced.

The different diseases have many similarities in how they make themselves known and what they depend on. Children can also get corresponding illnesses and these are then counted in pediatric rheumatic diseases.

HLA-B27

Nine out of ten people with Bechterew’s disease have inherited genes, genes, for a special type of tissue called HLA-B27.

This means that most of the body’s cells carry a small protein molecule on the surface, HLA-B27, which is important for the body’s defense against viruses. For some reason, it also seems to have to do with Bechterew’s disease, but it is not known in what way. However, this does not mean that everyone who has this type of tissue will get sick.

Ehtisham Nadeem

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