Screening to identify people who are predisposed to the development of Bekhterev's disease is currently considered unjustified. However, screening measures are recommended for the early diagnosis of Bechterew's disease among people aged less than 30 years with chronic low back pain who are at risk for developing the disease (for example, acute unilateral anterior uveitis or the presence of Bechterew's disease or other seronegative spondylitis in the relatives of the first degree of kinship).
In what cases can Bekhterev's disease be suspected?
Back pain is more than 3 months, especially if they increase after a long rest. Pain can radiate into the buttock, hamstring, groin, stiffness in the spine in the morning, muscle tension in the lumbar region, pain in the muscles of the chest, a significant increase in ESR - up to 30 mm / hour.
As a rule, with such complaints all patients get to a rheumatologist or vertebrologist. The establishment of the correct diagnosis depends on them. On how qualitatively the examination was carried out, complaints were collected and the correct methods of investigation were assigned, the early diagnosis of Bekhterev's disease and the purpose of further treatment depended. The earlier treatment was started, the more likely it is to prolong the patient's working period, to postpone the appearance of prolonged painful pains and the development of complications.
What diagnostic methods are needed?
This is an x-ray study of the spine, MRI - magnetic resonance imaging, clinical studies of blood and urine, biochemical blood test, blood for the detection of HLA-B27 antigen.
Bechterew's disease refers to chronic inflammatory diseases, it is characterized by the defeat of the sacroiliac, synovial (intervertebral and rib-transverse) and non-synovial (discovertebral) joints of the spine, as well as the attachment of ligaments and tendons to the bodies of the vertebrae and the bones of gas. The primary sacral lesions are sacroiliac joints, thoracolumbar and lumbosacral spine. Subsequently, changes can determine in all parts of the spine. The involvement of peripheral joints in the pathological process is moderately expressed. In this case, they speak of the peripheral form of Bekhterev's disease. Changes in the hip and shoulder joints are most common in comparison with other peripheral joints.
For the diagnosis, Bekhterev's disease requires the presence of changes in the sacroiliac joints. The absence of sakroileitis causes great difficulties in verifying this disease and doubt the diagnosis. Very rarely changes in the spine can occur with the absence of convincing radiologic symptoms of sacroiliac joint damage. In this case, dynamic monitoring of changes in these joints and differential diagnosis with other diseases from the group of seronegative siondilloarthrites are required. Sacroiliitis with ankylosing spondylitis occurs at the earliest stages of the development of the disease and is characterized in typical cases by bilateral and symmetrical spreading.
Spine with ankylosing spondylitis
The primary lesions of the spine, especially in men, are the thoracolumbar and lumbosacral spine, in women in the early stages of the disease, the cervical spine can be affected. Anterior spondylitis associated with local erosive changes in the anterior region of the vertebral bodies and inflammation in the anterior longitudinal ligament of the spine leads to a decrease in the concavity of the vertebral body.
The result of these changes is the "quadraticization" of vertebral bodies typical for Bekhterev's disease, clearly visible on the lateral radiograph of the spine. These changes are found in the lumbar spine, as the thoracic vertebrae normally have a configuration approaching the right of the coal. Syndesmophytes vertically oriented bone ossicata, located outside the fibrous ring of the intervertebral disc. They prevail in the region of the anterior and lateral parts of the vertebral bodies and form bone bridges between the vertebral bodies. In the late stages of the disease, multiple syndesmophytes join together on a large extent and form the characteristic length of Bekhterev's disease "bamboo" spine. It is important to note the fact that syndesmophytes. Characteristic of ankylosing spondylitis, as well as enterogenic spondylitis, differ from syndesmophytes and osteophytes found at corners of vertebral bodies in other diseases. They have a clear, even contour, smoothly passing from one vertebral body to another. Osteophytes with deforming spondylosis - triangular in shape, have the shape of a "jug handle" up to 10 mm in length, located on the front and side corners of vertebral bodies. With diffuse idiopathic bone hyperostosis in the spine (Forestier syndrome) calcification of the anterior longitudinal ligament is observed over a large extent with the formation of coarse, deformed osteophytes at the anterior and lateral angles of vertebral bodies with a wall thickness of up to 4-6 mm and a length of up to 20-25 mm. And differ from syndesmophytes in AS, the width of which does not exceed 1-2 mm. In addition, with ankylosing hyperostosis there are no changes in the sacroiliac joints. Erosion of articular surfaces and narrowing of one or more intervertebral discs (spondylodiscites) are characteristic radiographic symptoms for Bechterew's disease. These changes can be divided into local and common. The outcome of spondylodiscitis can be calcification of the intervertebral disc, and if spondylodisitis is combined with destructive changes in the articulating vertebral bodies, then bone ankylosis of adjacent vertebrae can form. Lesions of intervertebral joints occur later, but the outcome of arthritis can also be ankylosing. In addition to the lesion of the anterior longitudinal ligament, ossification of the posterior longitudinal and interocular ligaments of the spine is detected. Erosions in the dentate process and atlanto-axial subluxation can be detected with Bechterew's disease, although with a lower frequency than with RA. Ankylosis can also be found in the area of the atlanto-axial joint. In other parts of the cervical spine, changes, if found, are identical to those found in the thoracolumbar spine.
A distinctive characteristic of radiological changes can be a combination of erosive and proliferative changes and the attachment of ligaments, which makes it possible to conduct differential diagnosis with other inflammatory and non-inflammatory diseases, diagnosing Bechterev's disease.
However, it should be noted that there are no specific diagnostic signs for the presence of ankylosing spondylitis, there is only a complex of symptoms and data of laboratory and other types of studies that allow excluding other diseases, such as rheumatoid arthritis, and reliably diagnose Bekhterev's disease.