30/9-2014 
 
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Arthritis

Bechterews disease (Spondylitis Anchylopoietica, Morbus Bechterew)

Definition and causes of Bechterews disease

Bechterews disease is an inflammatory condition, which particularly affects the joints in the lower part of the back. Usually the disease initially only affects the sacro-iliaca joints which connects the pelvis with the lower part of the spine. Although the inflammation is transient, it may result in the joints becoming stiff and possibly even grow permanently together.

The reason for bechterews disease is unknown, but 9 out of 10 people with the disease have an antigen on the surface of their cells, called HLA-B27. An antigen is a substance that is able to provoke an attack from the body's own immune defense. The disease is therefore autoimmune, which means that it is the body's own immune system that attacks the body itself.

Most people with the HLA-B27 antigen do not develop bechterews disease, but it is believed that a bacterial infection can trigger the disease in people who are already predisposed. As there is some risk that this antigen will be inherited from the parents, this explains why the disease accumulates in certain families.

A variant of the disease is seen in connection with the skin disease psoriasis, or in association with chronic inflammation of the intestine, such as Crohn's disease or ulcerative colitis.

Bechterews disease is 3 times more common in men than in women, and typically affects younger adults aged 20-40 years.
 

Symptoms of Bechterews disease

Symptoms of Bechterews disease develop gradually over several months or up to several years. Initially the symptoms are often interpreted as general back problems. Men are often harder affected by the symptoms, that may include:
  • Pain and morning stiffness in the lower part of the back. The rigidity and pain are improved by stretching and general movement.
  • Nocturnal worsening of the pain is common as the joints are not moved during the night.
  • The inflammation can also involve the joints or tendons elsewhere in the body.
  • The joints between the clavicular bones and the sternum can be involved and give pain in the chest region.
  • Pain from the heal is caused by the involvement of the achilles tendon.
  • Pain and impaired movement of the shoulder, knee or hip joints are common.

Precautions and diagnosis

If you have these symptoms, it is important to see your doctor as the disease progression can be halted through proper treatment.

If your doctor suspects that you suffer from Bechterews disease, he or she can conduct a thorough investigation of the spine and other joints that are suspected to be involved.

X-ray examinations as well as MRI or CT scans of the infected joints can be performed to establish if there are changes to the bone.

Blood tests can measure the degree of inflammation in the body, and a specific test for the mentioned HLA-B27 antigen can be performed. If the test is positive, it can support the diagnosis, but it should be stressed that to be positive for HLA-B27, does not mean that one has the disease.
 

Treatment of Bechterews disease

Treatment aims to curb the development of stiffness of the spine. A therapist can instruct in proper back exercises and training. If these are carried out in a warm water basin the treatment is often more effective.

Analgesics and anti inflammatory medicines, in the form of so-called NSAIDs (non-steroids anti-inflammatory drugs) may alleviate pain and morning stiffness and improve training levels. In some cases with severe acute inflammation and pain adrenal cortical hormones may be employed. For longer-term treatment anti arthritis medication is often instituted.
 

Disease progression and complications

Although the disease is not curable, most patients experience a mild course, where the disease does not affect daily life substantially. As the disease often affects younger adults, it is however important to plan life so as to avoid employment with a high load of the spine and other joints. Pain and stiffness can usually be halted with early treatment and regular training, which prevents the development of spinal changes.

A few people with Bechterews disease may eventually develop so many complications that it will be debilitating. Stiffness of the neck and hip, as well as strong stooping curvature of the spine, may, for example. make it difficult to look forward. Stiffness in the chest can affect breathing. There is an associated increased risk of developing osteoporosis. Recurring inflammation of the eye may also occur.

Life length is not affected compared to healthy individuals.

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