Back pain is very common among adults. Usually they are harmless and disappear again after days or weeks. But for around five percent of people with chronic back pain - often men - there is more to it: Bechterew's disease, a special form of inflammatory rheumatism. This disease usually occurs for the first time between puberty and the age of 30, the frequency in this country is around five affected per 1,000 inhabitants. In this autoimmune disease, the body's own defense cells attack healthy skeletal tissue - usually in the sacrum and iliac joints first. This can cause painful bone growths up to the spine.
The disease progresses in phases and is different for each patient: with some so mild that it cannot even be clearly diagnosed, with others it is so aggressive that a life without pain medication is hardly possible. Inflammation of the vertebral joints can cause the joints to stiffen and the back to become immobile. Sometimes the spine also bends, which leads to a very bent forward posture. The disease also often lowers the density of bone mass, which can lead to osteoporosis. In some people, the mobility of the chest and thus breathing is impaired.
Occasionally, eye inflammation or inflammatory bowel disease accompany it. In very rare cases, the disease also affects other organs, for example the lungs, kidneys, heart or the main artery (aorta). If the heart is affected, heart valve defects can develop.
Root cause
In Bechterew's disease, the immune system is directed against the body's own cells. The reasons for this have not yet been clearly clarified. An infection with certain bacteria must presumably stimulate the body's defense system to react excessively and coincide with a hereditary predisposition to trigger the disease.
Symptoms
The disease often begins in the area of the sacrum and iliac joints (sacroiliac joints). This is a relatively immobile joint-like connection between the sacrum and iliac bone that is stiffened by ligaments. Sufferers repeatedly feel pain in their lower back and buttocks, especially when they sit for long periods of time. Typically, the pain is worst with rest (especially at night) and improves with movement. Those affected often report stiffness of the joints in the morning, which improves with movement. As the disease progresses, the spine and chest can become increasingly immobile. If a stiff hunchback develops, the disease is more advanced.
In almost half of those affected, the middle skin of the eye becomes inflamed, making the eye painful, sensitive to light and reddened.
Diagnosis
Since "normal" back pain is the first symptom, ankylosing spondylitis is often only diagnosed after five to ten years. If you suspect it, a visit to the rheumatologist is advisable. The doctor inquires about symptoms and previous illnesses, examines the mobility of the spine and measures its curvature. He also checks whether certain movements cause pain. A rheumatologist can use a special handle to determine whether the sacrum-iliac joint is inflamed. Magnetic resonance imaging (MRI) can reveal early symptoms such as inflammation.
If the disease has existed for a long time, evidence can also be found on x-rays, for example typical ossification on the spine. In the X-ray you can see a so-called bamboo stick spine: the overgrowths of bones between the vertebral bodies stiffen them like a bamboo stick. And the X-ray shows a spine comparable to a bamboo stick.
A blood test supplements the diagnosis. If the hereditary trait HLA-B27 is detected, ankylosing spondylitis is likely. The hereditary trait can be detected using a special protein on the surface of the white blood cells. This is the case for more than 90 percent of all those affected with ankylosing spondylitis.
The so-called BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) provides information about the activity of the inflammatory attacks: A point value (index) is calculated from information on pain, swelling in the joints and morning stiffness. If it is above 4, the disease is active.
Therapy with drugs
Like most rheumatic diseases, ankylosing spondylitis is a chronic disease. Affected people can slow the course of the disease or even bring it to a standstill. The prognosis is particularly favorable if you start modern drug therapy at an early stage. Therefore, people with deep back pain that has persisted for more than three months should not hesitate to see a rheumatologist. The specialist will work with the sick person to develop a treatment plan based on anti-inflammatory drugs.
In order to curb inflammation and relieve pain, various drugs are used in ankylosing spondylitis, including cortisone or TNF-alpha blockers. The signaling substance TNF (tumor necrosis factor) is involved in controlling the immune system. If it is blocked, inflammation can be inhibited, but the body becomes more susceptible to infections. If the drug is stopped, the inflammation comes back immediately. And: The drug doesn't last forever, the effect often wears off. Such a treatment costs up to 25,000 euros per year, but is covered by the health insurance companies.
Diet for ankylosing spondylitis
A special anti-inflammatory diet is a powerful additional strategy. Meat, especially processed meat such as sausage, should rarely be on the table because it contains a lot of inflammatory arachidonic acid. Good fats, on the other hand, have an anti-inflammatory effect, especially omega-3 fatty acids - for example in fatty fish such as herring, salmon, mackerel, tuna or in omega-protected linseed oil, best in combination with antioxidant wheat germ oil and DHA (docosahexaenoic acid) - and in vegetable ones Minerals and antioxidants. The stems and leaves that we throw away while cooking are particularly rich in these valuable substances and can be wonderfully processed into green smoothies. This diet also protects the heart. Proteins are also positive for the body's defenses. The proteins are contained in low-fat quark, for example.
Movement in ankylosing spondylitis
Sufficient movement is another pillar of the treatment: Special gymnastics keep the spine flexible and counteract stiffness. Sports such as backstroke swimming, hiking and cycling can also have a supportive effect, but back-stressing sports should be avoided. Even at work, those affected should, if possible, avoid all activities that require them to bend forward a lot. Ideally, they can switch between sitting, walking and standing at work.
Surgery for osteoporosis caused by ankylosing spondylitis
If osteoporosis occurs in the advanced stages of the disease, it is particularly important to keep the risk of falling to a minimum. In particularly severe cases of ankylosing spondylitis, those affected are also operated on, for example in the case of a stiff back, vertebral fractures or paralysis. Sometimes it is necessary to replace an inflamed hip joint with a prosthesis.
