Morbus Bechterew - (Spondylitis ankylosans)

What is Bechterew´s disease?

Bechterew´s disease – also called Spondylitis ankylosans – is a stiffening rheumatoid inflammation of the spine, which affects 0,5 - 1 % of the adult population in Central Europe and can lead to a complete stiffening (med.: acampsia) and serious curvature of the spine - in serious cases the lung function and breathing can be restricted. Joints can be afflicted by this disease as well.

How do I recognise if I have Bechterew´s disease?

A typical early symptom is a deep rooted pain in the back, either at night or early in the morning. (The inflammation does not sleep!). Often the discomfort gets so bad that the patient wakes up from it. Typically, the pain subsides (as opposed to degenerative deterioration diseases of the spine) during the course of the day and through exercise.
Most patients are affected by the disease between the ages of 16 and 30. However, it can also strike earlier or later. If you suffer from the typical inflammatory back pain (as described here) you should consult a rheumatologist for further clarification.

How does the disease progress?

With many patients – but not all – the disease begins with back pain that emanates into the backside and down to the knees. Mostly the disease then progresses in episodes. It can come to a hold at any stage of the disease. Without treatment, however, it can lead to serious curvature and stiffening of the spine and joints. Ligaments can be affected as well. Most prevalent are painful rheumatic inflammations of the Achilles tendon.

Which other complications does the disease entail?

The Spondylitis ankylosans is not purely a disease afflicting the spine and joints. Apart from the more or less serious restrictions of the muscular skeletal system, many Bechterew patients suffer from eye irritations, which range from harmless conjunctivitis to serious inflammations of the iris that has to be treated by an ophthalmologist immediately. Very rarely the disease afflicts the aorta (main artery) is afflicted or entails other serious complications.

As a woman I don’t need to worry about Bechterew´s disease?

Wrong! Women can also contract Spondylitis ankylosans. However, with women the disease more rarely leads to a complete stiffening of the spine but women suffer from stronger rheumatic pain more often.

How do you diagnose Bechterew´s disease?

After taking your case history through anamnesis and examination your rheumatologist will arrange for lab testing (including HLA-B27) and x-rays of the sacroiliac joint as well as other parts of the spine. Possibly, further examinations might be necessary for a clear diagnosis such as scintigraphy of the skeletal system, an MRI scan of the sacroiliac joint and spine or an arthrosonography (ultrasound of the joints).

How can Bechterew´s disease be treated?

Carrying out a long term and consistent course of physiotherapy is of vital importance. It is the only way to avoid the complete stiffening of the spine. The regular stay in a specialisted clinic for rheumatology with an in-patient rehabilitation program has proven very successful. This allows supervision and instruction of the necessary physiotherapy program.
In addition, physical therapy measures can be carried out for soothing pain, muscle relaxation and anti-inflammatory purposes. Particularly effective as an anti-inflammatory measure is the cold treatment of the complete body in the so-called cold chamber at -120° .

Oral treatment is possible with non-steroid anti-rheumatoid medication, e.g. Diclofenac or so-called disease modifying drugs, e.g. Sulfasalazin (Azdulfidine RATM or PleonTM)
If the joints are inflamed and retain water (oedema) an injection of cortisone into the joint can become necessary. In some cases oral medication containing cortisone coaldhelp.
In severe cases the so-called TNF-alpha-blockers are introduced, e.g. Etanercept (EnbrelTM) or Infliximab (RemicadeTM). These drugs, which are only available as injection or intravenous infusion, are options for the treatment of patients with advanced and active illness. They seriously affect the function of the immune system. NOTE: This therapy can only be applied by a qualified rheumatologist. If in doubt, always ask your doctor which types of therapy are suitable for you.
As a rule today, the signs of this illness can be suppressed and a stiffening of the spine or the destruction of joints can be prevented through a consistent and targeted therapy