How does ankylosing spondylitis affect foot health. What are the key features to look for in shoes for ankylosing spondylitis. Which types of shoes provide the best support and comfort for people with this condition. How can proper footwear alleviate pain and improve mobility in ankylosing spondylitis patients.

Understanding Foot Pain in Ankylosing Spondylitis

Ankylosing spondylitis (AS) is primarily known for causing back pain, but it can also lead to discomfort in other parts of the body, including the feet. Foot and heel pain often occurs in more severe cases of AS, presenting symptoms similar to severe arthritis. Tara Perry, an occupational therapist at Keck Hospital of the University of Southern California, describes the sensation as “walking on daggers with every step.”

Common foot problems associated with ankylosing spondylitis include:

• Plantar fasciitis
• Achilles tendinitis
• Heel pain
• General foot discomfort

The Importance of Proper Footwear for Ankylosing Spondylitis

Choosing the right shoes is crucial for individuals with ankylosing spondylitis, not only to minimize foot pain but also to support overall spinal health. Dr. Charla R. Fischer, an orthopedic surgeon at New York University Langone’s Spine Center, emphasizes that footwear can directly affect the spine. Proper shoes can help decrease pressure across the spine, providing much-needed relief for AS patients.

Why is footwear selection so critical for people with ankylosing spondylitis?

• Reduces pressure on the spine
• Minimizes foot pain and discomfort
• Encourages mobility and movement
• Accommodates difficulty in bending down
• Supports overall body alignment

Key Features to Look for in Ankylosing Spondylitis-Friendly Shoes

When selecting shoes for ankylosing spondylitis, several essential features should be considered:

1. Heel cushioning: Ample padding in the heel area helps reduce pressure on the spine.
2. Arch support: Good arch support facilitates comfortable walking and promotes proper foot alignment.
3. Toe box space: Shoes that don’t constrict the toes are crucial, as AS can lead to stiffening of soft tissues in the toes.
4. Easy to put on: Slip-on styles or shoes with Velcro straps can be beneficial for those who have difficulty bending.
5. Stability: Shoes that provide good stability reduce the risk of falls, which is particularly important for AS patients due to increased bone fragility.

The Role of Orthotics in Ankylosing Spondylitis Footwear

For many individuals with ankylosing spondylitis, additional support from orthotics can be beneficial. Dr. Fischer suggests evaluating whether orthotics are necessary, especially for those experiencing foot pain. When choosing shoes, consider options that have enough room to accommodate store-bought inserts or custom orthotics if needed.

Best Shoe Types for Ankylosing Spondylitis

While individual needs may vary, certain types of shoes are generally more suitable for people with ankylosing spondylitis:

1. Sneakers

Sneakers are often the top choice for AS patients due to their excellent heel and arch support. They typically offer ample cushioning and space for orthotics. When selecting sneakers, look for models with:

• Good shock absorption
• Breathable materials
• Wide toe boxes
• Supportive midsoles

2. Supportive Loafers

Loafers can be an excellent option for those who struggle with laces. However, it’s crucial to choose loafers with specific features:

• Closed back for heel support
• Cushioned insoles
• Arch support
• Non-slip soles

Dr. Fischer emphasizes the importance of a heel component in slip-on styles to reduce the risk of stumbling or tripping, which is particularly crucial for AS patients due to their increased risk of bone fractures.

3. Supportive Sandals

While flip-flops should be avoided due to their lack of support, certain types of sandals can be suitable for AS patients. Look for sandals with:

• Ankle straps for stability
• Contoured footbeds
• Heel cushioning
• Adjustable straps for a custom fit

Perry recommends choosing sandals that “hold onto the whole foot” and provide adequate support and stability.

Shoes to Avoid with Ankylosing Spondylitis

Certain types of footwear can exacerbate symptoms and should be avoided by individuals with ankylosing spondylitis:

• High heels: These shoes put excessive pressure on the spine and can cause imbalance.
• Flip-flops: Lack of support and stability make these a poor choice for AS patients.
• Completely flat shoes: Shoes without any arch support can lead to increased foot pain and fatigue.
• Tight or constrictive shoes: Footwear that squeezes the toes or puts pressure on sensitive areas should be avoided.

Balancing Function and Style in Ankylosing Spondylitis Footwear

While comfort and support are paramount, it’s important to consider personal style and cultural factors when selecting shoes. Perry notes that some patients may prefer dress shoes for cultural reasons, despite their potential drawbacks in terms of comfort and support.

For those who need to wear dress shoes, consider the following tips:

• Look for dress shoes with wider toe boxes and lower heels
• Consider orthopedic dress shoe brands that offer more support
• Use supportive insoles or orthotics when possible
• Limit the duration of wearing less supportive dress shoes

Remember that finding the right balance between function and style may require some experimentation and compromise.

The Impact of Proper Footwear on Mobility and Pain Management

Choosing the right shoes can have a significant impact on mobility and pain management for individuals with ankylosing spondylitis. Perry emphasizes that painful steps can lead to reduced mobility, which can, in turn, exacerbate AS symptoms. The right footwear can break this cycle by:

• Reducing pain with each step
• Encouraging regular movement and exercise
• Supporting proper body alignment
• Preventing falls and related injuries
• Improving overall quality of life

How can proper footwear contribute to pain management in ankylosing spondylitis? By providing adequate support and cushioning, the right shoes can alleviate pressure on painful joints and reduce the overall stress on the body. This can lead to decreased pain levels and improved mobility, allowing AS patients to maintain a more active lifestyle, which is crucial for managing the condition.

Customizing Footwear Solutions for Ankylosing Spondylitis

Every individual with ankylosing spondylitis may have unique needs when it comes to footwear. Customizing your approach to shoe selection can help optimize comfort and support:

Working with a Podiatrist

Consulting with a podiatrist can provide valuable insights into your specific foot health needs. They can assess your gait, foot structure, and any existing issues to recommend the most suitable shoe types and features for your condition.

Custom Orthotics

For some AS patients, over-the-counter insoles may not provide sufficient support. Custom orthotics, designed specifically for your feet, can offer tailored support and cushioning to address your unique needs.

Shoe Modifications

In some cases, existing shoes can be modified to better suit the needs of AS patients. This might include:

• Adding extra cushioning to the heel or sole
• Adjusting the shoe’s shape to accommodate foot deformities
• Installing specialized insoles or orthotics

Working with a skilled cobbler or orthopedic shoe specialist can help you explore these options.

Maintaining Foot Health Beyond Shoe Choice

While selecting the right shoes is crucial, maintaining overall foot health involves more than just footwear. Consider incorporating these practices into your routine:

• Regular foot exercises to maintain flexibility and strength
• Proper foot hygiene to prevent infections
• Regular check-ups with a podiatrist or rheumatologist
• Using assistive devices when necessary, such as a long-handled shoe horn
• Practicing good posture and body mechanics

How can individuals with ankylosing spondylitis maintain foot health beyond shoe choice? Implementing a holistic approach that includes regular exercise, proper hygiene, and professional care can complement the benefits of appropriate footwear. This comprehensive strategy can help manage symptoms, prevent complications, and improve overall quality of life for those living with AS.

Adapting Footwear Choices to Different Activities

People with ankylosing spondylitis often need to adapt their footwear choices to various activities and environments. Consider the following scenarios:

Work Environment

Depending on your profession, you may need to balance professional appearance with comfort and support. Some options include:

• Dress shoes with orthopedic features
• Smart casual options like supportive loafers or oxfords
• Formal sneakers for more casual workplaces

Exercise and Physical Activity

Engaging in regular exercise is crucial for managing AS symptoms. Choose athletic shoes that provide:

• Excellent shock absorption
• Stability for your specific activity (e.g., running, walking, cross-training)
• Breathability to prevent overheating and moisture buildup

Everyday Casual Wear

For daily activities, prioritize comfort and support while considering your personal style. Options might include:

• Supportive sneakers in various styles and colors
• Comfortable loafers or slip-ons with good arch support
• Orthopedic sandals for warmer weather

By adapting your footwear choices to different activities, you can ensure consistent support and comfort throughout your daily life.

The Future of Footwear for Ankylosing Spondylitis

As research into ankylosing spondylitis progresses and technology advances, the future of footwear for AS patients looks promising. Some emerging trends and innovations include:

• Smart shoes with sensors to monitor gait and provide real-time feedback
• 3D-printed custom orthotics and shoe components
• Advanced materials that offer superior cushioning and support
• Integration of wearable technology to track activity and symptoms

These developments may offer even more personalized and effective footwear solutions for individuals with ankylosing spondylitis in the coming years.

In conclusion, choosing the right footwear is a crucial aspect of managing ankylosing spondylitis. By prioritizing comfort, support, and functionality while considering individual needs and preferences, AS patients can significantly improve their mobility, reduce pain, and enhance their overall quality of life. Remember to consult with healthcare professionals and experiment with different options to find the best footwear solutions for your unique situation.

Best and Worst Shoes for Ankylosing Spondylitis

If you have ankylosing spondylitis, there’s a very good chance you experience back pain. But the condition can also cause pain in other areas of the body, including your hips, legs, and feet.

Foot and heel pain tends to arise in more severe cases of ankylosing spondylitis, according to Tara Perry, an occupational therapist at Keck Hospital of the University of Southern California in Los Angeles. “The foot and heel pain presents like very severe arthritis,” she explains. “It can feel like walking on daggers with every step.”

If you experience foot pain, one of the most important things you can do is choose the right shoes. In consultations with people who have ankylosing spondylitis, “Footwear is definitely something that comes up frequently,” says Perry.

Why Footwear Matters

There are a number of common foot problems in people with ankylosing spondylitis, including plantar fasciitis and Achilles tendinitis, according to the National Axial Spondyloarthritis Society in the United Kingdom. Minimizing foot pain is probably the most important consideration when choosing shoes.

But the right choice of shoes is important even if you’re not experiencing foot pain, because what you wear on your feet can directly affect your spine.

“Any sort of footwear that’s going to help decrease pressure across the spine — something that’s a little more padded in the heel like sneakers — is where you want to start out,” says Charla R. Fischer, MD, an orthopedic surgeon at New York University Langone’s Spine Center in New York City.

You should also consider any difficulty you may have bending down to put on your shoes. Because this can be a challenge for many who have ankylosing spondylitis, a slip-on shoe like a loafer may be a good choice. For people with ankylosing spondylitis, “Those are becoming more and more popular,” says Dr. Fischer.

Alternatives include shoes with straps fastened by Velcro or buckles, says Perry, but some people don’t like the look of Velcro. It’s important to find a shoe that fits your personality, lifestyle, and culture, as well as your condition, she says.

You should also choose footwear that encourages mobility. “If every step you take is painful, [you] pull back from mobility,” says Perry. You want to avoid this, she says, because, “A certain level of movement is needed to reduce the pain.”.

What to Look For

There are a number of features to consider in the shoes you wear, in addition to type or style.

Any shoe that constricts your toes is probably a bad choice, says Fischer. “As you get older, the soft tissues in your toes calcify and get a little bit stiffer,” she explains, so they’re less likely to tolerate pressure from the sides without causing discomfort.

Having enough cushioning in your heels — to reduce pressure on your spine — and good arch support are also necessary to facilitate comfortable walking, Fischer notes.

Some types of shoes are more likely to be a good fit for people who have ankylosing spondylitis, but even within a shoe type, there are better and worse choices, as explained below.

Sneakers: These are the natural choice for many people with ankylosing spondylitis, since they tend to have good heel and arch support. They also usually have plenty of room inside for store-bought inserts or custom orthotics, should you decide that you need even more cushioning or support.

“Anytime someone has foot pain, it’s a good idea to evaluate whether or not they need some orthotics,” notes Fischer.

Loafers: While slip-on styles, such as clogs and loafers, can be easier to put on and take off than sneakers Fischer recommends that you buy ones with a closed back. “There needs to be a heel component,” she says, to reduce the risk of stumbling or tripping.

Avoiding falls, Fischer notes, is especially important if you have ankylosing spondylitis, because your bones are more likely to fracture with even a relatively minor impact, putting you at increased risk for neck fractures in particular.

Sandals: Flip-flops are always a bad choice, says Perry, due to their lack of support and stability. But other types of sandals may be okay, she adds.

“You want a sandal that holds onto the whole foot, something with an ankle strap,” Perry notes. More rugged styles of sandals tend to have better heel cushioning and arch support and more adjustable straps than traditional sandals.

Dress shoes: It’s unlikely anyone would choose a dress shoe purely for function or comfort, but many people have good reasons to choose them, says Perry. “I’ve had patients — male and female — who will only wear dress shoes, because it’s a part of their culture,” she says.

Men’s dress shoes tend to offer more options for comfort and support than those for women, she notes, since orthotics “don’t fit into a ballet flat for a woman,” and many inserts may also be a tight fit in women’s dress shoes. Even so, some women’s dress shoes have more cushioning — or room for added cushioning — than others.

High heels: “Heels are really not recommended,” says Fischer. Wearing them changes the position of your pelvis in a way that increases pressure on your sacroiliac joint, which ups the chances of pain in the area, she notes. On top of this, you’re more likely to stumble or fall when wearing high heels, raising the risk of fractures.

If you’re unsure what type of shoe is best for you, don’t hesitate to ask your doctor or occupational therapist for advice. If you’re experiencing significant foot pain, both Perry and Fischer note that the best option may be a referral to a podiatrist who can evaluate whether orthotics may help or your condition requires further treatment.

Functional limitations due to foot involvement in
spondyloarthritis

J Phys Ther Sci. 2016 Jul; 28(7): 2005–2008.

, MD,^1,*, MD,², MD,¹, MD,¹ and , MD¹

Nihal Ozaras

¹⁾ Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University, Turkey

Nuri Havan

²⁾ Department of Radiology, Afsin State Hospital, Turkey

Emine Poyraz

¹⁾ Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University, Turkey

Aylin Rezvanı

¹⁾ Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University, Turkey

Teoman Aydın

¹⁾ Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University, Turkey

¹⁾ Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University, Turkey

²⁾ Department of Radiology, Afsin State Hospital, Turkey

^*Corresponding author. Nihal Ozaras, Department of Physical Medicine and Rehabilitation,
Bezmialem Vakif University: Istanbul, Turkey. (E-mail: moc.oohay@sarazolahin)

Received 2016 Jan 25; Accepted 2016 Apr 7.

Copyright 2016©by the Society of Physical Therapy Science. Published by IPEC
Inc.

This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

This article has been cited by other articles in PMC.

Abstract

[Purpose] Spondyloarthritis is a major inflammatory disease followed-up in the
rheumatology clinics, foot involvement in spodyloarthritis is common. The functional
states of patients with spondyloarthritis are usually evaluated globally. The aim of this
study was to assess the foot involvement-related functional limitations in patients with
spondyloarthritis. [Subjects and Methods] Patients with ankylosing spondylitis and
psoriatic arthritis with foot pain more than 4 weeks who underwent anteroposterior and
lateral feet radiography were enrolled into the study. A “clinical findings score” was
calculated by assigning 1 point for every finding of swelling, redness, and tenderness.
C-reactive protein and erythrocyte sedimentation rate were used as serum markers for
disease activity. Foot radiograms were evaluated using the spondyloarthropathy tarsal
radiographic index and the foot-related functional state of patients was determined by the
Turkish version of the Foot and Ankle Outcome Score. [Results] There were no relationships
between Foot and Ankle Outcome Score subscales and clinical findings score, serum markers,
or radiologic score. Pain and symptoms subscale scores were result positively correlated
with activity of daily living, sport and recreation, and quality of life subscale scores.
[Conclusion] Pain and symptoms are the main determinants of foot-related functional
limitations in spondyloarthritis.

Key words: Foot, Spondyloarthritis, Foot and Ankle Outcome Score

INTRODUCTION

Spondyloarthritis (SpA) is a group of rheumatic diseases characterized by inflammatory back
pain, peripheral oligoarthritis, enthesitis, and/or extraarticular manifestations¹⁾. Ankylosing spondylitis (AS) and psoriatic
arthritis (PsA) are the most frequently seen SpA subtypes in rheumatology units^2,3,4). Foot involvement in SpA is not uncommon and
enthesitis, erosive changes, or ankylosis are the main symptoms^{5, 6)}. This involvement
may affect foot functions negatively, similar to rheumatoid arthritis (RA)⁷⁾. In rheumatology units, the functional
states of patients with SpA are usually evaluated using Bath Ankylosing Spondylitis
Functional Index (BASFI) or other similar scales globally. However, these assessments may
underestimate the foot-related functional limitations in these patients.

The Foot and Ankle Outcome Score (FAOS) is a scale measuring the foot-related functional
limitations in the disorders affecting the foot^7,8,9,10). It consists of 5 subscales: pain,
symptoms, activities of daily living (ADL), function in sport and recreation (Sport-Rec),
and foot and ankle-related quality of life (QoL). The Turkish version of FAOS is a valid and
reliable instrument to assess foot and ankle related problems¹¹⁾.

The aim of this study was to assess specifically the functional limitations caused by foot
involvement in patients with SpA.

SUBJECTS AND METHODS

Patients with AS and PsA aged 18–70 years, with foot pain for more than 4 weeks who
underwent anteroposterior (AP) and lateral (L) feet radiography were included into the
study. They met the modified New York criteria for AS and Moll-Wright criteria for PsA^{12, 13)}. Informed consent was obtained from all patients. Patients who had
flatfoot, previous foot surgery, or any other foot disorder unrelated to SpA, and who had a
systemic disease such as diabetes or hyperthyroidism were excluded. Ethical approval for
this study was obtained from the ethical committee of the university where the study was
conducted.

The demographic features of subjects were determined. The clinical findings of foot
involvement were assessed by observing for swelling, redness, or tenderness. To obtain a
numerical value, a “clinical findings score” (CFS) was calculated by giving 1 point for
every finding on one foot [swelling: 1 point, redness: 1 point, tenderness: 1 point; the
maximum CFS score was 6 for the two feet]. The radiologic involvement of the foot was
evaluated by the spondyloarthropathy tarsal radiographic index (SpA-TRI), which is a valid
and reliable radiologic index developed specifically for the assessment of foot involvement
in SpA, and is suitable for use with two or more X-ray projections. It has five points; 0:
normal, 1: osteopenia or suspicious findings, 2: definite joint space narrowing, bony
erosions, periosteal whiskering, enthesophytes, 3: paraarticular enthesophytes/incomplete
bridging, 4: bony ankylosis/joint space fusion or complete bridging. The maximum SpA-TRI
score for the two feet (total SpA-TRI score) is 56¹⁴⁾. Foot X-ray images were evaluated by a radiologist who had no
information about the clinical status of subjects. Talonavicular, calcaneocuboid,
intercuneiform, cuneonavicular, and subtalar joints, and the calcaneal attachments of the
Achilles tendon and plantar fascia (7 places) were assessed using the SpA-TRI.

The foot-related functional status of patients was determined by the Turkish version of the
FAOS. It was a self-assessment questionnaire filled by patients themselves. FAOS is
calculated by a specific equation, and “100” indicates no problems while “0” indicates
extreme problems⁸⁾. Since the pain
assessment was achieved in detail by FAOS, no other pain assessment scale was needed.

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were used as serum
markers for disease activity.

Statistical analysis was done using Statistical Package for Social Studies, version 10.0.
Pearson correlation analysis was used to reveal the relationships between parameters.

RESULTS

Thirty patients with SpA (14 AS, 16 PsA) with a mean age of 49 years (range 26–70 years)
completed the study. The mean FAOS subscale scores were as follows: pain=58.70 ± 21.75,
symptoms=64.88 ± 26.05, ADL=66.27 ± 22.56, Sport-Rec=44.33 ± 26.42, and QoL=42.08 ± 24.99.
Pain subscale scores correlated positively with ADL, Sport-Rec, and QoL subscale scores.
Symptoms subscale score also positively correlated with ADL, Sport-Rec, and QoL subscale
scores (). Pain and symptoms subscale scores positively correlated with each other (r:
0.679, p<0.001).

Table 1.

Positive correlation between Pain and Symptoms subscale scores with other FAOS
subscale scores

		ADL	Sport-Rec	QoL
Symptoms	r	0. 749*	0.693*	0.552*
Pain	r	0.875*	0.872*	0.629*

The mean CFS was 1.5 (0–4). This value demonstrated that although patients had foot pain,
they did not have prominent physical examination findings. The mean CRP and ESR were 1.1
(0.1–8.5) mg/dl and 32 (7–100) mm/h, respectively, showing low disease activity. There were
no relationships between FAOS subscale scores and CFS or serum markers (CRP/ ESR).

The mean SpA-TRI score was 7.7 (0–24) and no correlation was found between FAOS subscale
scores and radiologic score.

DISCUSSION

Foot disorders may affect mobility and life quality significantly. AS frequently involves
the foot; the Achilles tendon is the second most common site of enthesitis after the
chondro-sternal junction, and the ankle is the second most common site for peripheral joint
disease after the knee⁶⁾. The involvement
of the ankle and small joints of the foot is also frequent in PsA¹⁵⁾. These effects of AS or PsA on the foot may lead to
functional limitations. The functional states and quality of life of patients with SpA are
usually evaluated using questionnaires such as BASFI, Health Assessment Questionnaire for
Spondyloarthropathies (HAQ-S), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL),
or PsA-specific Quality of Life Questionnaire (PsAQoL)^16,17,18,19). However, these
questionnaires evaluate the functional activities in a global manner without considering the
specific cause of the limitation. Therefore, the functional cost of foot involvement cannot
be assessed clearly with these indices leading to underestimation.

FAOS is a 42-item questionnaire developed for the assessment of functional limitations
after ankle ligament reconstruction, but it was also used in other disorders affecting the
foot such as hallux valgus and rheumatoid arthritis^7,8,9). It has 5 subscales; Pain, Symptoms, ADL, Sport-Rec, and QoL. Pain
subscale include 9 questions evaluating the frequency and severity of pain in certain
situations such as walking on flat surface or at night while in bed. Symptoms subscale has 7
questions assessing the stiffness, swelling, and movement properties of the foot/ankle. The
ADL and Sport-Rec subscales evaluate the degree of difficulty experienced due to foot/ankle
disorders in functional activities. The fifth subscale, QoL, focuses on the awareness of the
foot/ankle problem^{8, 11)}. Pain and symptoms subscale scores significantly and positively
correlated with each other and with ADL, Sport-Rec, and QoL subscale scores. Pain and
symptoms such as stiffness or range of motion loss, were the major cause of limitation of
functional activities in patients with SpA.

Plain radiography is a routinely used imaging technique in the evaluation of radiologic
involvement in rheumatic diseases. SpA-TRI is the radiologic index developed specifically
for the assessment of foot involvement in SpA. In this study, no correlation was found
between SpA-TRI and FAOS subscale scores. The mean SpA-TRI score was 7, a very low score
when compared with the maximum score of 56. It could be speculated that although patients
had symptoms, radiography did not show the involvement clearly, and therefore, no
statistically significant results were obtained. The magnetic resonance imaging technique is
quite successful in demonstrating very early changes at the feet even in patients with
asymptomatic AS and PsA^{20, 21)}. Therefore, this should be the preferred technique for
future studies.

In this study, the relationships between the FAOS subscale scores and CFS and serum markers
were also assessed. There were no relationships between FAOS subscale scores and CFS. The
foot is composed of small joints and their examination is relatively difficult than that of
the large joints. The inflammatory changes producing pain in these small joints may not
always lead to swelling, redness, or tenderness. These reasons may explain the lack of a
relationship between CFS and FAOS subscale scores. In our study, CRP and ESR values were
distributed in a wide range (0.1–8.5 mg/dl and 7–100 mm/h, respectively) showing that foot
involvement may not be directly affected from the disease activity. This hypothesis remains
to be clarified with studies having a larger sample size.

In conclusion, rheumatic pain, resulting from the inflammatory changes in the joints and
related structures, is a very important clinical problem disturbing the mood, sleep, and
quality of life of patients^22,23,24). It is the most
common presenting symptom of rheumatic diseases of the foot and may precede clinical and
radiologic findings²⁵⁾. This study
demonstrated that foot pain in patients with SpA might result in significant foot-related
functional limitation. Therefore, foot involvement and its functional results should be
evaluated separately regardless of the global functional state and disease activity of the
patient. To improve pain and function physical therapy modalities or orthosis may be
used^{26, 27)}. More studies about the foot involvement at the early and late
stages of the disease are needed and the possible treatment approaches must be
investigated.

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Ankylosing Spondylitis Effects on The Body: More Than Back Pain

Carrie Bonin was just 17 when her knees began to hurt so badly that she could barely walk. The pain tended to come and go, but was worst in the mornings. Bonin told her doctor about her agony.

“His response was, ‘Most people wake up with some pain in the morning. It’s completely normal,’” recalls Bonin, now 46, of Monroe, CT.

Over the next several years, Bonin endured the same pain in her hips, thumbs, wrists, and feet. Her doctor thought it might be related to Bonin’s earlier car accident. They prescribed anti-inflammatory pills, cortisone shots, and physical therapy. This gave her little relief.

“I was 21, but I waddled with the stiffness of a 90-year old woman,” Bonin says. It wasn’t until she was 25 that an orthopedic surgeon finally identified her ailment: ankylosing spondylitis (AS).

An Allover Disease

Lower back pain is a hallmark symptom of AS. But it’s not the only one. AS often can affect the joints in places like the shoulder or hips. That’s especially true in younger people, says Lawrence Brent, MD, a professor of medicine in the section of rheumatology at Temple University Hospital in Philadelphia.

AS can also cause enthesitis, or inflammation where your ligaments or tendons attach to your bones. The two most common spots are the Achilles tendon in your heel and plantar fascia in your foot. That’s where Bonin hurt the most. Today, she wears special inserts in her shoes and applies anti-steroid cream to her feet every day.

Unfortunately, some people with AS can go years before they get the right diagnosis. Some may not think to report their pain to their doctors. Other times, it’s because “some of the tendon-related issues are easy to overlook, especially if you’re being seen by your primary care doctor who may not be thinking about inflammatory arthritis,” says Erin Bauer, MD, a rheumatologist at Virginia Mason Medical Center in Seattle.

How to Spot AS

AS is a lifelong condition that in severe cases can lead to permanent damage to your posture and mobility and other problems. Pain that appears in places other than your back could be a sign that you have a more serious form of the disease.

Hips and shoulders. Pain in these locations affects about 1 in 3 people with AS. It usually comes on little by little. The pain can spread to your groin, knees, or the front of your thighs.

Eyes. About 40% of people with AS have an eye inflammation called uveitis. If you notice pain or redness, see your doctor right away. They may prescribe treatments like steroid eye drops. 

Gut. As many as 1 in 10 people with AS get an inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis. Symptoms of IBD include bloody diarrhea, weight loss, or tiredness.

Even if you don’t have IBD, you may have tummy trouble from the nonsteroidal anti-inflammatory drugs (NSAIDs) that are often used to treat AS, says Bauer of Virginia Mason. If you have symptoms like nausea, vomiting, heartburn, or diarrhea, let your doctor know. You may need to switch your medicines or cut back on them.

Jaw. About 10% of people with AS have jaw inflammation that makes it very hard for them to eat. If your jaw hurts, see your dentist, who can prescribe pain relievers like muscle relaxants or even a mouth guard.

Bones. Osteoporosis, or low bone density, affects about half the people with AS.  Two ways to help ward off this disease is with supplements and exercise. You need 1,000-1,200 milligrams of calcium and 400-1,000 IU of vitamin D a day. Weight-bearing exercises like walking help keep your bones strong. Also, tai chi, yoga, and other exercises that improve your balance may prevent falls.

Lungs. Sometimes AS can make it hard to breathe because the stiffness between the ribs and spine prevent your chest from expanding, says Stuart Kaplan, MD, chief of rheumatology at Mount Sinai South Nassau in Oceanside, NY. You may also get chest pain from scar tissue around your rib joints. If you notice either, see your doctor right away. Ice packs and deep-breathing exercises can also help.

Heart. AS makes you more likely to get heart disease. Your aorta, the artery that pumps blood from your heart to the rest of your body, can become swollen. Your heart can beat too quickly or too slowly.

AS-linked inflammation itself may also raise your chances of heart disease, Kaplan says. Keeping your weight, blood pressure, and cholesterol under control can help lower those risks. You should also get an echocardiogram, or heart ultrasound, annually.

Ankylosing Spondylitis and Heel Pain

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that affects the spine, but did you know that it can also affect the heels? AS can cause inflammation in not only joints, but also in entheses – points where ligaments and tendons attach to bones. Inflamed entheses result in enthesitis, and a common location for this problem in people with AS is the heel. The Achilles tendon at the back of the heel and the plantar fascia ligament along the bottom of the foot can both become inflamed, causing sharp pain and difficulty walking. If you have AS, it is suggested that you stay vigilant of any foot or ankle symptoms. If you notice these, a podiatrist can help you manage your heel pain.

Many people suffer from bouts of heel pain. For more information, contact Hillary Brunner, DPM of Basin Podiatry. Our doctor can provide the care you need to keep you pain-free and on your feet.

Causes of Heel Pain

Heel pain is often associated with plantar fasciitis. The plantar fascia is a band of tissues that extends along the bottom of the foot. A rip or tear in this ligament can cause inflammation of the tissue.

Achilles tendonitis is another cause of heel pain. Inflammation of the Achilles tendon will cause pain from fractures and muscle tearing. Lack of flexibility is also another symptom.

Heel spurs are another cause of pain. When the tissues of the plantar fascia undergo a great deal of stress, it can lead to ligament separation from the heel bone, causing heel spurs.

Why Might Heel Pain Occur?

• Wearing ill-fitting shoes                  
• Wearing non-supportive shoes
• Weight change           
• Excessive running

Treatments

Heel pain should be treated as soon as possible for immediate results. Keeping your feet in a stress-free environment will help. If you suffer from Achilles tendonitis or plantar fasciitis, applying ice will reduce the swelling. Stretching before an exercise like running will help the muscles. Using all these tips will help make heel pain a condition of the past.

If you have any questions please contact our office located in Odessa, TX . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

Read more about Heel Pain

What Is Enthesitis? Causes, Symptoms, Treatments

If you have ankylosing spondylitis or psoriatic arthritis, you may be familiar with the pain of enthesitis, an inflammation where tendons and ligaments attach to the bone — even if you aren’t aware it has a name. “I didn’t know what it was called!” Monica D. told us on Facebook. “I have pain all the time. Makes it difficult to walk very far.”

What Is Enthesitis?

“Enthesitis is inflammation of the ‘enthesis,’ which is where a tendon or ligament attaches to bone,” says Joan Appleyard, MD, a rheumatologist at Baylor College of Medicine in Houston, Texas. “Symptoms are pain sometimes accompanied by swelling.”

There’s a reason the enthesis is susceptible to this problem. “The enthesis has a lot of blood flow and [thus] is subject to both infection and inflammation,” says Theodore R. Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery in New York City. “Two of the most common entheses are the area where the Achilles’ tendon inserts on the back of the heel, which causes Achilles’ tendonitis, and where the sheet of connective tissue, or fascia, inserts on the bottom of the heel, which causes plantar fasciitis.”

Types of Arthritis That Cause Enthesitis

If you have rheumatoid arthritis or osteoarthritis, chances are you won’t experience enthesitis, because it generally only occurs with certain types of arthritis called spondyloarthropathies (SpA), which include non-radiographic axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis (a type that occurs in people with inflammatory bowel disease), and reactive arthritis (which can occur after infection, formerly called Reiter’s syndrome).

Enthesitis is actually one of the hallmark traits of SpA. “It is not a feature of rheumatoid arthritis — this is one of the ways in which SpA differs from RA,” Dr. Appleyard says.

Doctors aren’t exactly sure why SpA targets the enthesis, but it may be that a specific inflammatory response occurs in areas under biomechanical stress (stress on the joint from movement).

“About half of people with psoriatic arthritis and ankylosing spondylitis have enthesitis,” says Dr. Fields. “In both psoriatic arthritis and ankylosing spondylitis, the back and under portions of the heel are common sites of enthesitis.”

There are many other areas where enthesitis can occur, he says, including the inner and outer sides of the elbows, the area where the ribs meet the breastbone, the back of the head where it meets the neck, and in the spine in the area closest to the skin.

What Does Enthesitis Feel Like?

The main symptom of enthesis is pain, which CreakyJoints patients described as “horrible” or “burning.”

“Quite a bit of my PsA pain is due to enthesitis,” Ruth O. shared on Facebook. “It moves around from ball of my foot, to left shoulder, hands, wrists and left hip.”

Marcia G. told us, “I have [enthesitis] in my right ankle and heel mostly. My feet hurt randomly and the right toes and top of foot swell up.” Although many patients noted that enthesitis occurs in their feet, Kelly C. says it hurts “especially around my rib cage.”

Does Enthesitis Signal Worsening Disease?

Enthesitis might not mean your disease is progressing. “Enthesitis can be part of both severe and relatively mild cases of psoriatic arthritis or ankylosing spondylitis,” Dr. Fields says. It may indicate active disease, but not necessarily worsening disease, says Dr. Appleyard.

Your doctor will diagnose enthesitis based on a physical exam, in which they’ll note the location of pain, tenderness, or swelling. “Ultrasound can also be helpful in diagnosing enthesitis, and at times MRI can also be used,” Dr. Fields says.

Treatment for Enthesitis

“Managing enthesitis is important since it can cause a lot of discomfort,” Dr. Fields says. Some specific biologic therapies used to treat SpA seem to improve symptoms of enthesitis. “Treating the underlying disease with anti-TNF agents [a type of biologic] often helps with enthesitis, but traditional DMARDs such as sulfasalazine don’t treat enthesitis,” Dr. Appleyard says. Non-steroidal anti-inflammatory agents (NSAIDs) can be used for mild cases.

When deciding on a treatment regimen for SpA, Dr. Fields says it’s important to take into account all the affected areas. “In patients where enthesitis is the major issue, and more severe than the arthritis, we may skip the non-biologic agents and go directly to biologic therapies, since they tend to be more effective for enthesitis,” he says.

In addition to TNF blockers, other biologic options include blockers of the proteins IL-17, IL-12, or IL-23. “One exception is the non-biologic agent apremilast, which does not appear to cause infection and can be used in psoriatic arthritis, and which has been shown to have effectiveness in some people with enthesitis,” says Dr. Fields.

In addition, “local injection of corticosteroids can be used in enthesitis at times, but needs to be used carefully to avoid weakening of the surrounding tendons and ligaments,” Dr. Fields says.

Talk to your doctor about which medications are right for your individual case. (Here’s what one study found about picking the right treatment for enthesitis in PsA.)

Home Remedies for Enthesitis

A physical therapist can give you gentle stretches to do at home to help relieve the pain of enthesitis, Dr. Fields says. In addition, the doctors and patients we talked to suggested:

• Apply heat or ice to affected areas
• Maintain a healthy weight. “Weight loss can take pressure off the involved areas,” Dr. Fields says.
• Rest and elevate the affected foot. “I try to keep the swelling down by icing it, and keeping my leg and foot elevated,” Lesley P. told us on Facebook.
• Wear special shoes. “People with plantar fasciitis can benefit from shoe inserts to cushion the heel and may be helped by a consultation with a podiatrist,” Dr. Fields says.
• Wear compression socks, braces, wraps, or even a medical boot.
• Watch salt intake to control swelling. “Salt intake does make a difference,” Ruth says.
• Over-the-counter remedies (check with your doctor first). “I love using Biofreeze on the bone in my foot — it helps!” Caroline P. told us on Facebook. Other CreakyJoints members recommended Epsom salt soaks, diclofenac gel, magnesium, or CBD products.

Keep Reading

Ankylosing Spondylitis – Bone, Joint, and Muscle Disorders

• Nonsteroidal anti-inflammatory drugs

• Sulfasalazine, methotrexate, tumor necrosis factor inhibitors, and secukinumab or ixekizumab

Treatment of ankylosing spondylitis is focused on

• Relieving back and joint pain

• Maintaining range of motion in the joints

• Preventing damage in other organs

• Preventing or correcting spinal deformities

In some people, sulfasalazine or methotrexate may help relieve the pain in joints other than those of the back. The tumor necrosis factor inhibitors etanercept, adalimumab, infliximab, golimumab, and certolizumab pegol effectively relieve back pain and inflammation. Secukinumab, an interleukin-17A receptor antagonist, can also reduce inflammation and joint symptoms. Ixekizumab, another interleukin-17 inhibitor, is used for active ankylosing spondylitis.

The long-range goals of ankylosing spondylitis treatment are to maintain proper posture and develop strong back muscles. Daily exercises strengthen the muscles that oppose the tendency to bend and stoop. It has been suggested that people spend some time each day—often while reading—lying on their stomach propped up on their elbows because this position extends the back and helps to keep the back flexible.

Corticosteroid eye drops and dilating eye drops may help in the short-term treatment of inflammation of the eyes that comes and goes, and an occasional corticosteroid injection may be helpful for 1 or 2 joints other than the spine. Muscle relaxants and opioid analgesics are occasionally used, but for only brief periods to relieve severe pain and muscle spasms.

If the hips become eroded or fixed in a bent position, surgical treatment to replace the joint can relieve pain and restore function.

Because chest wall motion can be restricted, which impairs lung function, cigarette smoking, which also impairs lung function, is strongly discouraged.

Arthritis, Back Pain, Symptoms, Treatment

Overview

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (pronounced ankle-oh-sing spon-dill-eye-tiss) is a form of arthritis that causes chronic (long-term) spine inflammation. Ankylosing spondylitis (AS) inflames the sacroiliac joints located between the base of the spine and pelvis. This inflammation, called sacroiliitis, is one of the first signs of AS. Inflammation often spreads to joints between the vertebrae, the bones that make up the spinal column. This condition is known as spondylitis.

Some people with AS experience severe, persistent back and hip pain and stiffness. Others have milder symptoms that come and go. Over time, new bone formations may fuse vertebrae sections together, making the spine rigid. This condition is called ankylosis.

How common is ankylosing spondylitis (AS)?

Ankylosing spondylitis belongs to a group of diseases known as spondyloarthropathies. Between three and 13 out of 1,000 Americans have one of these diseases.

Who might have ankylosing spondylitis (AS)?

Anyone can get AS, although it affects more men than women. Symptoms usually appear in people between the ages of 17 and 45. Ankylosing spondylitis has a genetic link and may run in families.

Symptoms and Causes

What causes ankylosing spondylitis (AS)?

About 95% of people who have AS have a variation of the human leukocyte antigen-B gene (HLA-B). This changed, or mutated, gene produces a protein called HLA-B27 that increases disease risk. However, most people with a mutated HLA-B gene don’t get AS. In fact, 80% of children who inherit the mutated gene from a parent with AS don’t develop the disease. More than 60 genes have been linked to the condition.

Having one of these conditions may also increase your risk:

What are the symptoms of ankylosing spondylitis (AS)?

Symptoms typically appear between the ages of 17 and 45 but may develop in younger children or older adults. Some people have persistent pain, while others experience milder symptoms. Symptoms may flare up (worsen) and improve (go into remission) off and on. If you have ankylosing spondylitis, you may experience:

Diagnosis and Tests

How is ankylosing spondylitis (AS) diagnosed?

There isn’t a test that definitively diagnoses ankylosing spondylitis. After reviewing your symptoms and family history, your healthcare provider will perform a physical exam. Your provider may order one or more of these tests to help guide diagnosis:

• Imaging scans: Magnetic resonance imaging (MRI) scans can detect spine problems earlier than traditional X-rays. Still, your provider may order spine X-rays to check for arthritis or rule out other problems.
• Blood tests: Blood tests can check for the presence of the HLA-B27 gene. About 8% of people of European descent have this gene, but only a quarter of them develop ankylosing spondylitis.

Management and Treatment

What are the complications of ankylosing spondylitis (AS)?

Ankylosing spondylitis may affect more than the spine. The disease may inflame joints in the pelvis, shoulders, hips and knees, and between the spine and ribs. People with AS are more prone to spinal fractures (broken vertebrae). Other complications include:

• Fused vertebrae (ankylosis).
• Kyphosis (forward curvature of the spine).
• Osteoporosis.
• Painful eye inflammation (iritis or uveitis) and sensitivity to light (photophobia).
• Heart disease, including aortitis, arrhythmia and cardiomyopathy.
• Chest pain that affects breathing.
• Jaw inflammation.
• Cauda equina syndrome (nerve scarring and inflammation).

How is ankylosing spondylitis (AS) managed or treated?

Ankylosing spondylitis is a lifelong condition. While there’s no cure, treatments can prevent long-term complications, reduce joint damage and ease pain. Treatments include:

• Exercise: Regular physical activity can slow or stop disease progression. Many people experience worse pain when they’re inactive. Movement seems to lessen pain. Your healthcare provider can recommend safe exercises.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, including ibuprofen (Advil®) and naproxen (Aleve®), ease pain and inflammation.
• Disease-modifying anti-rheumatic drugs (DMARDs): Medications such as sulfasalazine reduce pain and joint swelling. The drugs also treat lesions caused by inflammatory bowel disease. Newer DMARDs called biologics help control inflammation by changing the immune system. Biologics include tumor necrosis factor (TNF) and interleukin inhibitors (IL-17).
• Corticosteroids: Injectable corticosteroids temporarily ease joint pain and inflammation.
• Surgery: A small number of people with ankylosing spondylitis may need surgery. Joint replacement surgery implants an artificial joint. Kyphoplasty corrects a curved spine.

What other steps can I take to manage or treat ankylosing spondylitis (AS)?

In addition to standard AS treatments, these steps may also help ease inflammation and pain:

• Eat a nutritious diet: Fried foods, processed meats and foods high in fat and sugar can have an inflammatory effect. Anti-inflammatory diets, such as the Mediterranean diet, may help fight inflammation.
• Maintain a healthy weight: Obesity and excess weight puts pressure on joints and bones.
• Limit alcohol consumption: Drinking too much alcohol can weaken bones and increase the risk of osteoporosis.
• Stop smoking: Tobacco use accelerates spinal damage and intensifies pain. Your provider can help you quit smoking.

Prevention

How can I prevent ankylosing spondylitis (AS)?

Because ankylosing spondylitis has no known cause, there isn’t any way to prevent it.

Outlook / Prognosis

What is the prognosis (outlook) for people who have ankylosing spondylitis (AS)?

Ankylosing spondylitis symptoms may gradually worsen as you age. The condition is rarely disabling or life-threatening. Still, symptoms like joint pain may interfere with your ability to do the things you love. Early interventions can ease inflammation and pain. A combination of physical activity and medications can help.

Living With

When should I call the doctor?

You should call your healthcare provider if you have AS and experience:

• Chest pain.
• Difficulty breathing.
• Vision problems.
• Severe back pain or other joint pain.
• Spine rigidity.
• Unexplained weight loss.

What questions should I ask my doctor?

If you have ankylosing spondylitis, you may want to ask your healthcare provider:

• Why did I get ankylosing spondylitis?
• What is the best treatment for ankylosing spondylitis?
• What are the treatment risks and side effects?
• What lifestyle changes should I make to manage the condition?
• Is my family at risk for developing ankylosing spondylitis? If so, should we get genetic tests?
• Am I at risk for other types of arthritis or back problems?
• What type of ongoing care do I need?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Ankylosing spondylitis is a form of arthritis that mostly affects the spine. It’s a lifelong condition without a cure. However, exercise, medications and lifestyle changes can help manage symptoms so you can enjoy a long, productive life. It’s rare for someone with AS to become severely disabled. Talk to your healthcare provider about the steps you can take to stay active and manage symptoms.

90,000 Ankylosing spondylitis – what is it

The official international name of the disease is ankylosing spondylitis. The term “Ankylosing spondylitis” is used only in Russia and until recently was used in Germany.

Ankylosing spondylitis is a systemic inflammatory disease, a type of spondyloarthritis that affects the joints, spine and entheses (the places where ligaments and tendons attach to the bones). The difference between the disease and other spondyloarthritis lies in the fact that ankylosis (fusion) of the vertebrae occurs among themselves, as a result, the spine can turn into a single bone and deform.The quality of life with this disease is significantly reduced. The second serious complication of ankylosing spondylitis is damage to the hip joints, up to complete loss of mobility and disability.

Why does this disease occur?

The exact cause of the development of the disease is unknown. According to one hypothesis, certain intestinal microbes can trigger pathological inflammation in the entheses and joints. For the appearance of the disease, it is not enough for a certain infection to enter the body; a certain state of the body’s immune system is necessary, in which self-sustaining inflammation is possible.Scientifically proven risk factors for the development of ankylosing spondylitis are heredity and smoking.

Symptoms

Ankylosing spondylitis usually begins at a young age. The most common symptom of ankylosing spondylitis is back pain. This pain has a number of characteristics (called “inflammatory back pain”). It increases with prolonged immobility, including during a night’s sleep, and decreases with physical activity.Painful sensations of an inflammatory nature are often accompanied by a feeling of stiffness, especially in the morning when the patient wakes up. The presence of this symptom is a reason for an immediate appeal to a specialist to clarify the diagnosis. Young people often experience pain in the area of ​​the calcaneus or the attachment points of the Achilles tendons.

Most often, the disease begins with sacroiliitis, which is manifested by pain in the lower back (lumbar region). But in some cases, the patient may feel pain in the neck or at the level of the thoracic spine.In the later stages, there is a restriction of movements, in especially severe cases, a “supplicant’s pose” is formed.

Often, patients notice pain, limited mobility and swelling in peripheral joints, for example, the shoulder, hip, small joints of the hands and feet, and temporomandibular joints.

The disease can also cause extra-articular manifestations – damage to organs: heart, kidneys, eyes. The latter occurs most often and is manifested by uveitis (pain, photophobia, redness of the eye).

Among the associated conditions, the presence of psoriasis, inflammatory bowel diseases, intestinal or genitourinary infections are distinguished.

Depending on the zone where the inflammation develops, the central and peripheral forms of the disease are distinguished.

Diagnostics

The diagnosis is confirmed using instrumental and laboratory diagnostic methods. X-ray and MRI in the diagnosis of ankylosing spondylitis are used as complementary methods. Often, ultrasound or MRI of the hands and feet can effectively detect enthesitis (inflammatory lesions of entheses).

Laboratory diagnostics play a significant role. 90% of patients with ankylosing spondylitis carry the HLA B-27 gene. It is a genetically determined antigen of leukocytes, which is associated with the possibility of developing an autoinflammatory response. However, the presence of HLA B-27 does not mean the development of the disease, this gene only indicates an increased risk of ankylosing spondylitis.

Early diagnosis is the key to successful treatment of ankylosing spondylitis, but it is not easy to recognize the disease.Much depends on the qualifications of a rheumatologist.

Treatment of ankylosing spondylitis

Drug treatment

The basis of treatment is non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, naproxen, nimesulide, etoricoxib, ketoprofen, aceclofenac, meloxicam, etc. They are able to inhibit ankylosis of the spine, reduce the inflammatory response and improve the prognosis can be used simultaneously as pain relievers.The drugs block the self-sustaining autoinflammatory process and block the disease mechanism. Patients with peripheral involvement, in whom arthritis prevails, are recommended to take basic anti-inflammatory drugs (sulfasalazine, leflunomide, methotrexate). In the absence of the effect of taking non-steroidal anti-inflammatory drugs, patients are prescribed genetically engineered drugs from the group of tumor necrosis factor inhibitors

Surgical treatment

Surgical treatment may be required to correct conditions associated with complications of the course of the disease, for example, with severe deformities of the spine, vertebral fractures, destruction of the hip joints, and heart damage.

Physiotherapy

To relieve pain, physiotherapeutic methods can be used: massage, acupuncture and other methods. Their disadvantage is that they do not provide long-term sustained effects. Physiotherapy is not included in the official recommendations for the treatment of ankylosing spondylitis.

exercise therapy

Regular exercise, in addition to basic therapy, helps maintain joint mobility. Exercises to strengthen the muscles of the back are especially recommended.

Prevention

The reasons for the development of the disease have not been reliably established, therefore, no special prophylaxis has been developed.

General recommendations can be to maintain an active lifestyle, while trying to avoid injuries of the spine and joints, refrain from smoking, the Mediterranean diet is preferred in food.

Diagnostics and treatment in EMC

Thanks to a wide range of diagnostic methods and modern technologies, most patients with this disease can achieve a good effect in treatment.At the European Medical Center (Moscow), comprehensive care is provided according to the protocols adopted by international rheumatological organizations (ASAS, EULAR, ACR). For patients who cannot come to the clinic, it is possible to organize a correspondence consultation.

90,000 Ankylosing spondylitis (ankylosing spondylitis) V.A. Nasonova

Ankylosing spondylitis (AS) refers to systemic inflammatory diseases in which the spine is predominantly affected.The pathological process proceeding in the spine gradually leads to the fusion of individual vertebrae with each other (ankylosis), which results in the development of limitation of mobility due to the formation of ankylosis (fusion of bones with each other). Hence the name of the disease comes from. At the same time, ossification of the ligaments surrounding the spine occurs. As a result, the spine can completely lose its flexibility and turn into a solid bone.

Symptoms

Usually the disease develops at a young age and has a gradual onset in the form of lower back pain, which eventually spread to other parts of the spine.Pain can occur sporadically, but more often it is persistent and only temporarily decreases after taking medication. The nature of the pain has the following features:

• Pain worse at rest, especially in the second half of the night or in the morning;
• are accompanied by stiffness;

90,075 decrease or disappear completely after exercise;

• are quickly stopped by taking non-steroidal anti-inflammatory drugs.

Changes in the spine usually spread from the bottom up, so difficulties in the movement of the neck appear rather late.Along with a decrease in the flexibility of the spine, there may be restrictions on the mobility of the joints. In some patients, in addition to changes in the spine, pain and restriction of movement in the shoulder, hip, temporomandibular joints appear, less often pain and swelling of the joints of the arms and legs, pain in the sternum. These phenomena can be moderate and short-lived, but in some cases they are persistent and rather difficult. Unlike arthritis in other diseases, inflammation of the joints in patients with ankylosing spondylitis is rarely accompanied by their destruction, but leads to limited mobility in them.

The true cause of AS (ankylosing spondylitis) is not yet clear.

Extra-articular manifestations

In addition to the spine and joints, damage to various organs and systems is sometimes observed (damage to the heart, kidneys, eyes). The most commonly affected eyes (uveitis) are manifested by pain and redness of one eye, lacrimation, photophobia, blurred vision. In such cases, patients should be observed not only by a rheumatologist, but also by an ophthalmologist.Uveitis in AS is usually unilateral and, with adequate treatment, usually resolves within 2-3 months without consequences. If adequate treatment is not prescribed in a timely manner, then uveitis can lead to complications.

Diagnostics

All over the world, including in Russia, as early as 8-10 years ago, the diagnosis of AS was made on average 7-8 years after its onset. This was primarily due to the fact that one of the characteristic and diagnostically important clinical signs of the disease – sacroiliitis (inflammation of the sacroiliac joints), could only be detected by x-ray.However, this symptom could appear rather late, after many years from the onset of the disease. It is now possible to make a diagnosis at an early stage using MRI of the sacroiliac joints, which allows the detection of active inflammation of the SIJ in the early stages. X-ray examination of the spine in the early stages is of less importance for the diagnosis, but it is necessarily carried out for further comparative analysis of the detected changes as the disease progresses, as well as to exclude possible other causes of pain in the spine.

If a disease is suspected, a study is required for the carriage of HLA-B27 (a gene for susceptibility to AS), its presence is sometimes a significant argument in favor of the diagnosis of AS.

Among laboratory methods, the most important is the determination of ESR and C-reactive protein (CRP). These indicators make it possible to roughly judge how active the inflammatory process is. However, they do not always correctly reflect the patient’s condition, and normal ESR figures by themselves do not yet allow a conclusion about the absence of inflammation.

During the initial examination, a more complete examination of the patient is also carried out to identify concomitant diseases and to identify extra-articular manifestations of AS.

The main difficulty in diagnosing AS is to recognize the disease in the early stages, which largely depends on the analysis of purely clinical rather than structural changes in the skeleton and on the experience and qualifications of a rheumatologist.

Self-diagnosis tests are available at ref.

Treatment

Drug therapy should be prescribed by a specialist doctor, depending on the stage and activity of the disease.

At present, there are all possibilities for the successful treatment of ankylosing spondylitis.

Treatment should be comprehensive and must include, in addition to drug therapy, exercise therapy (exercise therapy).

Among the non-drug methods of treating ankylosing spondyloarthritis, the main place is occupied by regular physical exercise (exercise therapy) and educational sessions conducted in patient schools. The patient should regularly engage in exercise therapy. Regular exercise therapy for ankylosing spondylitis ensures the preservation of the mobility of the spine and joints.The role of other physiotherapeutic methods for the treatment of ankylosing spondylitis such as massage, magnetic therapy, acupuncture, etc. has not been proven.

You can watch the video tutorials at link

Currently in the arsenal of rheumatologists there are drugs that effectively treat this disease, especially if it was diagnosed at an early stage.

Cooperation with the attending physician

An AS patient must be constantly monitored by a rheumatologist who can always listen to you attentively and help you competently.

Try to regularly undergo the recommended examination, carefully keep medical records, X-rays. When visiting a doctor, prepare your questions and wishes in advance. Discuss any questions about changing treatment, as well as the use of pseudo-scientific therapies.

Currently, a mobile application ASpine has been developed for self-control in ankylosing spondylitis, which works on all modern smartphones. The program can be downloaded for free.

Specialists of the Laboratory of Spondyloarthritis and Psoriatic Arthritis of the N.I.V.A. Nasonova, are leading experts in the treatment and diagnosis of ankylosing spondylitis (ankylosing spondylitis).

Make an appointment with a specialist:

90,000 Ankylosing spondylitis or ankylosing spondylitis

Ankylosing spondylitis or ankylosing spondylitis

“If the pain is excruciating, it is short-lived,

And if it is long, then it is not painful “

Cicero M.T.

Ankylosing spondylitis or ankylosing spondylitis is a chronic form of arthritis with a predominant lesion of the joints of the spine, paravertical soft tissues, sacroiliac joints. It is characterized by pain and stiffness in the lower back, buttocks, in the thoracic back, neck and sometimes in the hips, feet, chest, more often occur at rest, in the second half of the night, decrease with movement. It can also manifest itself as swelling and limited mobility in other joints.This disease is more common in men than in women. Today, there is no way to completely cure this disease. The goal of treatment is to relieve symptoms and stop progression. Most patients remain able to work and physical activity. A complication of AS (ankylosing spondylitis) can be inflammation of the iris of the eyes (iritis) and impaired respiratory function associated with kyphosis and chest deformity, damage to the cardiovascular system, aortitis, pericarditis, rhythm disturbances.

“Ankylosis” – means to become motionless or rigid; “Spondyl” means the spine; “It” means inflammation. In ankylosing spondylitis, inflammation occurs outside the joint, where the ligaments and tendons attach to the bone, whereas in most forms of arthritis, inflammation affects the inside of the joint. This condition usually affects the small joints between the vertebrae and reduces the mobility of those joints. Thus, the main feature of joint inflammation is the gradual limitation of their mobility with the formation of ankylosis (bone fusion with each other).At the same time, ossification of the ligaments that strengthen the spine occurs. As a result, the spine can completely lose its flexibility.

Ankylosing spondylitis is a chronic (that is, long-term, long-term) condition, but in most cases the symptoms are moderate. With timely diagnosis and proper treatment, pain and stiffness in ankylosing spondylitis can be minimized, and disability and deformities can be significantly reduced or even prevented.

Ankylosing spondylitis is a systemic disease from the group of rheumatoid arthritis, that is, inflammation is noted not only in the area of ​​the intervertebral joints, but also in other tissues. This means that inflammation can affect other joints (hip, shoulder, knee, or ankle) as well as tissues in the eye, kidneys, heart, and lungs.

Ankylosing spondylitis usually affects young people 13 to 35 years old (mean age 24 years), but can appear in the older age group.Men are affected about three times more often than women.

What are the causes of ANC ilesing spondylitis?

As with other forms of arthritis, the cause is unknown, but the hereditary factor is not denied (the HLA B27 gene is found in 90% of people with ankylosing spondylitis, although the presence of the gene does not mean that you will develop ankylosing spondylitis).

Symptoms of ankylosing spondylitis.

Usually, the disease develops gradually, there are small pains in the lower back, which intensify over time and spread to other parts of the spine. Pains are persistent and only temporarily decrease after taking medication. Usually in the early morning, lower back stiffness and pain are more severe.

Gradually there is a limitation of the mobility of the spine, which sometimes occurs imperceptibly for the patient himself and is detected only during a special examination by a doctor.Sometimes pains are very weak or even absent, and the only manifestation of the disease is impaired mobility of the spine. Changes in the spine usually spread from the bottom up, so difficulties in moving the neck appear rather late. In some cases, limitation of movement and pain in the cervical spine are observed from the first years of the disease.

Pain is not always limited to the back. Some people have chest pain from time to time.

Along with a decrease in the flexibility of the spine, the mobility of the joints connecting the ribs with the thoracic vertebrae is limited.This leads to impaired breathing and weakening of ventilation of the lungs, which can contribute to the onset of chronic lung disease.

In some patients, in addition to changes in the spine, pain and limitation of movement in the shoulder, hip, temporomandibular joints appear, less often pain and swelling of the joints of the arms and legs, pain in the sternum. These phenomena can be moderate and short-lived, but in some cases they are persistent and rather difficult.One side is usually more painful than the other.

Pain and stiffness increase after prolonged sedentary periods, and this condition may be interrupted by sleep before the onset of morning pain and stiffness.

Unlike arthritis in other diseases, inflammation of the joints in ankylosing spodilitis is rarely accompanied by their destruction, but contributes to the limitation of mobility in them.

Diagnostics.

In advanced forms, the diagnosis does not cause difficulties.But the main problem with ankylosing spondylitis is the late diagnosis. What are the first signals? What symptoms should you look out for? Stiffness, pain in the sacroiliac region, which can radiate to the buttocks, lower extremities, intensify in the second half of the night. Persistent pain in the calcaneus in young people.
Pain and stiffness in the thoracic spine . Increased ESR in the blood test up to 30-40 mm per hour and above. In case of persistence of such symptoms for more than three months, an immediate consultation with a rheumatologist is needed! The disease does not always begin with the spine, it can also begin with the joints of the arms and legs (resembling rheumatoid arthritis), with an inflammatory eye disease, with damage to the aorta or heart.Sometimes there is a slow progression, when the pain is practically not expressed, the disease is detected by chance during an X-ray examination. Over time, the limitation of the mobility of the spine increases, tilts to the side, forward, backward are difficult and painful, there is shortening of the spine. Deep breathing, coughing, sneezing can also cause pain. Movement and moderate physical activity – reduce pain.

Treatment.

How to treat ankylosing spondylitis? Treatment should be comprehensive, long-term, staged (hospital – sanatorium – polyclinic).Used non-steroidal anti-inflammatory drugs, glucocorticoids, with severe immunosuppressants. Physiotherapy (in remission), manual therapy, and therapeutic exercises are widely used. Therapeutic exercises should be carried out twice a day for 30 minutes, the exercises are selected by the doctor individually. In addition, you need to learn muscle relaxation. In order to inhibit the development of chest immobility, deep breathing is recommended. At the initial stage, it is important not to allow the development of vicious postures of the spine (posture of the proud, the posture of the supplicant).The bed should be firm and the pillow should be removed in the initial stages. Skiing and swimming are shown to strengthen the muscles of the back and buttocks. The bed should be firm and the pillow should be removed. The disease is progressive, but with proper therapy, it can be resisted. The main task is to delay the development of the disease, prevent it from progressing. Therefore, it is necessary to regularly undergo examinations by a rheumatologist, and in case of exacerbations, go to the hospital. The goal is to relieve pain and develop stiffness in the spine.If you follow the program of complex treatment individually selected by a competent specialist, then the consequences of ankylosing spondylitis that interfere with normal life can be minimized. Patients who are well informed about their disease and lead a healthy lifestyle report less pain, visit doctors less often, are more self-confident and remain more active despite the disease. Patients who regularly engage in physical education maintain a relatively good functional state and the ability to work for a long time, despite the advanced stages of the disease.

Outstanding personalities with ankylosing spondylitis: Nikolay Ostrovsky, Vladimir Kramnok, Aristotle Onasis, Dmitry Avaliani. Ankylosing spondylitis is not a sentence. With her you can live, work and enjoy all the benefits of our existence with you: travel, have children, make love.

As can be seen from practice, it is not the age, and not how far the disease has gone. It’s about the person himself. How he perceives himself and his illness.What is ready to do. For myself, to get rid of ankylosing spondylitis. Accept this disease as a challenge and accept the struggle with this “life partner” with confidence!

Go ahead and you will succeed!

Head of the neurological office Byk I.A.

90,000 Ankylosing spondylitis or Ankylosing spondylitis

What is it?

Ankylosing spondylitis is a chronic progressive disease manifested by inflammation of the joints of the spine.Prolonged inflammation leads to impaired movement in the joints. As a result, the spine is practically motionless.

This disease was first described by the Russian neurologist Vladimir Bekhterev. In his honor, ankylosing spondylitis got its second name – ankylosing spondylitis.

Ankylosing spondylitis mainly affects men aged 20-40 years, although the disease begins at late school age, about 15 years.

Reasons

The reasons for the development of ankylosing spondylitis are not exactly known.Apparently, the disease develops in people who have a specific hereditary predisposition and certain genetic characteristics of the immune system. Chronic infections (especially of the intestines and urinary tract) play a role.

What’s going on?

With the development of the disease, there is a gradual damage to the joints of various parts of the spine. First of all, ankylosing spondylitis affects the sacroiliac joints (connect the sacral spine with the pelvic bones).Then the intervertebral and costal-vertebral joints are involved in the inflammatory process. If the process is not taken under control in time, the patient’s mobility of the spine may be significantly impaired, up to its complete immobility.

How is this manifested?

The first signs of this disease are mild pains in the sacrum region, sometimes also in the groin and in the area of ​​the outer thighs. These sensations are most pronounced in the morning and at night. The patient’s sleep is disturbed. In the morning, stiffness is felt in the back, it is difficult for patients to get out of bed.Gradually, sometimes after several years, pain and stiffness appear in the neck and back, while discomfort is also felt in the morning. Bends to the sides, back and forth are difficult and painful. Deep breathing, coughing, and sneezing also cause pain.

Ankylosing spondylitis is characterized by an increasing limitation of the mobility of the spine, its shortening. If untreated, the disease can lead to complete immobility of the spine, the patient acquires a “supplicant pose” (arms bent at the elbows, stooped back, bowed head, legs, slightly bent at the knees).

Why is it dangerous?

In addition to limiting the mobility of the spine, if untreated, the disease spreads to other organs and systems.

Diagnostics

The following symptoms can be suspected: pain in the lumbar region, lasting more than three months and not decreasing with rest; chest pain and tightness; difficulty breathing. In the presence of these symptoms, it is necessary to consult a rheumatologist and prescribe additional research methods.Radiography of the spine or magnetic resonance imaging of the joints is of primary importance in diagnosis. A general and biochemical blood test is mandatory.

Sickness of the Young, or Living with Pain – Society

They turn on the radio and hear popular hits. “Turn around, turn around!” – the duet of imposing men calls upon them. “Not to run,” the brutal soloist complains to them. For most of us, these are just figures of speech, for them – a statement of a medical fact. They physically cannot run, or even turn their heads at the hail.They are often unable to raise their heads to look at the stars. Correcting a raised leg for them is an insoluble problem. Ankylosing spondylitis, better known as ankylosing spondylitis, turned their lives into torment.

Disease of young people

At the end of the 19th century, the famous Russian neuropathologist Vladimir Bekhterev described the symptoms of a chronic progressive disease affecting the joints and the spine, which mainly suffers from the disease named after the scientist – Bekhterev’s disease.Moreover, sometimes the spine changes to such an extent that over time, a person actually loses the ability to move.

• Ankylosing spondylitis in Russia can affect about 500 thousand people
• Tula doctors began to use exoskeletons for the rehabilitation of disabled people

The spine loses its elasticity, making it impossible to bend or straighten: often the patient spends the best years of his life either in the so-called supplicant’s pose, or in the proud pose.In other words, either in a constantly twisted state, or, conversely, in an eternally straightened one, like a bamboo stick. Naturally, this means a disability and a ruined life, since ankylosing spondylitis in an advanced stage is practically not cured. The only way to prevent a person from becoming helpless is to identify the disease at an early stage.

The problem is that the overwhelming majority of those affected by this ailment are people from 15 to 35 years old, who risk becoming disabled in their prime.At this age, people, as a rule, are dismissive of their health: well, they say, it will pass by itself. It is extremely important to help them “turn around” in time: listen to your body and recognize the initial symptoms of impending disaster. This is the main goal of the exhibition “Disease of the Young, or Life with Pain”, which is held in the capital until December 13.

Pain in each letter

The organizers of the exhibition – the Novartis Pharma company, the Society for Mutual Aid for Bekhterev’s Disease and the Association of Rheumatologists of Russia – exhibited light sculptures in the pedestrian zone of Gogolevsky Boulevard.These are figures of people, created from transparent resin, frozen in poses that are natural for most of us: here a man sat down to tie a lace, now he waved his hand, here he puts on a coat. But everyone’s spine is highlighted in red: it’s like a red light for those suffering from ankylosing spondylitis, who can only dream of these elementary movements. An impressive proof is the plaques on each sculpture. On them – short, but chilling – quotes from patients. Here in every line, in every letter – pain, pain, unbearable pain.Both physical and mental.

I do not have a single pair of shoes with laces, because if the lace is untied on the street, I simply cannot, like everyone else, sit down and tie it.

Even when I just put on a jacket or coat – this is a real test, passing which you only feel depressing fatigue.

It’s so easy to wave your hand, for example, to reach for something or say goodbye to someone … But not for me anymore!

Kiss me if you can

Imagine what it would be like not to be able to raise your head to look into the eyes of your loved one.Or bending over to kiss your beloved – this happens more often, because men, as a rule, are taller. It is men who make up the main risk group: until relatively recently, there were nine men for one woman suffering from ankylosing spondylitis. Only in recent years has this gap narrowed.

The spine is the first and main object that incapacitates ailment. It all starts with back pain, often in the lower half. It mainly hurts at night and closer to the morning, and during the day, when a person is actively moving, the pain subsides.Aching pain in the morning in the lower back, which disappears after exercise and a hot shower, is also a reason to think: the beginning ankylosing spondylitis manifests itself primarily when the body is at rest (this is its main difference from sciatica, with which ankylosing spondylitis at the initial stage is often confused ).

When meeting with a loved one, I cannot respond with a kiss, because simply raising or lowering my head is already an impossible task for me.

But the spine is only the first stage.Further, the joints of the hands and feet are included in the process. Any joints can be affected – shoulder, hip, and hand joints. Ligaments and tendons are often hit, and then the whole body aches. The disease can develop at different rates, and this is another manifestation of its insidiousness. Deterioration can gradually and not very noticeably occur over several years, so that a person, in essence, does not realize the difference, realizing only at a late stage of the disease, when it is no longer possible to effectively fight the disease.And the quality of life is declining to such an extent that the patient will soon be unable to take care of himself.

Cold as torture

Note: “As long as I can see at all” is not a desperate cry from the heart, but a cold-blooded statement of fact.

Festive fireworks, solar eclipse, starry sky: I can’t throw my head back to the sky, that’s why I see them only on TV. As long as I can see at all …

If the disease progresses, fixed joints and ossification of the cervical spine are not all the troubles that ankylosing spondylitis threatens.Often, patients develop uveitis – inflammation of the eyes, which is manifested by sharp pain, severe redness, profuse lacrimation and blurred vision. These phenomena are observed on average in every third or fourth patient and require immediate referral to a specialist.

By the way, the scheme also works in the opposite direction: often it is the inflammation of the eyeball that makes it possible to recognize ankylosing spondylitis in the early stages. The patient comes to the ophthalmologist complaining of vision, and he sends him for further examinations.

A common cold is torture for me. In order not to faint from the pain one day, I learned to sneeze and cough in a different way.

The legendary Hippocrates, the ancient Greek healer and philosopher, the “father of medicine” and the author of the oath that novice doctors take to this day, is credited with the phrase: “If you have a lot of diseases, then you have a sore spine.” In this case, the formula can be turned over: a sick spine is also a harbinger of other serious health problems.

With ankylosing spondylitis, the patient may be disturbed by pain in the thoracic spine, which is often mistaken for manifestations of intercostal neuralgia or heart disease. There are also really serious pathologies of the heart and blood vessels – pericarditis (inflammatory lesion of the serous membrane of the heart), aortitis (inflammation of the aortic wall), damage to the aortic valve, followed by heart failure. Sometimes fibrous lesions of the lung tissue, renal failure develop.Intestinal inflammation and osteoporosis are common.

In general, there are so many possible concomitant diseases of ankylosing spondylitis that a person can only sigh. But even with this, enormous difficulties arise: a deep breath, coughing, sneezing cause unbearable chest pains. And about the psychological problems associated with the fact that simple and until recently habitual actions lead to hellish torment, and an elementary cold becomes unbearable, there is probably no point in talking.

“From genes and chromosomes”

And one more disappointing fact: ankylosing spondylitis is inherited.It is associated with the presence of a gene called HLA B27. Approximately 7-10% of the world’s inhabitants are considered its carriers. Of a thousand children born in couples that do not have this marker, ankylosing spondylitis develops in five. In sick parents, children get sick in 30 cases out of a thousand, that is, six times more often. Unfortunately, it is impossible to prevent the disease. But modern medico-genetic techniques make it possible to calculate the risk of ankylosing spondylitis in children born to parents suffering from this disease.The main thing is to do everything on time.

When my son ran for the first time, I already knew that I would not be able to tell him: “Come on, who is faster, we ran a race!” And I can never, and not only run …

Not a sentence

With timely detection and quality treatment, ankylosing spondylitis allows you to lead a completely normal and successful life. She did not prevent the Russian Vladimir Kramnik from becoming the world chess champion, the Czech writer Karel Capek – from writing books that have become classics.Norwegian Jens Stoltenberg was the prime minister of his country and now heads NATO, and the Greek billionaire Aristotle Onassis amassed a huge fortune.

Still, the words “with timely detection” are key here. Severe consequences can be avoided only if you start to fight this ailment at the initial stage. That is why it is so important not to pass by the exposition on Gogolevsky Boulevard. Non-standard sculptures and heartbreaking testimonies of those to whom help came too late are the best reason to think and take a closer look – to your health, the health of your children, friends and loved ones.Perhaps your attentive gaze and timely intervention will allow someone to look into the sky all their lives without difficulty and pain.

____________________________________

^{Age category 0+}

^{873319 / RHEUM / A4 / 12.17 / 1}

Memo to rheumatological patient

30 September 2016

Introduction

Please don’t think that arthritis is a sentence!
Keep in mind that a patient can do a lot on his own to alleviate his condition, maintain efficiency, and improve the quality of life.The most important thing is to maintain an active position in relation to your illness, and, along with the recommendations of a rheumatologist, do something for your health yourself, moreover, every day. The will to live is a “therapeutic factor” and as long as you have something to live for (children, grandchildren, work, friends, books, art, music and continue on your own), you should try to improve the quality of your life every day. This requires your efforts!

Correct functional stereotype for patients with shoulder lesions in osteoarthritis and rheumatoid arthritis.

Before following the recommendations listed below, you should consult with your doctor. Each lesion of the shoulder joint is individual. Listed below are some general principles that require medical correction for you.

• Avoid stress on the shoulder girdle during all movements and especially when abducting the shoulder.
• Avoid sudden movements in the shoulder joint, do not carry weights more than 3 kg.
• It is correct to carry small weights: shoulders are straightened, the spine is straightened, do not bend forward, carry bags light with a hook grip. while the flexors of the arms are relaxed.
• Correct posture: straightened shoulders, back straightened, the angles of the shoulder blades are maximally connected (as much as the patient can).
• Active shoulder exercises should be discussed with your doctor (raising your arms up, lowering them down, moving back and forth, and especially useful circular movements with your hands).In case of individual lesions of the shoulder joint or the soft tissues surrounding it, only passive exercises are advisable (the healthy arm helps to raise the sore arm to the side using a lever in the form of a gymnastic stick) and only outside the acute period.
• Exercises with a stick: arms extended at shoulder level, an even spine; raise your hands up, lower them down, bring them to you, away from you; put the stick behind your back, moving it away from your back.
• It is necessary to remember about exercises for the neck (perform head movements forward, backward, right, left; circular movements clockwise and counterclockwise).
• Positioning treatment: in case of severe pain syndrome, it is necessary to find a comfortable position for the arm that will relieve pain as much as possible, for example, using a bandage in the form of a scarf supporting the arm or placing a roll under the arm (you can combine a roll and a scarf). Sleep on a low, flat pillow or cushion. You cannot bring your head to the side of the sore shoulder during sleep, it is better to move your head in the opposite direction with a turn of 15-20 degrees.
• To restore function in the shoulder girdle, without exacerbation, you can do homework associated with movement in the shoulder joint in all planes without load (wiping windows, mirrors, panels).
• Do not put a heavy load on the shoulder joint and the spine, it is necessary to avoid sudden movements of the hand and head. Do not make sharp bends of the body. Avoid fixed poses.
• Wear a head support for pain in the cervical spine.

Basic provisions of the correct functional stereotype in patients with hand lesions with rheumatoid arthritis.

• Compliance with the straight axis of the hand, as an extension of the forearm, when performing industrial and household manipulations.
• Reduce the load on the end phalanges as much as possible (do not exert large force loads on the fingerpads).
• Avoid movements with the deviation of the hands outward like the flippers of a walrus (ulnar deviation).
• Maintain the transverse and longitudinal arch of the hand.
• The main starting position of the hand when performing remedial gymnastics is to put the hands and forearms on the table with thumbs up “on the edge” (on the little fingers) or with the palm down (without deviating the hand outward).
• Observe the correct position of the hand at rest (hand on a tennis ball, cylindrical surface or cone-shaped).
• For power action, use a hook grip lever with cylindrical or tapered handles.
• Write with thick tapered pens and pencils.
• Become familiar with self-care skills in occupational therapy classes.

Functional stereotype in ankylosing spondylitis (ankylosing spondylitis)

Ankylosing spondylitis (AS) – chronic inflammatory disease of the spine and joints. The main feature of joint inflammation in this disease is the gradual limitation of their mobility with the formation of ankylosis (adhesions). As a result, the spine loses its flexibility, the mobility of the joints connecting the ribs with the thoracic vertebrae is limited, which leads to limited ventilation of the lungs. Regular exercise therapy is very important, which significantly helps to maintain the mobility of the spine.

• To reduce the progression of ankylosis, it is necessary to strive as much as possible to unbend and unload the spine and joints of the lower extremities.
• To prevent deformities in the early stages, it is recommended to sleep on a flat and not too soft surface, without a pillow or cushion under your head, or sleep on your stomach. In later stages, if you sleep on your back, use a thin pillow or roll under your neck. Do not sleep with your knees bent.
• Try to maintain correct posture when standing or sitting. Make sure that your back is straight, your shoulders are deployed, and your head is kept straight.Try to sit upright with maximum extension in the lumbar spine.
• You can check the correct posture by standing with your back to the wall. The heels, buttocks, shoulder blades, and the back of the head should touch the wall at the same time. Avoid fixed poses.
• Regardless of how you feel, every morning it is necessary to start with remedial gymnastics, this must be done even in cases where the mobility of the spine is severely limited and there is no hope of its recovery, but at the same time you improve ventilation of the lungs.You should also quit smoking and take enough time to walk. Inadequate ventilation of the lungs contributes to the development of lung infections.
• In case of signs of flexion contracture in the knee or hip joints, it is advisable to use a support (cane) to relieve the joint when walking. Do not carry weights, develop a joint in the pool. In case of contracture of the knee joint, a roller is placed under the lower third of the lower leg.

Correct functional stereotype for patients with osteoarthritis

• Weight correction
• Physiotherapy exercises in a sitting position, lying down, in the pool
• Alternating active, passive and isometric exercises
• Elimination of contractures
• Avoid fixed poses, lifting and carrying weights
• Walking with a cane, wearing knee pads, insoles-instep supports

In all inflammatory diseases of the joints and spine, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and non-inflammatory diseases of the musculoskeletal system, such as osteoarthritis, osteochondrosis, muscle strength decreases.Isometric exercises play an important role in the repair function of weakened muscles in these patients. Isometric exercises are also shown with congenital weakening of the ligamentous apparatus, when pathological mobility appears in the joints with elements of overextension in them. It is not always possible to prescribe physical therapy and massage in full in the treatment of these diseases. Isometric exercises come to the rescue, in which muscle tension and relaxation alternate while lying down.A number of exercises (2nd, 5th) should not be performed with subluxation in the hip joints and with dysplasia, which the doctor will tell you with whom you will consult before you are going to include this gymnastics in your life.

Exercises for the upper limbs:

• Starting position: Lie on your back. Hands along the body, palms down. We press with our whole hand on the couch, then we relax our hands. The number of repetitions is 10 – 15 times. Breathing is arbitrary.
• Lying on your back.We try to raise our hands up, resisting an imaginary obstacle or weight, but do not raise them, as if our hands are holding.
• Lying on your back. We try to spread our arms to the sides, all with the same imaginary resistance, but we do not spread them.

Lower Extremity Exercise:

• Lying on your back. Legs together, arms along the torso, feet towards you. We are trying to spread straight legs, but do not spread them. The number of repetitions of each exercise is 8-10 times.
• Lying on your back.Legs apart, feet on themselves. We try to connect the legs, overcoming imaginary resistance, but we do not connect.
• Feet together. We tighten the muscles of the thigh. 6-8 times.
• The legs are bent at the knees. We try to spread our knees to the sides, but we do not part. 8-10 times.
• Bend your legs at the knees and spread them apart at the knees. We are trying to connect the knees, but we do not connect. 8-10 times.
• Legs are straightened, feet are on themselves. Stretch your heels towards the headboard, return to the starting position.4-6 times.
• Every day, each exercise, start by determining the maximum muscle strength, and then do the exercises at half strength.
• Muscle strength should be determined while lying on the couch. Hands along the body, palms down and with all force press on the couch. This is maximum strength. But it is necessary to perform the exercises at half of the maximum strength due to the possible increase in pain syndrome. Isometric exercises can help build muscle strength. Give loads up to 5, and then relax in the same way, increase the number of repetitions gradually.Monitor tolerance and well-being, especially with concomitant cardiovascular diseases and increased blood pressure (BP). With high blood pressure and dizziness, it is better to skip the procedure.

Isometric exercises therefore help build muscle strength while sparing the joints.

Memo on psychological rehabilitation

We actually have a huge reservoir of untapped resources within us that we can tap into in times of hardship and hardship.For without such hope, without such a goal, without such faith in our own strengths and opportunities, there is so little left to fight for, and we must constantly fight – with a number of obstacles in our life.

We must not despair or lose courage, especially at times when we feel that everyone is against us and we have nothing to lean on. In moments like this, we go through a true test of strength. In its wisdom, nature can sometimes bend us, it seems, in the most inconceivable way, but it will never break us.Trials and sufferings and what seems to us an undeserved blow – all this comes our way. We must accept them as such and not consider them punishment and retribution for our past wrongs; nor should we think that we deserve to be unhappy.

We can all achieve our goals, whatever they may be, by perceiving ourselves as whole, perfect, unique, loving and loved beings, which we really are, including those cases when we are sick and weak. Perceiving ourselves in this way and recognizing our negative and positive qualities, we are able to go beyond the limiting and paralyzing fear of weakness and illness.
It is necessary to understand that no one will do this for us, although we need others, their guidance and the ability to show us the path to healing, especially in those periods when we find ourselves in a black strip of our life. How much we can help ourselves depends only on us and our inner wisdom. This necessarily presupposes a delicate balance between intuition and knowledge that can be achieved through the use of techniques such as autogenic training.
It is extremely important to remember that no matter how calm, serenity and positive attitude we may experience, these are only relatively transitional states, as well as those negative and overwhelming sensations and feelings that we may experience from time to time.
When you wake up in the morning, try to create a good mood for yourself for the whole day. Without getting out of bed, mentally say positive affirmations to yourself.

We offer you some examples of verbal formulas for a positive affirmation:

• “I feel calm and creative”
• “I love myself, life and others”
• “I love every new day of my life and everything that it brings”
• “I can live and love, and nothing will stop me from doing this”
• “I know that my inner space is filled with love, light, beauty and peace”
• “I am confident that I can overcome my illness”
• “My life is filled with love, joy and light, and there is no room for illness”
• “Love and serenity in me can dispel disease”
• “I am full of strength, health and energy”
• “I am filled with energy and vitality”
• “I completely accept myself”
• “My life is in my hands”
• “I am calm and confident in myself”
• Knowing the nature of your disease, you can carry out autogenic training during the day:
• “I will fight with all my might against the progression of the disease”
• “I will help the attending physicians in the process of my treatment: take medication clearly, observe the daily routine and work”
• “I will create a good mood for myself and others”
• “I will always be an optimist”
• “I will look at the difficulties in a philosophical way – today they are, and tomorrow they are not”
• “I will not panic in the face of difficulties”
• “I will always consider myself a strong and full-fledged person”
• “I will help myself and, as far as possible, others in overcoming difficulties”
• “I will try to do everything myself” (as far as possible)

Communicate with people more; do something nice for yourself every day.Get some work done.

Before lunch or before dinner, you can carry out another complex of autogenic training. The psychotherapeutic effect is best done every other day.
Registration of the results obtained is of great importance.

Create a notebook where you can register your feelings.

In the future, it will help you keep track of how much it helps you and improves your health:
1. Elimination, change in pain syndrome, increase in hand temperature.
2. Elimination and mitigation of various neurotic complaints (irritability, poor sleep, tearfulness, headache, etc.)
We offer an option for autogenous training:
1. I am completely calm …
2. Nothing worries me …
3. All my muscles are completely relaxed …
4. My whole body is pleasantly resting …
5. I feel a pleasant warmth in the joints of my hands … (Imagine a burning fire, remember how pleasantly the firewood of a burning fire crackles, how bright tongues of flame radiate warmth.You reach out to the burning fire) …
6. I feel a pleasant warmth in the elbow joints … (Imagine vividly, figuratively, that you immersed your elbows in warm water, warm water caresses, warms the skin of the hands, the area of ​​the elbow joints, the elbows become warm) …
7. I feel a pleasant warmth in the shoulder joints … (Imagine putting a pleasantly warm heating pad on your shoulders …)
8. I feel a pleasant warmth in the hip joints … (Imagine that a warm heating pad is applied to the thighs …)
nine.I feel a pleasant warmth in my knee joints … (Imagine putting a warm heating pad on your knees, or wrapping your knees in a warm woolen blanket …)
10. I feel a pleasant warmth in the ankle joints, in the joints of the foot … (Imagine that you immersed your feet in very warm water, a pleasant sensation of warmth spreads over your feet, completely warms your feet up to the tips of your toes …)
11. My arms and legs are relaxed and filled with warm blood …
12. Warm blood intensively supplies all the muscles and joints of my body with nutrients and oxygen …
13.Throughout my body, in all joints, muscles, I feel pleasant warmth, lightness …
14. I do not experience any unpleasant painful sensations in the joints of my arms or legs …
15. Every time, as soon as I want, I can cause myself the same state of relaxation, a feeling of heaviness and warmth in my arms and legs …

Instruction for patients on the use of orthopedic and technical means of rehabilitation

Orthopedic means of rehabilitation (prosthetic and orthopedic products) – orthoses, splints, head supports, reclinators, bandages, corsets, knee pads, instep supports.

Technical means of rehabilitation – canes, canadian sticks, crutches, handrails, wheelchairs, walkers, etc. deformities of the joints and violations of the axis of the limbs. Untimely appointment and use of orthopedic rehabilitation devices can lead to the development of serious deformities and changes in the axes of the limbs, which requires their surgical correction.

• In the presence of flat feet, correction with instep supports (orthopedic insoles) is necessary. The instep supports must be worn constantly, investing in all shoes. This helps to correctly distribute the load not only on the joints of the foot, but also on all joints of the lower extremities and the spine.
• In case of damage to the hip and knee joints with severe pain and contractures, it is necessary to move with additional support (cane, Canadian sticks, crutches).The cane should be at the level of the hip joint and on the side opposite the affected joint.
• For arthritis of the knee joints, the appointment of knee pads is necessary. Depending on the local activity, pain syndrome and the degree of damage to the articular cartilage, soft, semi-rigid or rigid knee pads are used. Wearing knee pads is possible under static load (walking, standing) up to 8 hours a day. Be sure to combine with physiotherapy exercises. Knee pads should be removed at night.
• In case of damage to the joints of the spine, the use of head supports, reclinators, bandages, corsets up to 8 hours a day in combination with exercise therapy is indicated.
• In case of arthritis of the wrist and small joints of the hands, the combined use of static (made of thermoplastic materials) orthoses-hand-holders during sleep and functional (elastic) orthoses during work is optimal.
• It is better to select all orthopedic products individually, which ensures optimal correction of the existing deformity.
• Regular (once every 6 months) medical supervision of the corresponding orthopedic device is required for staged correction or manufacture of a new device.

www.revmo-nadegda.ru

90,000 “Pain is my mentor”: Siberians against ankylosing spondylitis

© Vera Salnitskaya

28 Feb 2018, 06:02

Once, due to back pain that does not go away for a long time, a person does not stand up.Without a diagnosis and treatment, it literally twists, joints and spine become inflamed. Taiga.info learned how they live with ankylosing spondylitis in Novosibirsk.

Bechterew’s disease (ankylosing spondylitis) is a chronic autoimmune rheumatological disease. According to clinical data, there are more than 146 thousand patients with this disease in Russia. In 2012, when examining Russian patients with ankylosing spondylitis, it was found that permanent disability occurred on average 15 years after the onset of the disease, and the average age of disability was 46.3 years.In Europe, ankylosing spondylitis has been diagnosed in 1.7 million people.
Sibmeda Health Magazine

Berdchan resident Vladimir Kuznetsov, a minibus driver, says that the first call was pain in the knees, but at first it was tolerable. It was a shock for the young man when the temperature suddenly knocked him down, and his joints ached so unbearably that he could not get out of bed.

“I went to see the doctors and had an X-ray done. At first they thought it was a bruise. Then – rheumatoid arthritis, – he recalls.- Three years were treated for the wrong thing. Following the knees, the elbow began to hurt, and now he does not straighten up. You are driving – your hand hangs out of the window. Then the neck … Only massage removed the pain. ”

As a result, the idea that a competent rheumatologist is needed was thrown to Vladimir by a traumatologist, who suspected ankylosing spondylitis. So he got first to specialists at NIITO, and then to the regional hospital.

The worst outcome of ankylosing spondylitis is complete ossification of the spine.And, although today patients rarely reach such a state, negative changes in joint mobility are sometimes impossible to “play back”. The disease develops, as a rule, very slowly over many years. The first symptom (when the immune cells for some reason react to the cells of the joints of the spine as enemies and begin to destroy them, which leads to inflammation) is back pain. At first, it is insignificant, gradually it becomes more pronounced and passes to other parts of the back. The pain is worse at night or in the morning, after prolonged rest, but may decrease or even disappear after a warm-up.

One of the newest methods of treatment of ankylosing spondylitis is the use of tumor necrosis factor (TNF-α) blockers. This treatment was also recommended to Vladimir.

“When a rheumatologist prescribed Humira for me ( adalimumab – approx. Taiga.info ), her hands were trembling: the drug was expensive, there was no money in the budget. From the moment I was prescribed the drug “Humira” until the appointment of “Enbrela” ( etanercept – Taigi.info ) and receiving it took a year and a half. One package of such drugs costs at least 25 thousand, and somewhere around 50 thousand.But in the end, they began to buy them from the budget, ”he says.

In the photo three years ago, Vladimir looks obese, unfriendly and hunched over. Today he is peaceful and open, although he cannot fully straighten his back. He says that he used to be a byaka, but now he is a completely different person. “Thanks to the disease,” he smiles. – Anyone who is tormented by the question “why do I need this” I pull back: “Not for what, but for what?” “

Selected therapy, physiotherapy exercises, Nordic walking and family support helped to come to terms with the diagnosis.Without all this, it would be much more difficult to cope. You need certain forces not to pay attention to people who look after your constrained and stooped figure.

“Thanks to my wife, she still cares. They took me everywhere when I could not walk, for example, to an operation: I had a hip replacement, ” explains the interlocutor of Taiga.info. – But my wife says that she does not feel sorry for me. There is no pity – there is support. And I decided that pain is my mentor. It means that you, Vova, did something wrong.As a result, I accepted the disease. She is with me for life, and if we are fighting a disease, we are fighting ourselves. And, in general, if not for my knees, I would have been running. ”

“My wife says that she doesn’t feel sorry for me. No pity – there is support ”

As often happens, not only doctors, but also people who have gone through the same, help to pull yourself together in case of a serious incurable disease. The Novosibirsk branch of the Society for Mutual Aid for Bechterew’s Disease was opened in 2016.

“Our main goal is to increase patient awareness of this disease.Often people, even knowing the diagnosis, do not understand how to live with it. We also fight for everyone’s responsibility for their health. To feel good, you need to do exercises every day – it takes willpower. It seems like a trifle, but it has a big impact on the state of health, ”says the head of the organization Svetlana Sidorova.

Another goal of the self-help society is to maintain contacts between doctors and patients. According to Sidorova, only about 1,700 rheumatologists work in Russia, and mostly in big cities, and people in small towns often cannot get qualified advice.

“It takes a long time from the onset of the first symptoms until a person gets to a rheumatologist,” regrets the interlocutor of Taiga.info. – There are also problems with drugs, which are expensive. I would like more people to be able to take advantage of modern drug supply, but, as far as I understand, a certain budget is not enough for everyone in need ”.

The disease overtakes young people, 30–40 years old, mainly men, when they are at the peak of their activity.The prognosis and quality of life largely depend on early diagnosis and treatment initiation. According to official statistics, about 700 people with ankylosing spondylitis were registered in the Novosibirsk region last year. Genetically engineered biological drugs – the very same tumor necrosis factor (TNF-α) blockers – are received in 49 people in the region.

“I started doing this myself because my husband got sick. In ten years, while we waited for the diagnosis, a lot has been lost, – she sighs. – A big burden falls on the family of the sick person.If the condition is serious, then the money is too high, given that the drugs are quite expensive. ”

The Novosibirsk branch of the Mutual Aid Society for ankylosing spondylitis conducted three patient schools. The meetings were held with the support of the Novosibirsk Regional Hospital and the chief freelance specialist-rheumatologist of the regional Ministry of Health Larisa Bogoderova.

“When I walk around the city, I see my patients at once: a stooped figure, a peculiar gait, turns with the whole body,” she says, sitting in her office, she says, affectionately glancing at Vladimir and Svetlana.

“The later stages, if we are talking about a lesion of the spine, are either a very straight back – like a stake swallowed, or a bent back – the pose of the supplicant. But we have very few of them, – the doctor adds. – Pain in the spine that bothers at night, in the morning – this is already a reason to contact us, and not to go to fortune-tellers, so that we could start anti-inflammatory therapy on time. In this case, the chances of maintaining a high labor and functional status will be high. ”

There are indeed a lot of people in need of genetically engineered drugs, she says: “True, the need for expensive treatment would be much less if patients had come earlier.The main thing is to come to us on time. So Vladimir walked for a long time and came, and we won back something from the disease, but not all ”.

Vladimir cheerfully declares to this: “I know many who, after a diagnosis, simply throw their carcass on the sofa: they lie there, take painkillers and that’s it. I pull them: let’s go for a walk, we must move! Because you can’t give up. ”

Text: Margarita Loginova
Photo: Vera Salnitskaya

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