How does ankylosing spondylitis affect your eyes. What are the symptoms of uveitis in AS patients. What treatments are available for AS-related eye inflammation. How can you manage eye health with ankylosing spondylitis. What is the connection between AS and uveitis. How often does uveitis occur in people with AS. What are the different types of uveitis associated with ankylosing spondylitis.

The Link Between Ankylosing Spondylitis and Eye Health

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that primarily affects the spine. However, its impact extends beyond joint pain and stiffness. One of the most significant complications of AS is its effect on eye health, particularly through a condition called uveitis. Understanding this connection is crucial for those living with AS or those who suspect they may have the condition.

Uveitis, an inflammatory eye disease, affects approximately half of all individuals with ankylosing spondylitis at some point in their lives. This high prevalence makes it one of the most common extraarticular manifestations of AS. The inflammation typically targets the uvea, the middle layer of the eye, but can affect various parts of the eye structure.

Types of Uveitis in Ankylosing Spondylitis

Uveitis associated with AS can manifest in different forms, depending on the affected area of the eye:

• Anterior uveitis (iritis): The most common type in AS patients, affecting the front part of the eye, including the iris.
• Intermediate uveitis: Inflammation in the vitreous, the gel-like substance in the eye.
• Posterior uveitis (choroiditis): Affecting the back of the eye, including the retina and optic nerve.
• Panuveitis: The most severe form, involving all parts of the eye.

Each type of uveitis presents unique challenges and requires specific treatment approaches. Recognizing the symptoms early is crucial for preventing long-term vision problems.

Symptoms of Uveitis in Ankylosing Spondylitis Patients

Identifying the symptoms of uveitis is crucial for early intervention and prevention of vision loss. Patients with ankylosing spondylitis should be vigilant about the following signs:

• Redness in one or both eyes
• Eye pain, which can range from dull to severe
• Blurred or decreased vision
• Increased sensitivity to light (photophobia)
• Floaters or dark spots in the visual field

These symptoms can develop rapidly, often affecting one eye at a time. In some cases, uveitis may be a one-time occurrence, while others may experience recurrent episodes over the years. The unpredictable nature of uveitis in AS underscores the importance of regular eye check-ups and prompt medical attention when symptoms arise.

Is uveitis always painful in AS patients?

While pain is a common symptom of uveitis, not all cases are painful. Some individuals may experience only redness or blurred vision without significant discomfort. This variation in symptoms highlights the need for comprehensive eye examinations, even in the absence of pain.

The Genetic Link: HLA-B27 and Uveitis in Ankylosing Spondylitis

The connection between ankylosing spondylitis and uveitis goes beyond mere coincidence. Genetic factors play a significant role in this association, with the HLA-B27 gene being a key player. This gene is present in a large percentage of individuals with AS and is also associated with an increased risk of developing uveitis.

Research indicates that about 90% of AS patients are HLA-B27 positive, and this gene is present in approximately 50% of those with acute anterior uveitis. This genetic link provides valuable insights into the underlying mechanisms of both conditions and may guide future treatment strategies.

How does the HLA-B27 gene influence eye inflammation in AS?

The HLA-B27 gene is involved in immune system function. Its presence can lead to an overactive immune response, causing inflammation in various parts of the body, including the eyes. In individuals with AS, this genetic predisposition may trigger uveitis when combined with other environmental or physiological factors.

The Gut-Eye Axis: A New Perspective on Uveitis in Ankylosing Spondylitis

Recent research has shed light on a fascinating connection between gut health and eye inflammation in ankylosing spondylitis. This concept, known as the gut-eye axis, suggests that the trillions of microorganisms living in our digestive system may play a crucial role in the development of uveitis.

The gut microbiome, composed of various bacteria, fungi, and viruses, is integral to our immune system function. In individuals with AS, an imbalance in this microbial ecosystem (dysbiosis) may contribute to the onset of uveitis. This theory proposes that certain gut bacteria can trigger immune cells, specifically T cells, to attack the eyes, leading to inflammation.

Can modifying gut bacteria help prevent or treat uveitis in AS patients?

While research is ongoing, there is growing interest in using probiotics, prebiotics, and dietary modifications to manage uveitis in AS patients. Some approaches being explored include:

• Consuming probiotic-rich foods like yogurt and kefir
• Incorporating prebiotic fibers found in bananas, onions, and garlic
• Taking gut health supplements such as butyrate
• Adopting a primarily plant-based diet to promote beneficial gut bacteria

It’s important to note that while these strategies show promise, they should be pursued under medical supervision and in conjunction with conventional treatments for uveitis and AS.

Diagnosis and Early Detection of Uveitis in Ankylosing Spondylitis

Early detection of uveitis is crucial for preventing vision loss and managing the condition effectively. For individuals with ankylosing spondylitis, regular eye examinations are an essential part of their overall health management strategy.

Interestingly, eye doctors may sometimes be the first to suspect ankylosing spondylitis in a patient. The presence of recurrent uveitis, especially in young adults, can prompt further investigation into underlying systemic conditions like AS.

What diagnostic tests are used to confirm uveitis in AS patients?

Diagnosing uveitis in the context of ankylosing spondylitis typically involves a combination of the following:

1. Comprehensive eye examination, including visual acuity tests and intraocular pressure measurement
2. Slit-lamp examination to assess the structures of the eye
3. Dilated fundus examination to evaluate the back of the eye
4. Optical coherence tomography (OCT) to image the retina and optic nerve
5. Blood tests to check for inflammatory markers and the HLA-B27 gene
6. In some cases, imaging studies of the spine and sacroiliac joints to confirm AS diagnosis

These tests, combined with a thorough review of the patient’s medical history and symptoms, help healthcare providers make an accurate diagnosis and develop an appropriate treatment plan.

Treatment Strategies for Uveitis in Ankylosing Spondylitis

Managing uveitis in the context of ankylosing spondylitis requires a multifaceted approach. The primary goal of treatment is to rapidly reduce inflammation and prevent long-term damage to the eye. Treatment strategies may vary depending on the severity and location of the uveitis, as well as the patient’s overall health status.

What are the first-line treatments for acute uveitis in AS patients?

For acute anterior uveitis, which is the most common form in AS patients, initial treatment typically involves:

• Topical corticosteroid eye drops to reduce inflammation
• Cycloplegic eye drops to dilate the pupil and relieve pain
• In some cases, oral corticosteroids for more severe inflammation

These treatments aim to quickly control the inflammatory response and alleviate symptoms. However, it’s crucial to use corticosteroids judiciously due to potential side effects, especially with long-term use.

Are there alternative treatments for chronic or recurrent uveitis in AS?

For patients with chronic or recurrent uveitis, or those who cannot tolerate corticosteroids, alternative treatment options may include:

• Immunomodulatory drugs such as methotrexate or mycophenolate mofetil
• Biologic agents like tumor necrosis factor (TNF) inhibitors, which can treat both AS and uveitis
• Localized treatments such as periocular or intraocular steroid injections
• In some cases, implantable steroid-releasing devices for long-term management

The choice of treatment depends on various factors, including the severity of uveitis, frequency of recurrence, and the patient’s response to previous treatments. A collaborative approach between rheumatologists and ophthalmologists is often necessary to optimize care for AS patients with uveitis.

Long-Term Management and Prognosis of Uveitis in Ankylosing Spondylitis

Managing uveitis in the context of ankylosing spondylitis is an ongoing process that requires vigilance and a comprehensive approach to care. While acute episodes can often be successfully treated, the chronic nature of AS means that patients may face recurrent bouts of eye inflammation throughout their lives.

What strategies can AS patients employ for long-term eye health?

Long-term management of uveitis in AS involves several key strategies:

• Regular eye examinations, even during periods of remission
• Prompt reporting of any new eye symptoms to healthcare providers
• Adherence to prescribed treatments for both AS and uveitis
• Lifestyle modifications, such as wearing sunglasses to reduce light sensitivity
• Smoking cessation, as smoking can exacerbate both AS and uveitis
• Stress management techniques, as stress may trigger flare-ups
• Maintaining overall health through diet, exercise, and adequate sleep

By implementing these strategies, patients can significantly improve their prognosis and quality of life. It’s important to note that each individual’s experience with AS and uveitis is unique, and management plans should be tailored accordingly.

Can uveitis lead to permanent vision loss in AS patients?

While uveitis can potentially cause vision loss if left untreated, prompt and appropriate management significantly reduces this risk. The prognosis for most AS patients with uveitis is generally good, especially with early intervention and consistent follow-up care. However, complications such as cataracts, glaucoma, or macular edema can occur, particularly in cases of chronic or recurrent uveitis.

Regular monitoring and proactive treatment can help prevent or manage these complications effectively. Patients should work closely with their healthcare team to develop a comprehensive care plan that addresses both their AS symptoms and eye health.

Emerging Research and Future Directions in AS-Related Uveitis

The field of rheumatology and ophthalmology continues to evolve, with ongoing research shedding new light on the complex relationship between ankylosing spondylitis and uveitis. These advancements are paving the way for more targeted and effective treatments, as well as improved diagnostic techniques.

What are some promising areas of research in AS-related uveitis?

Several exciting avenues of research are currently being explored:

• Genetic profiling to identify individuals at higher risk of developing uveitis
• Novel biologic therapies that target specific inflammatory pathways
• Microbiome-based interventions to modulate the gut-eye axis
• Advanced imaging techniques for earlier detection of eye inflammation
• Personalized medicine approaches to tailor treatments based on individual patient characteristics

These research directions hold promise for improving outcomes for AS patients with uveitis. As our understanding of the underlying mechanisms deepens, we may see more targeted and effective treatment options emerge in the coming years.

How might future treatments for AS-related uveitis differ from current approaches?

Future treatments for AS-related uveitis may focus on:

1. Precision medicine: Tailoring treatments based on an individual’s genetic profile and specific inflammatory markers
2. Combination therapies: Using multiple targeted treatments to address different aspects of the disease process
3. Localized drug delivery: Developing new methods to deliver medications directly to the eye, minimizing systemic side effects
4. Immunomodulation: Fine-tuning the immune response to prevent uveitis without compromising overall immune function
5. Regenerative therapies: Exploring the potential of stem cells or growth factors to repair eye damage caused by chronic inflammation

As research progresses, these approaches may revolutionize the management of uveitis in AS patients, potentially reducing the frequency of flares and improving long-term outcomes.

How It Can Affect Your Eyes

Written by Linda Rath

• What Is Uveitis?
• Why People With AS Get It
• Symptoms
• Treatments

Ankylosing spondylitis (AS) is a type of arthritis. It causes pain and stiffness, mainly in your spine. But it can also cause eye inflammation called uveitis. Left untreated, uveitis can harm your vision and, in some cases, lead to blindness.

Uveitis is a large group of inflammatory eye diseases. It gets its name from the fact that these diseases mostly strike the uvea, the middle part of your eye. But uveitis can show up almost anywhere inside the eye.

Doctors usually describe uveitis based on where you have it:

Anterior uveitis (also called iritis) happens in the front part of your eye. That includes the iris, the colored part. It’s the most common type of uveitis for people with AS. If it’s not treated, anterior uveitis can lead to cataracts, glaucoma, or a buildup of fluid called retinal edema.

Intermediate uveitis is in the vitreous. That’s the big, fluid-filled space in your eye attached to your retina, a layer of cells that sense light and send signals to your brain.

Posterior uveitis (also called choroiditis) attacks the back of your eye. It may affect your retina and your optic nerve, which connects your eye to your brain.

Panuveitis affects all parts of your eye. It’s the most severe type. It can cause blindness if it’s not treated.

About half of people with ankylosing spondylitis have uveitis at least once. It’s one of the most common complications of that form of arthritis.

Your eye doctor could actually be the first to figure out you have AS. That’s because the same inflammation that makes your back hurt can also cause inflammation in your eyes and other parts of your body.

Some experts think the inflammation starts in a place you might not think of: your gut.

It’s home to trillions of tiny organisms called microbes. They perform so many vital functions that you can’t live without them. One of their main jobs is to control your immune system. When the microbes get out of whack, your immune system does, too.

Uveitis may start when gut bacteria tell immune cells called T cells to attack your eyes. But that’s probably not the whole story. Many people with AS and anterior uveitis have a gene called HLA-B27. This gene makes eye inflammation much more likely.

Keep an eye out for:

• Redness
• Pain
• Blurred vision
• Sensitivity to bright light

These symptoms can come on quickly in one or both eyes. Sometimes uveitis is a one-time thing. In other cases, you may go years between flares. In still others, it can also be long-lasting and need ongoing treatment.

The goal of uveitis treatment is to ease inflammation fast. For anterior uveitis, doctors usually prescribe two types of eye drops:

• Steroid drops to lower inflammation
• Drops that widen your pupil to ease pain

For other types of uveitis, you may need steroid pills or shots around your eyes. Sometimes doctors implant a steroid capsule inside your eye.

Steroids can cause serious side effects, including eye diseases like glaucoma and cataracts. Usually, you won’t use steroids for more than 3 months. As you taper off them, your doctor may start you on another medicine.

Some experts think a change in gut bacteria can ease uveitis. You might try:

Probiotics. These are live, friendly bacteria. You find them in yogurt and other fermented foods. They’re in supplements, too.

Prebiotics. These plant fibers feed healthy bacteria in your gut and make them stronger. You can find them in foods like bananas and onions.

Supplements for gut health like butyrate are another option. A diet that’s mostly plant-based could also help.

Talk with your doctor to find out which treatment might work best for you.

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Why Ankylosing Spondylitis Causes Eye Pain – Cleveland Clinic

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that typically affects your lower back.

While those who have AS may experience stiffness, fatigue and pain, the autoimmune condition can also cause eye inflammation known as uveitis.

Rheumatologist Ahmed Elghawy, DO, explains why you may experience eye problems and what treatments are available.

Why does AS cause eye pain?

The short answer is: Doctors aren’t entirely sure.

“With autoimmune conditions like ankylosing spondylitis, your body is acting inappropriately against its own tissue,” explains Dr. Elghawy. “We think this is also the case when it comes to uveitis. There may have been some sort of pathogen that could have led to the body recognizing a self-antigen instead of the pathogen. The body makes the mistake of attacking itself.”

There may also be a link between a certain gene known as HLA-B27 that’s common in both ankylosing spondylitis and uveitis.

Between 25% to 35% of individuals with ankylosing spondylitis will go on to develop some sort of uveitis.

There are different types of uveitis:

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• Anterior uveitis. This affects the front part of your eye, including your iris. About 90% of people with AS will develop this type.
• Posterior uveitis. The back part of your eye is affected, including your retina and optic nerve.
• Intermediate uveitis. This type attacks your vitreous, the clear fluid between your lens and retina.
• Panuveitis. This type affects every part of your eye. It’s the most severe type.

“The longer the patient has ankylosing spondylitis, the more likely they are to develop uveitis,” says Dr. Elghawy.

Uveitis symptoms

Uveitis typically only affects one eye at a time; though, it’s possible to have symptoms in both eyes at once.

If you have uveitis, you may experience the following symptoms:

• Redness.
• Swelling.
• Inflammation.
• Pain.
• Blurred vision.
• Sensitivity to light.
• Increased floaters or spots in your vision.
• Decreased vision.

“In people who are older, uveitis increases the risk of developing cataracts or glaucoma or making those conditions worse,” says Dr. Elghawy.

Treating eye pain and AS

If not treated, uveitis can harm your vision and could potentially lead to blindness.

“We recommend that those who have eye issues at all, especially who already carry a diagnosis of ankylosing spondylitis, that they let their doctor know immediately because it needs to be it needs to be addressed quickly,” emphasizes Dr. Elghawy.

Your doctor will not only treat uveitis, but will also treat your ankylosing spondylitis. In many cases, your rheumatologist may suggest you see an ophthalmologist, too.

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Treatment options for uveitis may include anti-inflammatory eye drops or eye drops with corticosteroids.

Treatments options for AS can include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Either an over-the-counter or prescription NSAID can work as an anti-inflammatory and help with other symptoms as well.
• Disease-modifying anti-rheumatic drugs (DMARDs). This type of drug can also help control your overactive immune system and help with symptoms.
• Corticosteroids. To help temporarily ease joint pain and inflammation, your doctor may recommend an injection of corticosteroids.

Often, the biologic therapies used for ankylosing spondylitis also address uveitis.

“A common scenario would be a person who has low back pain and was treated with prescription or over-the-counter NSAIDs. They’re doing well, but later they develop eye issues, and then, that’s what kind of prompts us to start the biologic therapy,” explains Dr. Elghawy. “There are other individuals who are on biologic therapy who never go on to develop uveitis and that’s probably because they’re already being treated with the biologic therapy.”

And don’t overlook the importance of regular eye exams, says Dr. Elghawy.

“Sometimes, you may find evidence of uveitis during a typical eye exam, even before you have symptoms,” he adds. “So, it’s important if you do have evidence of uveitis, it’s treated properly to prevent the long-term consequences.”

Ankylosing spondylitis – what is it

The official international name of the disease is ankylosing spondylitis. The term Bechterew’s disease 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 (attachments of ligaments and tendons to bones). The difference between the disease and other spondyloarthritis lies in the fact that ankylosing (fusion) of the vertebrae among themselves occurs, as a result, the spine can turn into a single bone and deform. The quality of life in this disease is significantly reduced. The second severe complication of Bechterew’s disease is damage to the hip joints, up to a complete loss of mobility and disability.

Why does this disease occur?

The exact cause of the disease is unknown. According to one hypothesis, certain intestinal microbes can trigger pathological inflammation in entheses and joints. For the appearance of a disease, it is not enough to get a certain infection into 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 Bechterew’s disease is back pain. This pain has a number of characteristic features (the so-called “inflammatory back pain”). It increases with prolonged immobility, including during nocturnal sleep, and decreases with motor activity. Pain of an inflammatory nature is 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 have pain in the calcaneus or Achilles tendon attachments.

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 “posture of the supplicant” is formed.

Often, patients report pain, limited mobility and swelling in peripheral joints, such as the shoulder, hip, small joints of the hands and feet, temporomandibular.

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

Associated conditions include the presence of psoriasis, inflammatory bowel disease, intestinal or genitourinary infections.

Depending on the area where inflammation develops, 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 enthesis).

Laboratory diagnostics plays a significant role. 90% of patients with ankylosing spondylitis are carriers of the HLA B-27 gene. This is a genetically determined leukocyte antigen, which is associated with the possibility of developing an autoinflammatory reaction. 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 Bechterew’s disease, but it is not easy to recognize the disease. Much depends on the qualifications of the rheumatologist.

Treatment of ankylosing spondylitis

Drug treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, naproxen, nimesulide, etoricoxib, ketoprofen, aceclofenac, meloxicam, etc. are the mainstay of treatment. They can inhibit ankylosing of the spine , reduce the inflammatory response , improve the prognosis of the development of the disease, increase the range of motion and at the same time can be used as painkillers. 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 inhibitors of tumor necrosis factor

Surgical treatment

Surgical treatment may be required to correct conditions associated with a complication of the course of the disease, such as severe spinal deformities, vertebral fractures, destruction of the hip joints, and heart damage.

Physiotherapy

Physiotherapeutic methods can be used to relieve pain: massage, acupuncture and other methods. Their disadvantage is that they do not give a long-term sustainable effect. Physiotherapy is not included in the official recommendations for the treatment of Bechterew’s disease.

Exercise therapy

Regular physical exercise in addition to the main therapy helps to maintain mobility in the joints. Especially recommended exercises to strengthen the muscles of the back.

Prevention

The causes of the development of the disease have not been reliably established, therefore, special prevention has not been developed.

General recommendations would be to maintain an active lifestyle while trying to avoid spinal and joint injuries, refraining from smoking, eating a Mediterranean diet is preferable..

Diagnosis and treatment at EMC

Thanks to a wide range of diagnostic methods and modern technologies, the majority of 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 arrange a remote consultation.

Bechterew’s disease: possible complications | Clinical Diagnostic Center

“Bekhterev’s disease”: possible complications / Interview with Anna Okhotnikova, 24-hour hospital rheumatologist at the BUZOO “CDC” dorsal joints, which can proceed simultaneously with the defeat of peripheral joints, entheses and internal organs. Anna Okhotnikova, a rheumatologist at the CDC round-the-clock hospital, talks about the symptoms of the disease and its various consequences for the body:

Clinical manifestations of spondyloarthritis are varied, they appear gradually, sometimes imperceptibly for the patient, long spontaneous remissions are often observed at the onset of the disease. Ankylosing spondylitis most often begins with inflammatory back pain (in 75-85% of cases) and peripheral arthritis (in 15-25% of cases)

The following symptoms are characteristic of the onset of ankylosing spondylitis:

Deep-seated pain in the spine associated with restriction of movement in the lumbar

Morning stiffness of the spine that disappears during the day.

The central place in the clinical picture is occupied by the lesion of the axial skeleton (spine, pelvis, hip, shoulder and mandibular joints).

Criteria for inflammatory back pain are:

slow (creeping) onset extending over weeks

nocturnal pain better on waking

better with exercise

worse during sleep and at rest .

Inflammatory pain reflexively causes muscle spasm, which contributes to the development of stiffness of the spine. In the early stages of the disease, the restriction of movements in the spine is due to inflammation and painful spasm of the muscles of the back, in the later stages – mainly ossification of the spine.

If the thoracic spine, costovertebral joints are affected, there is pain in the chest, sometimes encircling, aggravated by coughing, deep breathing, turning the torso. As a result of damage to the costovertebral joints, the respiratory excursion of the chest decreases, while the respiratory function is compensated by the diaphragm.

Damage to the joints of the anterior chest wall (sternoclavicular, sternocostal, manubrium and body of the sternum) can be observed at any stage of the disease. Arthritis of the joints of the anterior chest wall occurs in ankylosing spondylitis in 17% of cases. Symptoms can range from mild soreness to severe, firm swelling.

Involvement of the cervical spine occurs at a later stage of the disease. Initially, pain appears, the range of motion of the neck gradually decreases: rotation and inclinations are limited. In some cases, complete ankylosis of the cervical spine occurs with absolute immobility of the head and neck. Spondylitis of the cervical spine may result in dyscirculatory encephalopathy, accompanied by dizziness, nausea, and headache.

Peripheral joint involvement can occur at any stage of the disease and is sometimes one of the first symptoms. In more than 50% of patients, peripheral joints are involved in the process, including the hip and shoulder joints. Peripheral arthritis can be either a temporary manifestation of the disease and pass without a trace, or a frequently recurring manifestation leading to a permanent dysfunction of the joint. Large and medium joints of the lower extremities (hip, knee, ankle) are predominantly involved, arthritis of individual joints of the toes is possible, temporomandibular joints may be affected.

A special variant of arthritis in this disease is damage to the hip joint (coxitis). It develops in about 1/3 of patients with ankylosing spondylitis; in adults, coxitis develops in the first 10 years of the disease. It is manifested by pain in the inguinal region, which can radiate along the anterior and lateral surface of the thigh, to the buttocks, and the anterior surface of the lower leg. It is possible to identify asymptomatic x-ray changes in the hip joints.

In addition to pain in the joints, there are also pains in the bones. We are talking about inflammation of those places where the tendons are attached to the bones. The very first symptoms of Bechterew’s disease are sometimes pains in the heels, which make standing on a hard floor very unpleasant. Inflammation of the attachment of the tendons at the ischium makes sitting on hard chairs unpleasant. Other tendon attachments may also be affected. Inflammation of the tendon attachments is so characteristic of Bechterew’s disease that, together with other characteristic signs, they can even be considered as a diagnostic criterion.

Bechterew’s disease is a “systemic disease”. The erroneous functioning of the immune system can also manifest itself in other organs, not only in the spine. General clinical manifestations of the disease:

fever in the evening not higher than 37.5 C, lethargy, weight loss with preserved appetite, fatigue.

EYES. Approximately 40% of patients develop eye inflammation at one or more times in their lives. We are talking about iritis (inflammation of the iris). If, in addition to the iris, the adjacent areas of the eye also become inflamed, the doctor speaks of iridocyclitis or uveitis. The eye hurts (especially with large changes in brightness, at which the pupil should constrict), becomes sensitive to pressure and reddens.

HEART. Pathology from the side of the heart occurs more often, the longer the disease lasts and the more severe it is. After a 15-year duration of the disease, 3.5%, and after a 30-year duration, 8-10%. Inflammatory changes in the heart caused by Bechterew’s disease develop where the aorta exits the heart. They can lead to heart valve failure (the valve no longer closes properly and blood flows back into the heart with every heartbeat). But inflammation can also block nerve regulation between the atrium and the main chamber and lead to abnormal heart rhythms. To avoid these unpleasant complications, it is important for patients to eliminate or reduce risk factors such as smoking, high blood pressure, being overweight, and lack of exercise.

LIGHT. Lung function is maintained through abdominal breathing, even with complete ossification of the costal joints. But the volume of breathing can be severely limited. In about 15% of patients, this results in upper lung fibrosis (an overgrowth of the connective tissue in the lung), which makes it easier for bacteria and fungi to infect the lungs. The countermeasure against this side effect (along with stopping smoking as a risk factor) is to maintain as much breathing volume as possible, which can be achieved with the help of breathing exercises and physical training.

KIDNEYS and LIVER. Due to inflammatory processes in almost all organs, there is a deposition of protein molecules, which is called amyloid. In the late stage, the lack of volume of the kidneys and liver can limit the function of these organs. Then they talk about amyloidosis. It is treated with diet and cortisone-containing drugs. Amyloidosis is a compelling reason to use these drugs despite their side effects.

NERVOUS SYSTEM. Rarely, but still, complications in the nervous system occur in the late stage of ankylosing spondylitis.