How does ankylosing spondylitis affect your eyes. What are the symptoms of uveitis in AS patients. What treatments are available for AS-related eye problems. How can you manage eye inflammation caused by ankylosing spondylitis. Why do people with AS develop uveitis. What is the connection between gut health and uveitis in AS. How can diet impact eye health in ankylosing spondylitis patients.

The Link Between Ankylosing Spondylitis and Eye Inflammation

Ankylosing spondylitis (AS) is a type of inflammatory arthritis primarily affecting the spine. However, its impact extends beyond joint pain and stiffness. One of the most significant complications of AS is eye inflammation, known as uveitis. This condition can have serious consequences for vision if left untreated, potentially leading to blindness in severe cases.

Uveitis refers to a group of inflammatory eye diseases that primarily affect the uvea, the middle layer of the eye. However, inflammation can occur in various parts of the eye, leading to different classifications of uveitis:

• Anterior uveitis (iritis): Affects the front part of the eye, including the iris
• Intermediate uveitis: Involves the vitreous, the fluid-filled space attached to the retina
• Posterior uveitis (choroiditis): Affects the back of the eye, potentially impacting the retina and optic nerve
• Panuveitis: Involves all parts of the eye and is the most severe form

Approximately half of all AS patients experience uveitis at least once in their lifetime, making it one of the most common complications of this form of arthritis. In some cases, an eye doctor may be the first to suspect AS, as the same inflammatory processes causing back pain can also lead to eye inflammation.

The Role of Gut Health in AS-Related Eye Inflammation

Recent research suggests that the inflammation associated with AS and uveitis may originate in an unexpected place: the gut. The human gut is home to trillions of microorganisms collectively known as the microbiome. These microbes play a crucial role in regulating the immune system. When the balance of gut bacteria is disrupted, it can lead to immune system dysfunction.

How does gut health influence eye inflammation in AS patients? Some experts believe that certain gut bacteria may trigger immune cells called T cells to attack the eyes. This theory is supported by the observation that many people with AS and anterior uveitis carry a specific gene called HLA-B27, which is associated with an increased risk of eye inflammation.

Promoting Gut Health for Eye Protection

Given the potential link between gut health and uveitis, some researchers suggest that modifying the gut microbiome may help alleviate eye inflammation. Strategies to improve gut health include:

• Consuming probiotics: Live, beneficial bacteria found in yogurt and fermented foods
• Incorporating prebiotics: Plant fibers that nourish healthy gut bacteria, found in foods like bananas and onions
• Taking gut health supplements: Such as butyrate
• Adopting a plant-based diet: May help promote a healthy gut microbiome

While these approaches show promise, it’s essential to consult with a healthcare provider before making significant dietary changes or starting new supplements.

Recognizing the Symptoms of Uveitis in AS Patients

Early detection and treatment of uveitis are crucial for preserving vision in AS patients. Being aware of the symptoms can help individuals seek prompt medical attention. Common signs of uveitis include:

• Redness in one or both eyes
• Eye pain
• Blurred vision
• Increased sensitivity to bright light

These symptoms often develop rapidly and can affect one or both eyes. The frequency and duration of uveitis episodes can vary among individuals. Some may experience a single occurrence, while others may have recurrent flares separated by years of remission. In some cases, uveitis can become chronic, requiring ongoing treatment.

Treatment Options for AS-Related Eye Inflammation

The primary goal of uveitis treatment is to quickly reduce inflammation and prevent potential complications. The choice of treatment depends on the type and severity of uveitis, as well as the individual patient’s needs.

Anterior Uveitis Treatment

For anterior uveitis, the most common type in AS patients, doctors typically prescribe two types of eye drops:

1. Steroid drops: To reduce inflammation
2. Pupil-dilating drops: To alleviate pain and prevent the iris from sticking to the lens

Treatment for Other Types of Uveitis

More severe or persistent cases of uveitis may require additional treatments, such as:

• Oral steroid medications
• Steroid injections around the eye
• Implantation of a steroid-releasing capsule inside the eye

It’s important to note that long-term steroid use can lead to serious side effects, including an increased risk of glaucoma and cataracts. Therefore, steroid treatments are typically limited to three months or less. As patients taper off steroids, doctors may introduce alternative medications to manage inflammation.

The Genetic Component: HLA-B27 and Its Role in AS-Related Uveitis

The HLA-B27 gene plays a significant role in the development of both ankylosing spondylitis and uveitis. This genetic marker is present in a large proportion of AS patients who experience eye inflammation. Understanding the connection between HLA-B27 and uveitis can help healthcare providers better assess an individual’s risk and develop appropriate monitoring and treatment strategies.

HLA-B27 and Increased Uveitis Risk

Individuals who carry the HLA-B27 gene are at a higher risk of developing uveitis, particularly anterior uveitis. While the exact mechanism is not fully understood, researchers believe that this gene influences the immune system’s response to certain triggers, leading to increased inflammation in both the joints and the eyes.

Genetic Testing and Its Implications

Genetic testing for HLA-B27 can provide valuable information for AS patients and their healthcare providers. A positive result may indicate an increased likelihood of developing uveitis, prompting more frequent eye examinations and closer monitoring. However, it’s important to note that not all HLA-B27 positive individuals will develop uveitis, and conversely, some HLA-B27 negative patients may still experience eye inflammation.

The Importance of Regular Eye Examinations for AS Patients

Given the high prevalence of uveitis among AS patients, regular eye examinations are crucial for early detection and prompt treatment of eye inflammation. These check-ups can help prevent vision loss and other complications associated with untreated uveitis.

Recommended Frequency of Eye Exams

The frequency of eye examinations may vary depending on individual risk factors and previous history of uveitis. Generally, AS patients should have their eyes examined:

• Annually for those without a history of uveitis
• Every 3-6 months for those with a history of uveitis or who are HLA-B27 positive
• Immediately if any symptoms of eye inflammation develop

What to Expect During an Eye Examination

During a comprehensive eye exam for AS patients, an ophthalmologist will typically:

1. Assess visual acuity
2. Examine the external and internal structures of the eye
3. Measure intraocular pressure
4. Evaluate the optic nerve and retina
5. Perform additional tests if uveitis is suspected

These examinations can detect early signs of inflammation, allowing for timely intervention and prevention of vision-threatening complications.

Managing AS-Related Eye Inflammation: A Multidisciplinary Approach

Effectively managing eye inflammation in AS patients often requires a collaborative effort between rheumatologists, ophthalmologists, and other healthcare professionals. This multidisciplinary approach ensures comprehensive care that addresses both joint and eye symptoms.

Coordinated Care for Optimal Outcomes

A coordinated care strategy may involve:

• Regular communication between rheumatologists and ophthalmologists
• Shared decision-making regarding treatment plans
• Monitoring of both systemic and ocular inflammation
• Adjustment of medications to manage both joint and eye symptoms
• Patient education on the importance of adherence to treatment and follow-up appointments

The Role of Biologics in Managing AS and Uveitis

Biologic medications, particularly tumor necrosis factor (TNF) inhibitors, have shown promise in managing both AS symptoms and associated uveitis. These drugs work by targeting specific components of the immune system responsible for inflammation. Some commonly prescribed biologics for AS patients with recurrent uveitis include:

• Adalimumab (Humira)
• Infliximab (Remicade)
• Golimumab (Simponi)

The choice of biologic therapy depends on various factors, including the severity of AS symptoms, frequency of uveitis flares, and individual patient characteristics. Close monitoring is essential to assess the effectiveness of these medications and manage any potential side effects.

Lifestyle Modifications to Support Eye Health in AS Patients

In addition to medical treatments, certain lifestyle modifications can help support eye health and potentially reduce the risk of uveitis flares in AS patients. These changes can complement existing treatment plans and contribute to overall well-being.

Dietary Considerations

While there is no specific diet proven to prevent uveitis, some dietary choices may help reduce inflammation throughout the body, potentially benefiting both joint and eye health:

• Incorporate omega-3 fatty acids: Found in fatty fish, flaxseeds, and walnuts
• Increase antioxidant-rich foods: Such as berries, leafy greens, and colorful vegetables
• Reduce processed foods and refined sugars: Which may contribute to inflammation
• Consider the Mediterranean diet: Known for its anti-inflammatory properties

Stress Management

Chronic stress can exacerbate inflammation and potentially trigger uveitis flares. Implementing stress-reduction techniques may help manage both AS symptoms and eye health:

• Practice mindfulness meditation
• Engage in regular, gentle exercise such as yoga or tai chi
• Ensure adequate sleep and rest
• Consider cognitive-behavioral therapy to develop coping strategies

Environmental Factors

Protecting the eyes from environmental stressors may help reduce the risk of inflammation:

• Wear UV-protective sunglasses when outdoors
• Use artificial tears to keep eyes lubricated, especially in dry or windy conditions
• Avoid smoking and limit exposure to secondhand smoke
• Maintain good eye hygiene, including regular hand washing

By incorporating these lifestyle modifications alongside medical treatments, AS patients can take a proactive approach to maintaining their eye health and potentially reducing the frequency and severity of uveitis flares.

Future Directions in AS-Related Eye Inflammation Research

As our understanding of the connection between ankylosing spondylitis and eye inflammation continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and prevention of uveitis in AS patients. These emerging areas of study hold promise for improving outcomes and quality of life for those affected by this condition.

Biomarkers for Early Detection

Scientists are investigating potential biomarkers that could indicate an increased risk of uveitis in AS patients. These molecular indicators could allow for earlier intervention and more targeted treatments. Some areas of focus include:

• Genetic markers beyond HLA-B27
• Inflammatory proteins in blood or tear samples
• Alterations in the gut microbiome composition

Novel Therapeutic Approaches

Research into new treatment modalities for AS-related uveitis is ongoing, with several promising approaches under investigation:

• Targeted immunotherapies: Drugs that selectively modulate specific components of the immune system
• Local drug delivery systems: Methods to deliver medications directly to the eye, reducing systemic side effects
• Combination therapies: Strategies that combine different treatment modalities for enhanced efficacy
• Gut microbiome modulation: Interventions aimed at altering the gut microbiome to influence immune function

Personalized Medicine Approaches

The future of AS and uveitis management may lie in personalized medicine, where treatments are tailored to an individual’s genetic profile, immune system characteristics, and other factors. This approach could lead to more effective treatments with fewer side effects.

As research in these areas progresses, AS patients can look forward to potentially more effective and less invasive methods for managing eye inflammation. However, it’s important to remember that the development and validation of new treatments take time, and patients should continue to work closely with their healthcare providers to manage their condition using currently available therapies.

In conclusion, the relationship between ankylosing spondylitis and eye inflammation is complex, involving genetic, immunological, and environmental factors. By understanding the mechanisms behind AS-related uveitis, recognizing its symptoms, and adhering to appropriate treatment and monitoring strategies, patients can significantly reduce their risk of vision-threatening complications. As research continues to advance, the outlook for managing this challenging aspect of AS continues to improve, offering hope for better outcomes and improved quality of life for those affected by this condition.

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.