Ankylosing spondylitis

Ankylosing spondylitis Ankylosing spondylitis
Is a chronic inflammatory diseases that affect the joints and tendons and ligaments when they relate to the bone, which primarily affects the joints pivot, which include spine, sacroiliac joints sacroiliac joints, which cause adhesion paragraphs, may include peripheral joints.


Pathophysiology:

Inflammation placements adhesion ligaments and tendons bone is the process sick first, and bone growth interactive, which grows with each new bout occur, and unrest have structural primarily, and a premium spine ankylosis of the spine, and the inclusion of joints thigh, knees, and incidentally may include small joints , may also cause inflammation of the plantar fascia plantar fasciitis.

And problems outside the bone associated with ankylosing spondylitis may include uveitis iritis, and uveitis uveitis, and inflammation of the aorta aortitis, and lung fibrosis pulmonary fibrosis, and amyloidosis amyloidosis, and inflammatory bowel disease inflammatory bowel disease, and neurological complications are subluxation of the vertebrae cervical first and second, and the tendency for fractures cervical paragraphs as a result of any minor trauma, spinal crush spinal stenosis in the cervical spine and lumbar, and chronic inflammation, and cauda equina syndrome cauda equina syndrome, and poor nerve roots radiculopathy due to a fracture or compression.

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Rates of the disease:
Generally Valasabh represent about 1.4% of the population.

Relationship of the disease to sex:
Incidence in male to female is about 3 to 1.

Relationship of the disease by age:
Up injuries to peak between the ages of 15 to 30 years, and no pattern affects events.

Symptoms:

The disease at the age of tens and twenties, and large joints of the lower party covered the disease is common in the style that affects events for coverage in the style that affects adults.

Patient usually describes the gradual start of lower back pain for 3 months or more, and the pain can be described as follows:

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Be severe in the morning and improves during the day.

Improves with activity and increases with comfort.

Pain is his style gradually rising from the bottom to the top, of the cervical spine to the thoracic spine and then to the cervical spine.

About 25% of patients initially complain of pain near joints of the body, and rarely a patient complains of pain the small joints.

The patient may describe the pain and stiffness ribs of the rib cage.

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Tags:
The presence of pain when pressure on the sacroiliac joints, and loss of normal lumbar lordosis lumbar lordosis, and the presence of a limited range of movement cotton.

In the early stages of the disease may be the extent to which the movement due to muscle spasm, but in the end be due to the integration of the bone.

A restriction on the expansion of the chest.

Range of motion for each paragraphs be restricted, and when you do not treat chronic conditions increased thoracic kyphosis thoracic kyphosis, and the resulting situation makes the patient can not look to the horizon.

Joints that are injured topped with sharp color purple.



Reasons:


The onset of the disease and increase the intensity suddenly may be the result of environmental factors are not well understood.

Supposed to benign microbes or viruses, similar to antigenically joints ligaments in humans, may be among the causes of the disease.

When people who are predisposed, may alert a simple infection abnormal immune response.

Tests:
Laboratory tests:
There may be anemia low-grade chronic diseases.

Results of analyzes of antinuclear antibodies (ANA), and rheumatoid factor (RF), are in the normal range.

C-reactive protein c-reactive protein could increase with the increase in disease activity, but not the best indicator of the speed of sedimentation.

Alkaline phosphatase blood serum alkaline phosphatase may rise in the time in which it occurs active reformulation of bone active bone remodeling.

Be human blood cell antigen - my 27 positive in 90-95% of the time, but it does not always exist, and its existence is not enough for diagnosis, and the role of this examination assistant when the diagnosis is not clear.

Cerebrospinal fluid proteins can occur by a simple increase during acute Altfaqmat.

Radiology tests:


Mini rays on the pelvis showing inflammation or merger of the joint sacroiliac.

Rays on the spine may show an ossification ossification Rabat anterior longitudinal anterior longitudinal ligament of the ligaments spine spinal ligaments, and a merger joints Wajihiya facet joints, and feel gives expression spine bamboo bamboo spine, however integration extends to paragraphs, it might be when the patient spine poker players.



CT scan shows the integration of the bone, and corroded plates eroded laminae and spinous process.

There may be a need to work MRI, to confirm the presence subluxation Gahqa pivotal, and may be required after trauma to evaluate the spinal cord, and the exclusion syndrome cauda equina, and epidural hematoma, may be acquired cauda equina inflammatory (and where the tunnel spinal spinal canal or natural with a large presence of diverticula diverticula of cerebrospinal fluid, which can be seen well MRI images), or stressful.

Other tests:
There may be a need to work suction means detailed joint aspiration to exclude septic arthritis septicarthritis.

In ankylosing spondylitis may reveal synovial fluid examination for the presence of the large number of leukocytes rates neutrophilic leukocytosis

Treatment:
Medical care:
Treatment includes the following principles:
Exercise and workouts.

Medicines to reduce pain and inflammation, and nonsteroidal anti-inflammatory non-steroidal are more treatments used, and lotion Asalafaslazen sulfasalazine be influential in treatment when coverage joints terminal, used as preparations steroids steroids and immunosuppressive, and injected steroids topically given respite from the symptoms of inflammation, giving anti-tumor necrosis (alpha) is a valuable recent addition to the treatment options, which when used quickly reduce symptoms and slow the progression of the disease, but their use is very expensive.

Diagnosis and treatment of potential complications.

Surgical Care:

Surgical treatment may be necessary for some complications inflammation ankylosing spondylitis.

Merger surgical surgical fusion may be required to install the partial dislocation axial Algahqa.

Need cervical spine fractures of the spine to install and is done through a collar halo, and in the past was not being surgical merger, and with the presence of neurological deficits recommended early surgical intervention to integrate work, which improves neurological deficit after surgery.

Surgery is rarely required to correct thoracic kyphosis others accompanied by complications, and in the case of the presence of functional damage, correct spinal deformity spinal deformity may be necessary, however, deaths after surgery as a result of various complications be about 4%.

Fractions paragraphs thoracic and lumbar need to reduce displacement and installation, which is usually using rods rods, and is rarely found a need for laminectomy laminectomy.

Relieve pressure restricting cervical or lumbar spinal be required when the disease include the neural structure.

When includes disease-bearing joints of the body weight, it may be the work of hip replacement or knee replacement is necessary, and the most common surgeries performed in these cases is a calendar of the joints.

Medical advice:
Patients who complain of eye pain, and vision change or increased secretion of tears, you should consult a specialist eye diseases for the evaluation and treatment of uveitis. And uveitis, and rule out other causes for these cases.

Chest pain may need further evaluation by a specialist heart disease, or a specialized disease of the lungs, and reflux aortic valve, which is accompanied bring heart heart block may need further treatment, and because cirrhosis summit lungs allows infected opportunism, the Care lungs are necessary.

Advice bone specialist or specialist neurological diseases will be required in the event of spinal trauma spinal trauma, or when there is persistent pain, or neurological deficits.

When the inclusion of disease-bearing joints of the body weight, or shoulder joint, or plantar fasciitis plantar fasciitis patient needs bone specialist advice

If there Inflammatory bowel disease patient needs the advice of a specialist in diseases of the digestive system.

Patient Activity:

The daily movements of the curvature and torsion, and the exercise of a nice range of athletic movements helps prevent disability status postural deformity, and reduce the range of motion of the joint.


Breathing exercises are important in preventing stop the movement of the chest wall.
Encourage the development of good sleep on a small pillow and mattress crusty, whether in a lying down on the back supine or المنبطح situation prone.

Complications:
Khula partial Algahqa pivotal atlantoaxial subluxation, may occur automatically and can be accompanied by impairment of spinal severe, which is located at about 20% of patients who have an average infection have 10 years, and myelopathy who needs merger surgical affects about 2% of patients.

Cervical fractures paragraphs are not uncommon, which is usually present when people with advanced cases, and arise as a result of minor trauma, and be between the cervical spine injury 5.6 or 6.7 cervical spine.

Myelopathy neck cervical myelopathy may arise as a result of tightening cervical spinal cervical spinal stenosis.

Thoracic fractures paragraphs and cotton, are less common than vertebral fracture neck, which usually arise due to minor trauma and may be multiple, and neurological deficit resulting severe and frequent.

Lumbar stenosis may give rise to a cauda equina syndrome.

Ill nerve roots radiculopathy may occur as a result of narrow holes foraminal stenosis, and intervertebral disc disease, and broken at the level of the nerve root.

Fate of the disease:
Pain and stiffness is common, and it may be moderate to severe intensity, and problems are few patients in social interaction, and depression is common.

Most patients continue in their jobs, and the number of relatively simple happen they have functional disability, and disability be linked to the duration of disease activity and the movement of the spine, and the inclusion of peripheral joints resulting in larger bug ........