Treatment of Ankylosing Spondylitis in a sanatorium

Bechterew's Disease

Ankylosing spondylitis (Bechterew's disease) is a chronic inflammatory disease primarily affecting the musculoskeletal system, especially the intervertebral joints of the spine, shoulder joints, sacroiliac joints, and hip joints. Inflammation of the spinal joints leads to their fusion (ankylosis), which results in significant limitation of mobility. The prevalence of Bechterew’s disease varies across countries, ranging from 0.5% to 2% of the population. Men between the ages of 20 and 40 are most at risk. The male-to-female ratio among affected individuals is approximately 9:1.

Causes of the Disease

The likely cause of Bechterew’s disease is genetic predisposition — specifically, a hereditary feature associated with the HLA-B27 antigen. Chronic infections, particularly those affecting the urinary tract and intestines, can act as triggers for the disease. Genital and intestinal infections, repeated stress, and trauma to the musculoskeletal system also significantly increase the risk of developing the condition. Notably, about 90% of patients suffering from Bechterew’s disease carry the HLA-B27 antigen, which is also associated with other rheumatic diseases.

Symptoms and Diagnosis

Patients often first encounter symptoms of Bechterew’s disease through pain and swelling in the lower limbs, and pain in the lumbosacral region — especially at night. In its chronic stage, the disease causes early ossification (bone formation) of tendons and ligaments, leading to stiffness of the spine and a characteristic posture. The cardiovascular and nervous systems, as well as the kidneys, may also be affected. Patients commonly develop difficulty breathing deeply, and blood test results show abnormalities.

Diagnosis at later stages of the disease usually presents no difficulties. Unfortunately, the main problem for patients suffering from ankylosing spondylitis is late medical consultation. At the same time, it is very important not only to detect the disease as early as possible but also to correctly identify its key causes. What symptoms might strongly indicate the onset and progression of Bechterew’s disease?

First of all, patient-reported symptoms should raise suspicion:

• Stiffness and pain in the sacroiliac joint area (sometimes radiating to the legs and buttocks), worsening during the second half of the night;
• Persistent heel pain in younger individuals;
• Stiffness and pain in the thoracic spine.

It is very important to obtain X-ray data of the sacroiliac joints, analyze blood tests for the presence of the HLA-B27 antigen, and check ESR levels (which may reach 30–40 mm/h or higher, indicating inflammation). If these symptoms persist for at least three months, immediate consultation with a rheumatologist is necessary.

Over time, external manifestations of the disease become increasingly pronounced. This includes progressive limitation of spinal mobility, painful and difficult bending sideways, backward, and forward, and shortening of the spine. Coughing, sneezing, and deep breathing may provoke pain. Immobility and rest tend to intensify pain and stiffness, while moderate physical activity and movement help alleviate them. Neglecting the progressively worsening symptoms may eventually lead to complete immobility of the spine ("bamboo spine"), resulting in a stooped posture with a bent head, elbows flexed, and knees slightly bent — the so-called "beggar's posture."

Treatment Approach

Treating Bechterew’s disease is typically a long-term, complex, and multi-stage process. Glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used; in advanced cases, immunosuppressants may be prescribed. Physiotherapy, therapeutic exercise, and manual therapy have proven effective in managing the condition. Recommended are twice-daily sessions of therapeutic gymnastics lasting 30 minutes each. The set of exercises must be individually tailored by a specialist. A key factor in achieving stable positive outcomes is teaching the patient muscle relaxation techniques and deep breathing. In the early stages, proper fixation of the spine is crucial. Swimming, cross-country skiing, and sleeping on a firm bed without a pillow are also recommended to strengthen the muscles of the back and hips.

Although the disease is progressive, with qualified treatment its progression can be effectively controlled. Therefore, patients diagnosed with ankylosing spondylitis are strongly advised to remain under the constant supervision of a rheumatologist and undergo periodic courses of comprehensive therapy aimed at reducing pain and improving spinal mobility in a hospital setting when necessary.

Treatment of Bechterew’s Disease at Berezoviy Gai Sanatorium

Our sanatorium is fully equipped for the accurate diagnosis and subsequent treatment of musculoskeletal disorders such as Bechterew's disease, spondylolisthesis, plexitis, sciatica, and others. Our guests enjoy comfortable accommodations, a warm and professional medical and support staff, and access to state-of-the-art diagnostic equipment.