SPONDYLARTHRITIS (Greek spondylos a vertebra + arthritis[es]) — an inflammation of intervertebral (dugootrostchaty) joints of various etiology.
As the isolated S.'s defeat meets seldom. More often S. represents one of clinical manifestations of the general diseases of a musculoskeletal system combined under the name of seronegative spondylarthrites i.e. S. at which rhematoid factor (see) in blood serum it is not found — Bekhterev's disease (see. Bekhtereva disease ), a disease of Reuters (see. Reuters disease ), psoriasis arthritis (see. Psoriasis ), etc., or specific infectious damages of a backbone. The information on seronegative S. supplied about damage of intervertebral joints at specific infections — see the relevant articles is provided in article (e.g., Brucellosis ; Tuberculosis extra pulmonary, tuberculosis of bones and joints etc.).
Etiology and pathogeny seronegative S. are opened insufficiently. Communication between incidence of these types of S. and existence of histocompatibility antigens (HLA) is revealed. HLA B27 antigen find in 80 — 90% of patients at prevalence it in the general population from 3 to 12%. Because seronegative S. have a number of the general a wedge, and rentgenol. the devil and at them is found B27 antigen, they are carried to «diseases of a circle of HLA B27». Important feature of carriers of B 27 antigen is the raised susceptibility to a number of activators intestinal (yersiniya, salmonellas, etc.) and urigenous (chlamydias, etc.) infections. The possibility of antigenic similarity between HLA B27 and nek-ry microorganisms is not excluded that causes a persistention of an infection and development of immune responses to tissues of joints. R. W. Ebringer and sotr. (1977, 1978) the possibility of cross-reactions between B27 antigen and Klebsiella pneumoniae antigens — the microorganism allocated from urine and a calla at patients with Bekhterev's disease in an active phase of a disease is shown. B27 antigen is a genetic marker of predisposition to S. and reflects communication with the genes determining features of an immune response at S. Sushchestvuyet also the point of view that B 27 antigen can be a receptor for yet not revealed activator (a virus or other external agent); it leads to formation of the complexes inducing immune responses.
Wedge, picture at seronegative S. it is quite similar and depends on prevalence and preferential localization patol. process. Almost obligatory simshtn the megohm is sacroileitis (see), developing, as a rule, in the first months of a disease. Pains in sacroiliac joints and various departments of a backbone, morning constraint, deformation of a backbone in the form of a smoothness of its physiological bends or strengthening chest are characteristic kyphosis (see) and cervical lordosis (see), tension of long muscles of a back. Further restriction of movements in a backbone up to its full immovability is quite often observed. For identification of restriction of movements in various departments of a backbone use a number of methods — Shober, Ott (see Bekhterev a disease). At a palpation are noted morbidity during the pressing on acanthas of vertebrae and juxtaspinal points in the affected intervertebral joints (see. Backbone ). Involvement in process of costovertebral joints leads to reduction of a respiratory excursion of a thorax. Therefore at sick S. it is reasonable to measure an excursion of a thorax and to watch dynamics of this indicator. For identification of a sacroileitis use a palpation, and also nek-ry special receptions (see. Sacroileitis ).
Seronegative S. in some cases are followed by damage of peripheral joints and various bodies and systems: eye (uveitis), aortas (aortitis), urinogenital system (urethritis, prostatitis), kidneys (amyloidosis), etc. S.'s current usually chronic, with the periods of remissions and aggravations and the general tendency to progressing which is the most expressed at Bekhterev's disease.
Diagnosis put on the basis of the anamnesis, clinic, datas of laboratory and rentgenol. researches. Is essential for S.'s diagnosis rentgenol. research. On the basis of usual roentgenograms, as a rule, it is impossible to make idea of a condition of intervertebral joints. Apply special laying of patients in so-called slanting projections to receiving their sharp image, at various extent of turn (from 15 to 55 °) around a longitudinal axis of a backbone. Essential help in assessment of a condition of intervertebral joints is given by a tomography (see) and a functional X-ray analysis (pictures at the maximum bending and extension of a backbone). At S. radiological find narrowing of cracks of intervertebral joints, and in the subsequent destruction of their joint surfaces and an ankilozirovaniye, disturbance of mobility in the struck segments of a backbone, occasionally — patol. shifts (incomplete dislocations) of vertebrae. Radiodiagnosis of a sacroileitis more is based on pictures at the same time of both sacroiliac joints in a direct projection; as the additional technique can be used the aim X-ray analysis of each joint separately made in slanting projections.
Changes a lab are characteristic. indicators of activity of inflammatory process (acceleration of ROE, emergence of S-reactive protein, increase in level of fibrinogen, etc.), especially at exacerbations of a disease.
Treatment The page is complex and is defined by character of a basic disease, activity patol. process and functional condition of a backbone. Non-steroidal anti-inflammatory drugs, especially indole are widely applied to seronegative S.' treatment (indometacin, etc.) and pyrazolon (Butadionum) derivatives; physiotherapeutic procedures, massage are carried out, to lay down. physical culture; it is shown a dignity. - hens. treatment. All system of medical and rehabilitation actions is planned for a long time in the conditions of dispensary observation for patients in view of S.'s tendency to a chronic current.
The physiotherapy exercises are carried out for the purpose of the prevention of disturbances of mobility in joints of a backbone, strengthening of muscles and the copular device, increase in static resilience of a backbone, improvement of function of external respiration and condition of cardiovascular system.
Sick S. shall be engaged constantly in LFK (remedial gymnastics, physical exercises, swimming in the pool, walking on skis, etc.). In the period of the expressed exacerbation of a disease of exercise carry out passively.
Feature of a technique of occupations are: performance of physical exercises in a dorsal decubitus, sitting on a chair or on a floor; for unloading of a backbone — in situation on all fours or standing at wall bars. At the same time it is necessary to use exercises as for a backbone in general, and its segments. Breathing exercises of dynamic character, and also exercise are of great importance for hands and legs. Carrying out physical exercises on wall bars is reasonable. Exercises with objects are applied (a gymnastic stick, maces, meditsinbola, etc.). Strengthening of pains in a backbone which is noted sometimes at patients shall not serve as the reason of cancellation of LFK.
In complex therapy of patients with seronegative S. the physiotherapy exercises occupy one of the leading places and are successfully combined with massage of muscles of a back, balneoterapiy (radonic, hydrosulphuric, iodine-bromine bathtubs) and physiotherapeutic procedures. It is reasonable to LFK to apply after balneo-and physiotherapy. Driving vehicles, especially on jolty roads, carrying weights is not recommended to sick S.; frequent change of provisions is during the day shown — standing, sitting, lying. The measures directed to prevention of aggravations are of great importance: elimination of the centers hron. infections, prevention of acute respiratory diseases, rational organization of work and life.
Forecast depends on character of a basic disease; it is most serious at Bekhterev's disease, more favorable at other seronegative Pages.
Bibliography: Leporsky A. A. Medical physical culture at diseases of a metabolism and diseases of joints, M., 1960; Matveykov G. P., etc. Use of a genetic marker of HLA B27 in practical rheumatology, Vopr. rheumatism, No. 3, page 37, 1982; Mosh-k about in V. N. Medical physical culture in clinic of internal diseases, page 3 56, M., 1977; Ebringer R. W. and. lake of Ankylosing spondylitis, Klebsiella and HL-A B27, Rheumat. Rehabilitat., v. 16, p. 190, 1977; Ebringer R. W. a. o. Sequential studies in ankylosing spondylitis, Association of Klebsiella pneumoniae with active disease, Ann. Rheum. Dis., v. 37, p. 146, 1978; Lawrence J. S. Rheumatism in populations, L., 1977.
AA. P. Agababova, H. M. Mylov; V. P. Illarionov (to lay down. physical.).