Bechterew's Disease

Bechterew's disease is also known as ankylosing spondylitis and it belongs to a group of so called autoimmune diseases. The disease affects mainly men and it is often detected at a relatively young age. If not treated, it can significantly degrade the quality of life and even cause serious disability.


Ankylosing spondylitis is a typical autoimmune disorder. The immune system of the patient responds aggressively to certain structures of his own body in this case against some joints and vertebral junctions. This pathological process apparently starts due to a genetic condition* that is combined with an outer triggering factor, most possibly a banal viral infection. By some people their immune system successfully defeats the infection but then it "resets" and attacks their own body structures. The primary target in this case is represented by vertebral ligaments that provide stability and mobility of the spine. In addition vertebral joints and both sacroiliac joints are affected. Bechterew’s disease is a chronic inflammatory process. Such a prolonged inflammation leads to irritation and damage of both ligaments and joints. It is accompanied by forming of calcium deposit in affected structures, the ligaments ossify and in advanced stages they become almost solid. Let’s imagine a situation when the spine consists of fixed vertebra, which allow no mobility.


* There is a strong association between ankylosing spondylitis and HLA B27 (an antigen present on cell’s surface) genotype.


The disease usually starts relatively quietly causing no significant troubles. Back pain is the most common symptoms. Virtually every part of the spine can be affected; lumbar spine comes often as the first. Pain has a rheumatic character as it emerges at rest and improves by movement and during physical exercise. As time passes the damaged joints and ligaments stiffen and spine mobility deteriorates. In severe forms of the disease spine mobility is practically lost. Spine usually “freezes” in “forward bent” position. A patient with Bechterew’s disease will therefore walk forward bent with bent knees. By bending the knees the affect person tries to compensate the deformation or spine. At this stage the patient is completely disabled. A number of patients with ankylosing spondylitis may suffer from other autoimmune diseases such as Crohn's disease.


The disease is suspected when finding above stated symptoms by young men. An X-ray of spine and sacroiliac joints could help by diagnosing certain signs of inflammation. The diagnosis could be confirmed by discovery of specific autoantibodies in patient’s blood.


The disease can’t be prevented. Therefore it is essential to diagnose it as soon as possible and start proper treatment, which could greatly change the prognosis and therapeutical outcome.


The goal of treatment is to stop the progression of the disease process or at least to slow it down. Rehabilitation is probably the most important part of therapy. Special exercises created by skilled rehabilitation specialists must be regularly performed. Patient’s cooperation is essential, preserved mobility and self-sufficiency is his reward. Ankylosing spondylitis when treated properly usually has a good prognosis with milder symptoms and significantly slowed progression.


In addition, conventional non-steroidal anti-inflammatory drugs are used. By more severe course of the disease, corticosteroids and other more advanced immunosuppressive drugs may be prescribed.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources