Ankylosing Spondylitis

Ankylosing Spondylitis – Control Over Disease

Pathogenesis

The cause of the disease is unknown. Of great importance is genetic predisposition, genetic marker which is the antigen HLA B 27, occurring in 90-95% of patients, 20-30% of their first-degree relatives and in only 7-8% in the population. It is believed that the gene sensitivity ankylosante spondylitis is coupled with the gene HLA B 27.

There are two theories of pathogenesis, explaining the important role of HLA B 27 in the development of Ankylosing Spondylitis  ‘s disease. According to the theory of receptor antigen HLA B 27 is a receptor for the damaging etiological factor (eg, bacterial antigen, virus, artritogennogo peptide, etc.). The resulting complex leads to production of cytotoxic T-lymphocytes, which can then damage the cells or tissue area, where the molecules of the antigen in 27.

According to the theory of molecular mimicry bacterial antigen, or any other damaging agent in combination with other HLA molecule can be similar to the HLA B 27 properties and identify cytotoxic T-lymphocytes as HLA B 27 or reduce the immune response to peccant peptide (the phenomenon of immune tolerance) .

As a result, developing immunovospalitelny process. Usually it begins with the defeat of the sacroiliac joint, and then involved intervertebral, costovertebral, rarely – peripheral joints. First is infiltration by lymphocytes and macrophages, and then develop active fibroplastichesky process with the formation of fibrous scar tissue, which undergoes calcification and ossification.
The main pathological manifestations of Ankylosing Spondylitis  ‘s disease are inflammatory enthesiopathies (inflammation of the place of attachment to the bone tendons, ligaments, fibrous part of the intervertebral discs, capsules of the joints), inflammation of the bones forming the joint (osteitis), and synovitis.

In the subsequent develop fibrous and bony ankylosis of the joints of the axial skeleton, at least – of the peripheral joints, comes early ossification of the ligamentous apparatus of the spine.

A constant in medicine dictates that early diagnosis is fundamental condition for the existence of better prognosis and control of a given condition.

The case of ankylosing spondylitis is no exception and for detection it is common that the specialist will ask the patient to undergo a series of studies such as blood count (number of red and white blood cells and variants) rate of erythrocyte sedimentation rate (shows the degree of inflammation in the body) and identification HLAB27 antigen (molecule that can induce the formation of antibodies which counteract the gene responsible in part). Of course pelvis and spine radiographs are essential.

In some cases either by experience or specialist for obvious signs of deterioration the doctor can get almost the certainty of diagnosis but nevertheless the evidence cited should be practiced.

ankylosing sponylitis

With regard to treatment it is usual that the specialist prescribed the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. However the interviewee said each case must be handled according to their circumstances since some patients experience very severe symptoms while others are more or less bearable.

Physical therapy or monitoring of specific exercise regime can help concerned but it is noteworthy that in recent times has shown the effectiveness of so-called biological therapies (genetic engineering acting on specific molecules) which in this case allowed the creation of a drug that inhibits or blocks tumor necrosis factor (TNF by its initials in English) a chemical is released by cells of the immune system (defense against diseases) and is involved in inflammation and joint destruction.

 

Most people respond well to this drug and can make normal life although much depends on when to initiate therapy. It is also true that anti-TNF therapy is expensive but if we turn to him the impact of the disease may involve even higher figures.

Moreover the interviewee explained that the biological therapy is called this because it is based on genetic procedure that aims to act on specific molecules not because they are some kind of vaccine or use of herbs.

I think anyone with pain in the waist or joint pain should seek help especially if it is a young man. To be more precise it is noted that if the discomfort is intense sustained and cause problems to raise work or perform normal life one must see the rheumatologist.

It is necessary that such cases are evaluated by the consultant rheumatologist ended the interview because many people who experience the symptoms of ankylosing spondylitis described consulting the general practitioner or other health professional that does not necessarily know about the disease implying delayed diagnosis and prognosis less optimistic.

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