Morbus Bechterew

Morbus Bechterew's disease is an incurable, rheumatic-inflammatory disease that mainly affects the vertebral joints and nearby joints. In Morbus Bechterew’s disease, the body’s immune defence is directed against bone and cartilage. This gradually stiffens and ossifies the vertebral joints. The severity and speed of progression of the Morbus Bechterew’s disease varies from person to person. We give you a brief overview of the disease and tell you how radon therapy in the Saxon State Spas positively supports the treatment of the Morbus Bechterew’s disease.

What is the Morbus Bechterew’s disease?

The Latin name of Morbus Bechterew’s disease is spondylitis ankylosans, which means something like bending or stiffening vertebral inflammation. The disease affects the spine or vertebral joints and, in later stages, the large joints nearby such as the hip. Diagnosing the disease is not easy, as it initially manifests itself in back pain and muscle tension and is therefore not recognised by those affected for a long time. With further progression, the musculoskeletal system is restricted, as the joints, usually starting in the lower part of the spine, stiffen. Morbus Bechterew’s disease is chronic and so far not curable. However, there are various forms of therapy that slow down the course of the disease and relieve the symptoms.

Thanks to written records and anthropological research, the disease is documented at least until the time of Pharaoh Ramses II (1304 - 1214 B.C.). However, it was Vladimir Bechterew who first described the clinical picture in detail in the 19th century, which is why ankylosing spondylitis bears his name in the vernacular.

[Translate to english:] Symptome bei Morbus Bechterew

Symptoms of the Morbus Bechterew’s disease

The course of the disease usually begins between the ages of 15 and 35. However, the diagnosis is usually not made until many years later, as back pain is usually explained by an incorrect posture or one-sided strain and rarely does anyone think of the Morbus Bechterew’s disease right away. Usually, the symptoms start in the sacroiliitis, the sacroiliac joint, i.e. in the lower back area and can radiate into the entire hip area. Typically, the symptoms are mainly present in the second half of the night or in the morning, accompanied by a feeling of stiffness - i.e. especially in a lying and resting position. The earlier in life the disease begins, the worse the prognosis. Moreover, the course of the disease tends to be more severe in men than in women.

The symptoms often occur in stages. The slow ossification of the vertebral joints is not directly due to the Morbus Bechterew’s disease, but to the body's immune response to the chronic inflammatory processes. Bone bridges are formed between the individual vertebrae, which is called syndesmophyte formation in the technical language. In the x-ray image, the spine visually resembles bamboo with increasing ossification, which is why we speak of a bamboo spine.

[Translate to english:] Ursachen von Morbus Bechterew Genetik

Causes of the Morbus Bechterew’s disease

The causes of the Morbus Bechterew’s disease are not yet fully understood. An interaction between certain genetic predispositions and environmental influences is suspected. Although the body's own immune system turns against itself in this condition, the Morbus Bechterew’s disease does not show the typical characteristics of an autoimmune disease. Some experts therefore call it an immune-mediated, auto-inflammatory disease, i.e. a disease mediated by the immune system. Hereditary factors, particularly the gene marker HLA-B27 (human leukocyte antigen B27), play a role in the onset of the disease, but not necessarily.

90% of all people affected by the Morbus Bechterew’s disease are carriers of the marker HLA-B27. However, only a small proportion of those who carry this marker suffer from the Morbus Bechterew’s disease. In addition to HLA-B27, the gene markers ERAP1 and IL23R are also suspected of promoting the onset of the Morbus Bechterew’s disease Ultimately, however, various environmental influences and previous infections are also part of the list of factors that can trigger this spondylitis.

Treatment of the Morbus Bechterew’ disease

It has already been mentioned that the Morbus Bechterew’ disease is currently not curable. However, there are comprehensive therapeutic measures that provide significant pain relief and slow down the progression of the disease. The different treatment methods are determined by the doctor according to the severity and characteristics of the Morbus Bechterew’s disease and can be combined with each other.

[Translate to english:] Morbus Bechterew Bewegungstherapie

Movement therapy

Gentle sports such as swimming, cross-country skiing, hiking or cycling are recommended for movement therapy, which should be done for at least 20 minutes a day. Hard sports like jogging, tennis, handball or football are not recommended. In general, training at peak performance levels should be avoided in all sports. Instead, a gentle and continuous training is desirable. Special physiotherapy prescribed by a doctor can also help. Heat-cold treatments or a radon therapy as part of a bath therapy with water containing radon have been proven to alleviate symptoms of the Morbus Bechterew’s disease. The effect also lasts for several months.

[Translate to english:] Morbus Bechterew Operation

Surgery

A surgical intervention should always be considered as a last resort. A hip joint damaged by the Morbus Bechterew’s disease is usually replaced here. Surgery is also conceivable if nerves are damaged due to stiffening of the joints. In severe cases of forward curvature due to ossification of the spine, the spine can be straightened surgically. This means that those affected can breathe much better again and do not have to tilt their head back excessively to see straight ahead.

Therapy of Morbus Bechterew’s disease with the natural remedy radon

Radon therapy relieves pain in various diseases of the locomotor system, including the Morbus Bechterew’s disease. We, the Saxon State Spas, use the “Wettinquelle”, which bubbles to the surface in Bad Brambach, for radon therapy: It is the world’s strongest known spring with the natural remedy radon.

The spring was discovered over 100 years ago. Since then, bath and radon therapies have been integrated into the medical treatment plan as gentle therapy methods in the form of spa and drinking treatments for all kinds of complaints. Besides the natural remedy radon, the spring water of the Wettin spring and other medicinal springs in Bad Brambach also contains carbonic acid and various minerals such as calcium and sodium. Each individual component has a positive effect on the body.

It has been proven that water containing radon has an analgesic and anti-inflammatory effect in connection with a spa or drinking treatment. In a natural process, the noble gas radon decays after a certain time. The radon contained in drinking and bath water is absorbed through the skin and gastrointestinal tract thanks to the carbon dioxide content. If it decays after absorption, high-energy particles are released. These in turn eliminate a number of functional disorders and stimulate the metabolism. They also activate the repair mechanism of the body’s own cells. This also leads to increased release of endorphins, which have been shown to relieve pain and its perception.

Symptoms of the Morbus Bechterew’s ?

Therapy of Morbus Bechterew’s disease with the natural remedy radon

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Drinking treatments with radon

During the drinking treatment, the radon mineral healing water enters the body through the gastrointestinal tract and thus unfolds its naturally gentle effect. The healing water is drunk regularly over a longer period of time for therapeutic purposes. The duration, amount and time of drinking is determined by the spa doctor. Especially the “Wettinquelle” with approx. 24,000 Bq/l radon is considered the strongest radon spring in the world.

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Spa treatments with radon

Natural healing water is created by the slow infiltration of rain water through different geological layers of rock. During this process it is cleaned, filtered and enriched with minerals and trace elements. In this enriched deep water, carbon dioxide is released by solidified magma from past volcanic activity. The noble gas radon is formed from the radium contained everywhere in the earth’s crust. The Bad Brambach mineral springs receive their health-promoting radon content from the Fichtelgebirge granite. All sources are strictly checked according to the Medicines Act..

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Diagnosis of the Morbus Bechterew’s disease

Early detection of the Morbus Bechterew’s disease is difficult, as the symptoms are usually considered normal back pain or tension. However, attention should be paid at the latest when there are already diagnosed cases of the Morbus Bechterew’s disease in the family. In addition, if the back pain lasts for a long time, is inflammatory and occurs mainly at night or when lying down. You should also see your family doctor if you have simultaneously inflammation of the joints, psoriasis, inflammatory bowel disease, inflammation of the iris or tendons or muscles. An initial diagnosis is already made or the potential Morbus Bechterew’s disease patient is referred directly to a rheumatologist.

Anamnesis

During the anamnesis, the doctor focuses on the area of the spine and nearby joints and also asks about typical accompanying symptoms.

Magnetic resonance imaging

By means of MRT (magnetic resonance imaging), current or subsided inflammations in the sacroiliac joint and the spine can be detected in the early stages.

X-rays

X-rays, on the other hand, can be used to detect changes in the advanced stages typical of the Morbus Bechterew’s disease.

Blood samples

During the anamnesis, if the Morbus Bechterew’s disease is suspected, the doctor also takes blood samples to determine whether there are elevated levels of inflammation. In case of the Morbus Bechterew’s, however, these can be within the normal range, which is why a combination of different symptoms and concomitant symptoms must be proven. The presence of the gene marker HLA-B27 provides an important indication.

Menell's test

In addition, the doctor will measure the mobility of the spine as well as the chest extension and posture. These include Menell’s test, which uses a thigh hyperextension test and pressure on certain areas to localise pain.

In about 5 to 10% of cases of chronic, deep-seated back pain, the Morbus Bechterew’s disease is the underlying cause, especially if it occurs before the age of 45 and especially in a resting position.

Four stages of the Morbus Bechterew’s disease

Suspicion stage

In this initial phase, also known as the prodromal or suspected stage, deep-seated back pain is one of the main symptoms. Inflammatory processes in the spine commence.

Stiffening of the spine

This stage is characterised by an increasing, irreversible stiffening of a section of the spine. A constant ossification of the fibrous rings of the intervertebral discs in the lumbar spine area can also be seen.

Breathing difficulties

In the third stage, not only the sacroiliac joint stiffens, but gradually also the costal vertebral joints. This is accompanied by a restriction in breathing, as the widening of the chest during inhalation is increasingly reduced. Typical is therefore increased abdominal breathing. The pain is now also spreading to the large joints.

Complete ossification and accompanying symptoms

In this fourth and final stage, the spine ossifies, the thorax and often also nearby joints slowly stiffen. The sacroiliac joint is now also completely ossified.

Risk factors of the Morbus Bechterew’s disease

[Translate to english:] Morbus Bechterew genetische Risikofaktoren

Genetic factors:

gene marker HLA-B27
confirmed cases in the family

[Translate to english:] Morbus Bechterew Risikofaktor Entzündungen

Diseases that favour the Morbus Bechterew’s disease:

certain bacterial infections that trigger auto inflammatory processes

Questions around the Morbus Bechterew’s disease

How common is the Morbus Bechterew’s disease?

It is estimated that about 0.5% of adults in Central Europe suffer from the Morbus Bechterew’s disease. This includes undetected cases that are so mild that they are not diagnosed or detected. Diagnosed cases affect about 0.1% to 0.2% of the adult population. In concrete figures, this means for Germany: About 350,000 people are affected by the Morbus Bechterew’s disease, and only about 150,000 of them have symptoms so severe that the Morbus Bechterew’s disease has been diagnosed.

Does the Morbus Bechterew’s disease influence life expectancy?

No, the Morbus Bechterew’s disease does not per se lead to a lowered life expectancy. Only the quality of life can be increasingly restricted. There are other factors that have an influence on health. Regular check-ups and the resulting therapy measures with a healthy diet and an adapted lifestyle mean that there is nothing to prevent a normal life expectancy.

What can I personally do to relieve the symptoms?

Regular medical check-ups should be as much a part of this as adapting your lifestyle. Firstly, health-promoting food should be consumed. Overweight and alcohol should be significantly reduced or preferably avoided altogether. Cigarettes and the like are absolutely taboo for patients suffering from the Morbus Bechterew’s disease. An optimal upright posture can reduce the excessive curvature of the spine as the disease progresses.

How does the Morbus Bechterew’s disease affect my ability to work?

Most professions can be continued with the diagnosis of the Morbus Bechterew’s disease. If symptoms become apparent, it helps to discuss with the employer how the work processes and the workplace could be adapted accordingly. For example, ergonomically designed workplaces or rehabilitation measures help. In severe and very advanced cases of the Morbus Bechterew’s disease and in professions that are physically demanding, occupational retraining may be necessary.

Can I travel with the Morbus Bechterew’s disease?

The ability to travel depends on the severity of the disease. As a rule, people affected by the Morbus Bechterew’s disease can travel like anyone else. However, care should be taken to ensure that sufficient breaks are planned during arrival, departure and stay to allow time to move around. Sitting for long periods can cause pain. In the case of medicines requiring refrigeration, it is advisable to find out in advance from the tour operator to what extent the cold chain can be maintained.

What must be taken into account during pregnancy?

This also applies here: People affected by the Morbus Bechterew’s disease can become pregnant normally. Pregnancy does not pose a particular risk. In most cases the birth also proceeds quite normally. Only in severe cases of the Morbus Bechterew’s disease with extreme immobility of the hip joints and pelvic bones can a Caesarean section be unavoidable. Talk to your doctor about this.

What costs are covered by health insurance?

The health insurance company will cover the costs of all necessary and appropriate diagnostic and therapeutic measures. For certain services, depending on the health insurance company and necessity, a self-cost coverage may apply.

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