Ankylosing spondylitis is a rare type of progressive arthritis that causes spinal stiffness and pain. This disease is chronic or lifelong and is also called Bakhterov's disease. This disease usually starts from the lower back and in some cases reaches the neck. There is also a possibility of damage to other joints of the body. Over time, this disease can limit the patient's movement and in severe cases even cause the spine to bend. Spinal rheumatism causes a moderate to severe level of inflammation in the vertebrae, and as a result, the patient will experience chronic and ultimately debilitating pain. In more advanced stages, inflammation sometimes leads to new bone formation in the spine and changes its shape. There is also the possibility of disease in other parts of the body, especially in large joints such as shoulders, knees and hips, and stiffness and pain in these areas. Symptoms of rheumatism of the spine Symptoms of rheumatism of the spine often begin with inflammation in the sacroiliac joints that connect the spine to the pelvis. The patient may first feel pain and stiffness in the lower back and pelvis. If ankylosing spondylitis progresses, it affects the connection areas of the tendons and ligaments to the bones and even causes fusion of the vertebrae. Be sure to read: rheumatism or rheumatoid arthritis Other symptoms of ankylosing spondylitis include: - Neck pain or stiffness - Shoulder pain - Pain and stiffness in the chest - Pain in the hip or thigh - Pain in the leg, heel or hand - Pain that gets worse in the morning or after sitting for a long time - Forward curvature in the spine - Feeling tired - Swelling in the joints - Skin rash - Vision problems - shortness of breath Symptoms of spinal rheumatism vary from person to person. Symptoms are likely to flare up from time to time, improve after a while, and then return again. Causes of rheumatism of the spine Unfortunately, the cause of rheumatism in the spine is not known and research is ongoing to determine the cause of this disease. Genetics seem to play a role in the disease, especially the HLA-B27 gene, but not all people with this gene develop the disease. Risk factors include the following: - **Family history:** Family history of spinal rheumatism, especially in first-degree relatives, significantly increases the risk of developing this disease. Age of disease onset: Ankylosing spondylitis usually begins in late adolescence or early adulthood. The age of onset, which is usually between 17 and 45 years, represents the critical period of the disease. - **Gender:** There is a possibility of AS in both women and men, but most cases of it are reported among men. The reason for this gender difference is still unclear. - **Ethnicity:** The prevalence of this disease is higher in Caucasian, Asian and Middle Eastern people. - **Psoriasis:** People with psoriasis are more at risk of developing AS, which indicates their common feature related to autoimmune mechanisms. Smoking: Smoking increases the risk of spinal rheumatism. In addition, usually the symptoms of smokers with this disease are more than non-smokers. Diagnosis of spinal rheumatism It is difficult to diagnose this disease because the main symptom is back pain, which many people suffer from. ### Ankylosing spondylitis tests There is no specific test to confirm the disease. The doctor usually makes the diagnosis by examining the patient's symptoms and using the following: - Physical examination - Blood test to check the presence of HLA-B27 gene Imaging such as X-ray or MRI Management and treatment of spinal rheumatism in Shiraz **The question is, how is rheumatism of the spine treated?** Treatments recommended by the doctor are to manage symptoms and reduce their impact on daily activities. Common treatments for rheumatism of the spine include: - **Exercise or therapeutic exercise:** With regular physical activity, stiffness can be reduced and disease aggravation can be prevented. Many people with less physical activity experience more severe pain. A physiotherapist can help the patient by teaching stretching movements and appropriate exercises to strengthen the muscles that support the back and spine. Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen reduce pain and inflammation. Consult your doctor to take these medicines for more than 10 days. - **Disease-modifying antirheumatic drugs (DMARDs)**: These prescription drugs reduce inflammation and pain and prevent the exacerbation of spinal rheumatism. Corticosteroids are prescription anti-inflammatory drugs. Some patients need cortisone injections (direct injection of corticosteroids into the affected joints). - **Surgery:** Cases requiring surgery to treat spinal rheumatism are rare. A doctor usually only recommends surgery if there are severe symptoms that do not improve with other treatments. ### When will I get better? After starting treatment, signs of improvement should appear very soon. Symptoms may not go away completely, but recovery should be achieved as effective treatments are found for each patient. Talk to your doctor about how long it will take to see signs of improvement. The healing process with exercise and physiotherapy is gradual and the effective time of the drugs is also different depending on their type. What is occupational therapy and why is it useful in the treatment of spinal rheumatism? Occupational therapy helps the patient in performing daily tasks or occupational activities. These tasks can include housework, tasks that require mobility and walking, and social activities. Occupational therapists prepare a treatment plan based on the patient's individual needs and movement abilities. The work of occupational therapists is to help people who have sensory, cognitive and physical disabilities and need help to achieve individual independence and improve the quality of life. Many people do not know the difference between occupational therapy and physical therapy. While in physical therapy to improve the symptoms of rheumatism of the spine, the physical therapist focuses on activities related to the range of motion, but the occupational therapist helps the patient to develop motor skills. The following are some exercises suggested by occupational therapists to spine rheumatism patients: - to play - Tying shoelaces - Bathing - Practicing the use of assistive devices such as support or balance devices - dressing up - Catching or throwing the ball The occupational therapist first sets goals for the patient and then designs exercises to achieve these goals. This treatment plan should be reviewed every few months based on the patient's progress and symptoms. If the doctor recommends occupational therapy as part of the treatment, it is important to know how this type of treatment affects the patient's condition. For some people, the progression of rheumatism in the spine can cause a loss of independence in doing everyday tasks, especially tasks that require bending and stretching. Many patients are no longer able to do their favorite social activities and hobbies after the disease progresses. The goal of occupational therapy for people with ankylosing spondylitis is to increase independence and the ability to perform daily tasks. The only downside to occupational therapy is that it is expensive and long, so it requires a commitment to continue treatment over a period of time. Specialist in physical medicine and rehabilitation in the management of spinal rheumatism in Shiraz Management of rheumatism of the spine (ankylosing spondylitis) by a physical medicine and rehabilitation specialist includes methods that help improve movement and reduce pain and inflammation. These specialists try to improve the patient's quality of life by using non-drug and rehabilitation methods. Some common methods of managing this disease include: **Exercise and stretching programs** Stretching exercises are very important to maintain the flexibility of the spine and prevent dry joints and tendons. These exercises usually include stretching exercises for the chest and back. Strengthening exercises that focus on the back and abdominal muscles help improve posture and support the spine. **Physiotherapy in Shiraz** Physical medicine specialists use physical therapy methods such as massage therapy, electrotherapy, and ultrasound therapy to reduce pain and reduce inflammation. Teaching correct posture is also very important, as having the correct posture while sitting, walking and sleeping can prevent extra pressure on the spine. Read more: Rheumatism treatment with physiotherapy **Hydrotherapy** Exercises in water help to reduce body weight and reduce pressure on joints and make sports activities easier and painless for the patient. Warm water can also help reduce muscle stiffness and pain. **Using assistive devices** In cases where the patient is facing movement restrictions, devices such as *braces* or *assistive equipment* are prescribed to improve movement and support the spine. **Education and modification of lifestyle** Physiotherapists teach patients how to manage symptoms with small lifestyle changes such as proper nutrition, smoking cessation and adequate sleep. *Stress management* through breathing exercises and relaxation techniques can also help reduce the severity of symptoms. **Complementary and alternative therapies** Sometimes complementary treatments such as acupuncture are used to reduce pain. These methods, along with drug therapy, help to better manage symptoms and prevent the progression of the disease. Physical medicine and rehabilitation specialists adjust the treatment plan based on the specific conditions of each patient and make the necessary changes over time to maintain the patient's recovery and quality of life. Read more: Common and uncommon causes of back pain and its treatment 👈 Dr. Zohra Eshghi is a specialist in physical medicine and rehabilitation and a specialist in the treatment of lumbar disc and back and neck injuries and diseases after correct diagnosis, and he will provide you with the methods of treatment and management of spinal rheumatism in Shiraz after finding the cause of the problem. ### Conclusion Ankylosing spondylitis or rheumatism of the spine is a progressive disease that worsens over time and eventually leads to disability. It is also a chronic disease and there is still no cure for it. However, regular exercise, medication, occupational therapy and alternative therapies can help prevent and slow the progression of the disease. In addition, with the help of useful occupational therapy techniques and exercises, the patient can better maintain his independence in old age. If you have been suffering from chronic back pain for some time, it is better to discuss your problem with a doctor. Remember that untreated spinal rheumatism can cause many problems, and in some cases, the resulting chronic inflammation can even cause fusion of the bones in the spinal cord.