Physiotherapy approach to ankylosing spondylitis

Abstract

Ankilozantni spondilitis (Morbus Bechterew) je upalna, kronična i progresivna reumatska bolest koja primarno zahvaća sakroilijakalne zglobove, korijenske i periferne zglobove, a može zahvatiti i visceralne organe. Naziv spondilitis potječe od grčke riječi spondylos (kralježak) i latinskog sufiksa -itis, što označava upalu kralješka. Bolest dovodi do ukočenosti zglobova, uzrokovane sraštavanjem dijelova ili cijele kralježnice. Klinički je karakterizirana bolovima u području stražnjice i kukova, pri čemu je tipično prisutno jutarnje ukočenje koje može ometati san oboljelih. Etiologija bolesti još uvijek nije u potpunosti razjašnjena. Najčešće se javlja u dobi između 15. i 29. godine života, a učestalije pogađa muškarce nego žene. U rođaka oboljelih bolest se pojavljuje 40 do 50 puta češće nego u općoj populaciji. Tijekom progresije bolesti dolazi do promjena oblika kralježnice, pri čemu se smanjuje lumbalna lordoza, a torakalna kifoza povećava. Proces koji započinje na sakroilijakalnim zglobovima naziva se obostrani sakroileitis. S napredovanjem bolesti razvijaju se karakterističan „stav skijaša“ i fenomen „gumene lopte“. Također, dolazi do smanjenja kostalnog disanja uz kompenzatorno povećanje abdominalnog disanja. Fizioterapijski pristup kod ankilozantnog spondilitisa usmjeren je na očuvanje i poboljšanje funkcionalne sposobnosti bolesnika, smanjenje boli te prevenciju deformiteta. Ključne intervencije uključuju individualno prilagođene vježbe za održavanje i povećanje opsega pokreta kralježnice, jačanje mišićne snage, poboljšanje posture i respiratorne funkcije te edukaciju bolesnika o važnosti redovitog provođenja terapijskih aktivnosti. Multidisciplinarni pristup, koji uključuje suradnju s liječnicima, fizioterapeutima i drugim zdravstvenim stručnjacima, od iznimne je važnosti za dugoročno očuvanje kvalitete života oboljelih. Pravovremena i kontinuirana fizioterapijska intervencija dokazano doprinosi smanjenju simptoma, usporavanju progresije bolesti te povećanju samostalnosti i socijalne uključenosti bolesnika.Ankylosing spondylitis (Morbus Bechterew) is an inflammatory, chronic and progressive rheumatic disease that primarily affects the sacroiliac joints, facet joints and peripheral joints, and can also affect visceral organs. The name spondylitis comes from the Greek word spondylos (vertebrae) and the Latin suffix -itis, which means inflammation of the vertebra. The disease leads to stiffness of the joints, caused by the fusion of parts or the entire spine. It is clinically characterized by pain in the buttocks and hips, with typical morning stiffness that can interfere with sleep in sufferers. The etiology of the disease is still not fully understood. It most often occurs between the ages of 15 and 29, and affects men more often than women. The disease occurs in relatives of sufferers 40 to 50 times more often than in the general population. During the progression of the disease, changes in the shape of the spine occur, with a decrease in lumbar lordosis and an increase in thoracic kyphosis. The process that begins in the sacroiliac joints is called bilateral sacroiliitis. As the disease progresses, a characteristic “skier’s stance” and the “rubber ball” phenomenon develop. Also, there is a decrease in costal breathing with a compensatory increase in abdominal breathing. The physiotherapy approach to ankylosing spondylitis is aimed at preserving and improving the patient’s functional ability, reducing pain, and preventing deformities. Key interventions include individually tailored exercises to maintain and increase the range of motion of the spine, strengthening muscle strength, improving posture and respiratory function, and educating patients about the importance of regular therapeutic activities. A multidisciplinary approach, which includes collaboration with physicians, physiotherapists, and other health professionals, is of utmost importance for the long-term preservation of the quality of life of patients. Timely and continuous physiotherapy intervention has been proven to contribute to reducing symptoms, slowing the progression of the disease, and increasing the independence and social inclusion of patients