Bechterev disease: What are the causes or symptoms leading to the disability?

Bechterev disease: What are the causes or symptoms leading to the disability?
Photo source: Getty images

Bechterev's disease is a chronic rheumatic inflammatory disease of the joints. It mainly affects the spine. It affects men more often than women. Its onset is at a younger age, up to 30 years.


It is estimated that about one percent of the population suffers from the disease, and the cause and cause of the disease are still unclear.

Contemporary medicine has made progress in clarifying it. The disease is named after the Russian neurologist Vladimir Bechterev.

The disease is also technically called ankylosing spondylitis or simply Bechterev. Other designations are, for example, Bechterev disease, spondylitis ankylosans.

Bechterev is a systemic inflammatory disease of the rheumatic type. It mainly affects the spine. Often also the shoulder and hip joint. On the contrary, less often other joints.

Ankylosing spondylitis  = radiographic axial spondylitis.
It belongs to the group of spondylarthritis.

The exact cause of the disease is unknown. Risk factors are also likely to be involved in the development of the disease. These include genetic, immunological factors and infectious diseases. Even an inherited occurrence in the disease is proven.

An association has been found between the presence of the specific antigen HLA-B27, which is not, of course, a causal relationship. Because, the presence of this antigen does not necessarily mean disease. but it just increases the risk.

The symptoms of the disease start only in a very slow manner.

Thanks to that many people overlook it. The disease is most often manifested by stiffness of the joints. However, the disease is chronic and the joints suffer from inflammation, which is also associated with the signs and symptoms of the disease.

Musculoskeletal disorders of this type usually start to show before the age of 30. On the other hand, rarely in adolescents and children. It affects approximately 1% of the population.

Ankylosing spondylitis affects:

  • rather men than women, in a ratio of 7: 1
  • it most often begins manifesting from the age of 20-30
  • after the age of 35, the onset is less frequent
  • the disease usually does not occur after the age of 40
  • affects approximately 0.2-0.9% of the population
Young man has back pain due to Bekhterev's disease
The disease affects the young population and especially men. Photo source: Getty images

It most often affects the spine, and especially its lumbar part.

However, this chronic inflammation also causes problems in the rest of the spine. In addition to the spine, it also affects the joints in the area of the shoulder and hip. Less often, other joints.

The inflammatory process affects the joint area, ligaments, intervertebral discs and other joint and nearby structures. Over time, leads to ossification in these places.

Ossification results in stiffening of the spine, in any position.

In addition to musculoskeletal problems, Bechterev can also affect other organ systems. The disease affects the eye, such as inflammation of the eye, iris, but also the digestive tract. The cardiovascular system (pericarditis, endocarditis, valve defects), lungs or kidneys may also be affected.


The presence of HLA-B27 antigen affects the onset of the disease. However, this antigen is found in less than 10 percent of the population. HLA antigens type are molecules on the surface of cells. According to these molecules, the immune system recognizes its own cells from foreign ones.

The presence of this antigen does not guarantee that the disease will break out. However, the probability increases with its presence up to three hundred times. Whereas, HLA is proven in up to 90% of cases.

Heredity is also a risk factor for the development of the disease, but Bechterev is not a directly inherited disease. However, a certain hereditary connection is proven. This is again in conjunction with the HLA antigen - B27. Doing so increases the risk of developing the disease.


Typically, this disease manifests itself mainly in joints that are stiff and sore. Very often, a person with this disease wakes up from sleep due to stiffness and joint pain.

The disease is accompanied by chronic pain in the spine.

The spine becomes less and less flexible due to ossification and thus solidification. Progression is relatively slow, however, in some people with the disease it can lead to complete immobilization of the spine.

In some cases, the symptoms are also noticeable on large joints, such as the hips or knees. Less often even small joints such as finger joints.

Symptoms that accompany the disease include fatigue, fever, chest pain when breathing deeply, swelling of the large joints. Above the affected joint, the skin may be reddened and deformations may occur.

Some people with this disease have inflammation of the iris.

Bekhterev's disease - a young man has morning pain and stiffness in the spine
Morning pain and spine stiffness. Photo source: Getty images

Summary of symptoms in Bechterev's disease:

  • chronic back pain, night and morning pain are common
  • long-term joint pain
  • heel pain
  • chest pain, and therefore chest pain
  • nocturnal, resting pain, receding after agitation
  • spinal movement disorder until warm-up
  • in severe and late stages, complete restriction of spinal movement, and thus disability
  • morning stiffness can last for an hour
  • joint damage, deformities, round back formation
  • damage to other systemic organs and the resulting difficulties
    • cardiovascular system (pericarditis, endocarditis, valve defects)
    • lungs
    • digestive tract
    • kidneys
    • eye, inflammation of the eye, iris, sensitivity to light
  • fatigue
  • increase in body temperature
  • swelling in the area of large joints
  • reddening of the skin above the joint
  • nail separation
Old man with curved spine
Gradual deformation of the spine and a posture typical of Bekhterev's disease. Photo source: Getty images

In Bechterev's disease, bending of the spine as well as posture are typical, namely:

  • forward bend
  • extended head
  • rounded shoulder
  • sflattened and bent chest (kyphosis, ie bending of the spine)


The disease is not diagnosed quickly due to the fact that, for example, morning stiffness or joint pain together with their possible deformation are relatively vague symptoms.

The examination includes a previous history, sampling of blood and the presence of HLA-B27 antigen, laboratory tests to determine the body's immune response, and a physiological examination of the individual joints and their flexibility.

Regular X-ray examinations are also performed to observe the course of the disease.

The so-called modified New York criteria from 1984 are also used in determining the diagnosis. Their aim is to determine 3 clinical manifestations and one objective X-ray finding.

The table shows the New York criteria for assessing Bechterev's disease

Criteria Description
1. back pain that lasts for more than 3 months and improves with movement, 
2. restriction of spinal motility in the stem area
3. stiffening of the chest and thus restriction of mobility when breathing
RTG findings the first X-ray changes occur after 3-5 years

Subsequently, the diagnosis is based on the presence of back pain, family history, inflammation of the cornea, inflammation of joints and tendons. A good response of difficulties to non-steroidal anti-inflammatory drugs, which are drugs with analgesic, antipyretic and anti-inflammatory effects, is also helpful.

Magnetic resonance imaging, or MRI, is also used to identify Bechterevo disease. In the event of an outbreak during adolescence, ie under the age of 16, a worsening course is expected.

Worse course is also determined by the occurrence of inflammation of the joints outside the spine, inflammation of the eye or intestine and psoriasis.


The disease is characterized by a slow, gradual onset.

The first symptom is stiffening of the spine in the area of the shaft and lower back. Other difficulties do not have to be associated during this period. The disease can also manifest atypically, and this in apainful way in the episodes.

Spine model highlighted lower part
Typical lower back pain. Photo source: Getty images

The painful form resembles acute lumbago or LIS, which is a lumbosciatic syndrome. Alternatively, with a general manifestation of fever and arthritis.

Over time, the symptoms of spinal stiffness come to the fore, and thus the pain and other difficulties resulting from degenerative changes.

The pain is primarily particular in the morning.

After warming up, the person feels improvement and relief of pain. This stiffness usually persists for up to one hour.

Pain worsens, passivly.

The development of the disease is usually a matter of years. However, in rare cases it can take place in a few months.

Problems with the mobility of the spine and joints are getting worse. The pain is getting more and more intense. In most cases, the disease ends with a complete immobilization of the affected structures, and that means disability.

If the disease has been isolated only to affect the spine, it is referred to as spondylarthrosis ankylopoetica simplex. And this is further divided into two forms.

The ascending form, the classical one, affects the primary joints in the area of ​​the sacrum, the so-called SI joints, which are the sacral-iliac joints.

Over time, the disability spreads to other parts. And thus the lumbar, thoracic and cervical spine. The descending form occurs mainly in women and is less common. It mainly affects the back.

What helps with the disease?

As mentioned in the section on treatment, it is important to adjust the environment, lifestyle, in obesity to lose weight, or to avoid gaining weight. Physical activity is the basis. Various exercises, application of heat or biolamps are suitable for the disease.

Useful information can also be obtained in clubs and forums on the Internet. They are provided by experts as well as people who have personal experience. Any information can be helpful in combating the aggravation of difficulties. 

How it is treated: Bechterev disease

Treatment of Bechterev's disease: medication and exercise and rehabilitation

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Video about the disease

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Interesting resources

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  • "Questions and Answers about Ankylosing Spondylitis". NIAMS. June 2016. Archived from the original on 28 September 2016. Retrieved 28 September 2016.
  • "Ankylosing spondylitis". Mayo Clinic. Retrieved 5 June 2022.
  • Khan MA (2009). Ankylosing Spondylitis. Oxford University Press. p. 15. ISBN 9780195368079. Archived from the original on 8 September 2017.
  • "Ankylosing spondylitis". GARD. 9 February 2015. Archived from the original on 2 October 2016. Retrieved 28 September 2016.
  • Sheehan NJ (January 2004). "The ramifications of HLA-B27". Journal of the Royal Society of Medicine97 (1): 10–4. 
  • Smith JA (January 2015). "Update on ankylosing spondylitis: current concepts in pathogenesis". Current Allergy and Asthma Reports15 (1): 489. 
  • Deodhar A, Reveille JD, van den Bosch F, Braun J, Burgos-Vargas R, Caplan L, et al. (October 2014). "The concept of axial spondyloarthritis: joint statement of the spondyloarthritis research and treatment network and the Assessment of SpondyloArthritis international Society in response to the US Food and Drug Administration's comments and concerns". Arthritis & Rheumatology66 (10): 2649–56. 
  • "Facts and Figures". National Axial Spondyloarthritis Society. Retrieved 27 January 2021.
  • Boos N, Aebi M (2008). Spinal Disorders: Fundamentals of Diagnosis and Treatment. Springer Science & Business Media. p. 25.