Modern treatment of ankylosing spondylitis

Bechterew's disease belongs to subgroup of spondyloarthritis. Even today there is still a delay of 5-10 years between the first occurrence of symptoms and the final diagnosis of ankylosing spondylitis. Without treatment the spine increasingly stiffens and the peripheral (mostly large) joints are often destroyed by inflammatory processes. Ankyloses of the joints between vertebrae and ribs may cause stiffness of the thorax. As the complaints most often start within the third decade of life and show a chronic progressive course, even young adults often have to deal with a considerable impairment due to pain and stiffness. Thus, early diagnosis is of utmost importance as today treatment with novel drugs is feasible and the TNFα inhibitors are particularly effective during the early stages of the disease. All conservative orthopedic measures are used concomitantly. Surgery encompasses the early resection of inflamed mucosa in joints. In later stages of the disease reconstructive methods, i.e. prosthetics are often applied. Spondylodesis to erect the body, necessary in the end stage of the disease, is beneficial, but elaborate. © 2007 Springer Medizin Verlag.