I.

Passport part

Full name: Soliyev Bokhodir
Nationality: Uzbek
Age: '45
Occupation: Disabled II-group
Home address: Tashkent province Parkent Toumani Oktepa village. Str. Mingurik House 1
Of the guide diagnosed with Ankylosing spondylitis, central form.
Date of admission to hospital: 28.08.2005, the

II. Complaints

The patient complains of pain in the spine, more in the neck and shoulder blades.
The sharp restriction of movement in the neck, can not straighten his head bent to the left or right
and there are pains. The pain in both shoulder joints and right hip joint, aggravated by
movement. On the morning stiffness, severe weakness overall. The patient feels weakness
throughout the body, and fatigue. The Fall of view.

III. Anamnesis Morbi

He considers himself a patient since 1978, when during a training fell from the rope and landed
on two feet. After the trauma patient began to bother a lot of pain on the back of the right and left
hip, which sharply intensified during movement due to pain-patient unable to walk. After
treatment the patient's condition improved, the pain passed, and the patient began to walk again.
In 1995 there was morning stiffness, pain in the lower back, general weakness. The patient asked
the med.san part TAPOVICH where diagnosed with ankylosing spondylitis, and the patient
began to regularly take medication, physical therapy: ultrasound with diclofenac, massage.
Himself regularly took indomethacin, diclofenac. The patient's condition improved after
treatment, but the disease progressed, the pain increased and the patient with the words "spread
the top", pains in the chest, inability to breathe, in the cervical spine radiating to the back of the
head, severely restricting movement of the head to the side, curvature of the spine in the thoracic
kyphosis-gain, pain in the hip and shoulder joints in motion, limitation of movement, weakness
in the lower extremities. And in 2000, addressed to the National Center for Rheumatology 2
Tashkent State Medical Institute. After that regularly receives hospital treatment two times a
year.

IV. Anamnesis Vitae

Born in Tashkent in 1960, in a working class family. Father holds the chair at the University of
Foreign Languages. Mother-housewife. They have three children, the third son of himself. Roth
and razvivalyas the average abundance, the food was reasonable and complete.
He graduated from the school for good, at 17 years old enrolled in school. He graduated in '21,
then worked as a coach at the school. Since 1995, 2 disability groups. He has 3 children, all
children are healthy.
Bad habits: drink alcohol, smoke.

Epidemiological anamnesis: As a child ill with mumps, measles and other infectious diseases are
not sick. At the dentist in the last 2 years it was not treated.

Allergoanamnez: allergic reactions to foods or drugs which are not noted.

Family history: hereditary disease in the family is not.

V. Status praesens objectivus

The general condition of the patient: severe
Consciousness: clear-answers the questions correctly without delay.
Patient position: forced, moves on their own, without any help.
Body type: the type of constitution-normostenichesky
Height: 165 cm
Weight: 47 kg
The degree of fatness sick lowered, skinfold thickness 1 cm in the left hypochondrium. Normal
posture, facial expression is calm, correct head shape.
Skin; wheat-colored, there is no rash, skin is clean, reduced turgor, skin moisture slightly
increased.
Nail plate unchanged pink, slightly tsianatichny. Mucous eyes pale pink. Mucous lips clean, pale
pink, swollen tongue, coated and neoblozhen.
On palpation the neck, parotid, submandibular, cervical, axillary, elbow, groin, popliteal lymph
node tenderness, deformity, increase is observed.
The muscles are weak, reduced muscle tone, pain and seals are not detectable.
Abnormal curvature of the spine was observed.
Deformation of the bones of the lower and upper limbs are not marked.
The state of the terminal phalanges of fingers and toes intact. The configuration of the joints is
not changed. Swelling, local redness missing.

RESPIRATORY SYSTEM

Complaints: on pain during the act of breathing.

Inspection of the chest:
Static: chest normostenicheskaya symmetrical. Epigastric angle of 75. Fortified with kyphosis of
the thoracic spine, "pose an asylum." Supraclavicular and infraclavicular fossa moderately
expressed, identical on both sides. Intercostal spaces are narrowed, the course of the fin scythe.
Dynamic: Type-abdominal breathing. Breathing shallow, rhythmic frequency
20 breaths in 1 min. Respiratory movements on both sides
symmetrically involved in the act of breathing.

Palpation of the chest:
The chest is elastic and the integrity of the edges is not broken. On palpation there is soreness.
Intercostal spaces are narrowed.

Percussion of the chest:

Comparative percussion:
Auscultated over the lung fields clear lung sounds.

The height of the tops of standing light:
right-3.5cm.
Left-3cm.
back-at 7 cervical vertebra (right and left)

Topographic percussion:

The lower boundary of the lungs:

Line right lung left lung
Okologrudinnoy fifth intercostal space -
Sredneklyuchichnoy VI rib -
Anterior axillary VII VII rib rib
Average axillary rib VIII VIII edge
Posterior axillary IX IX rib rib
Shoulder X ray X ray
Juxtaspinal processus spinosus XI thoracic processus spinosus XI thoracic vertebra


The mobility of the lower edges of the lungs:

Topographic Line the bottom of easy mobility, see
Right Left
The output on a breath you inhale on the total output of total
Sredneklyuchichnoy 1-2 1-2 2-4 ---
Average axillary 2-3 2-3 4-6 2-3 2-3 4-6
Shoulder 1-2 1-2 2-4 1-2 1-2 2-4




Field width Kreniga:

Right-to-Left 3 cm-3.5 cm

Auscultation:
Over the pulmonary fields auscultated vesicular breathing. Bronchial breathing heard over the
larynx, trachea and major bronchi.
There are individual finely wheezing, who heard over the projection area of the lower lobe of the
right lung. Bronhofoniya not strengthened.

CARDIOVASCULAR SYSTEM

Complaints: None.

Inspection of the Heart:
Shape of the chest in the projection of the heart-reinforced kyphosis, depressions and protrusions
in the heart is not.

Palpation:
The apical impulse is palpable in the fifth intercostal space 1.5 cm medially from the left
sredinnoklyuchichnoy line.

Percussion:

The boundaries of the heart Right Left Upper
The relative dullness of the heart by 1 cm outwards from the right edge of the sternum V
intercostal space 2 cm medially from the left sredinnoklyuchichnoy line III intercostal space, 1
cm to the left of the left sternal line
The absolute stupidity of the heart to the left edge of the sternum V intercostal space, 1 cm
medially from the border of the relative dullness of the heart IV intercostal space

The width of the vascular bundle of 5 cm
The diameter of the heart 12 cm

Auscultation of the heart:
Tones are loud, clear. Auscultated 2 tone, 2 intermissions. Mitral valve auscultated at the apex of
the heart. The aortic valve is auscultated in the second intercostal space to the right of the
sternum. Pulmonary valve stem in the second intercostal space to the left of the sternum.
Tricuspid valve at the base of the xiphoid sternum.

The study of the great vessels:
Pulsation of the carotid artery (carotid dance) is not observed, the visible pulsation of the neck
veins is not defined.


Investigation of the arterial pulse:
Pulse is the same on both the radial artery, the frequency of 60 beats per minute, regular, full,
regular, moderate fullness and height. Pulse deficit is not defined. Vascular wall is elastic, not
sealed. Blood pressure is 120/80.


Musculoskeletal System

Complaints: pain in the spine, more in the neck and shoulders
The sharp restriction of movement in the neck - can not straighten his head bent to the left or
right, pain.
The pain in both shoulder joints and right hip joint, aggravated by movement.

General inspection: enhanced kyphosis of the thoracic spine. Posture posture "supplicant".
Limited chest excursion. Smoothed the lumbar spine.

Pain in the shoulder and hip joints. Doskoobraznaya spin. Dorsal kyphosis. Stiff neck.

Identified symptom Forestier Kushelevsky, Thomayer, Ott and Schober.


Digestive organs

Complaints: None

Inspection of the oral cavity:
Tongue moist, not coated. Number of teeth 32, carious teeth are missing. The gums do not bleed.
The mucous membranes of the oral cavity and pharynx pink, clean, damp. The amygdala is not
increased, the gaps are not deep, there is no plaque.

Inspection of the abdomen:
The form is characterized by a protrusion of the stomach because of the large amount of liquid.
Abdomen enlarged, bulging belly. On the front of the abdominal wall vasculature visible. Color
of skin of the abdomen OK - wheat-colored, marked hernia bulge. When you change the
horizontal position to a vertical belly does not change shape.

Palpation of the abdomen:

Superficial palpation
At a superficial palpation of the abdomen tense, positive symptom fluctuations,
painful.

Deep palpation
It is not possible to carry out because of the large amount of liquid.

Percussion of the abdomen:
Determined by the dull sound is determined by the presence of a large amount of free fluid.


Of the liver:
Not increased, normal.

The upper limit of the absolute stupidity:

lin. Parasternalis Butt VI ribs
lin. clavicularis media dextra lower edge of the rib VI
lin. axillaris anterior VII edge

The upper limit of the relative dullness:

lin. Parasternalis Butt V ribs
lin. clavicularis media dextra lower edge of the rib V
lin. axillaris anterior VI edge

The lower limit ablosyutnoy dullness:

lin. parasternalis sinistra the lower edge of the left costal
lin. parasternalis dextra 2 cm below the lower edge of the right costal
lin. axillaris anterior dextra X edge
lin. Medioclavicularis the lower edge of the right of the arc
lin. mediana anterior 3-5 cm below the lower edge of the xiphoid

Palpation of the liver:
Palpation of the liver is not possible due to the highly strained abdomen and the presence of
liquid. Liver bolatiret.

SYSTEM OF urination

Complaints: None.
Lumbar region when viewed without changes.
Urination is a free, no painful.
The kidneys were not palpable. Pasternatskogo negative syndrome. Percussion sound of bladder
blunt character - filled.


The sense organs
Complaints: a sharp decrease of
Vision:
Hyperopia +3 (d) +4 (s)
Hearing and charm to normal.

The preliminary diagnosis

On the basis of the patient's complaints:
- Pain in the spine, more in the neck and shoulder blades.
- At the sharp restriction of movement in the neck, can not straighten his head bent to the left or
right and there are pains.
- On the chest pain during the act of breathing
- On pain of both shoulder joints and right hip joint, aggravated by movement.
- On the morning stiffness, severe weakness overall. The patient feels weakness throughout the
body, and fatigue.
- The Fall of view.

On the basis of history: He considers himself a patient since 1978, when he got injured. After
that, the patient began to bother a lot of pain on the back of the right and left hip, which has
sharply intensified during motion-sick because of the pain he could not walk. After treatment the
patient's condition improved, the pain passed, and the patient began to walk again. In 1995 there
was morning stiffness, pain in the lower back, general weakness. In med.san of TAPOVICH and
was diagnosed with ankylosing spondylitis, and the patient began to regularly take medication,
physical therapy: ultrasound with diclofenac, massage. Himself regularly took indomethacin,
diclofenac. The patient's condition improved after treatment, but the disease progressed, the pain
increased and the patient with the words "spread the top", pains in the chest, inability to breathe,
in the cervical spine radiating to the back of the head, severely restricting movement of the head
to the side, curvature of the spine in the thoracic kyphosis-gain, pain in the hip and shoulder
joints in motion, limitation of movement, weakness in the lower extremities.
Of bad habits: drink alcohol, smoke.
As a child ill with mumps and measles.

On the basis of objective data
Moderately developed muscles, reduced muscle tone, pain and seals are not detectable.
Abnormal curvature of the spine-reinforced kyphosis of the thoracic spine, "pose petitioner"
flattened lordosis of the lumbar, spine pain when moving the range of motion in the shoulder and
hip joints are limited.
Based on the foregoing may be a preliminary diagnosis
- Ankylosing spondylitis, a central form, slowly progressive course, activity-I. Functional failure
of joints - II. Ro - III.

These laboratory-instrumental study

Complete blood count:

Hemoglobin 104 g / L
Red blood cells are 3.4 * 1012 \ n
Color index 0.9
Erythrocyte sedimentation rate of 10 mm \ h
White blood cells are 5.7 * 109 \ l
Stab 2
Segmented 66
Eosinophil 1
Lymphocyte 31
Monocyte 3

Biochemical analysis of blood:

ALAT 1.1 mmol / l
ACAT 0.6 mmol / l
Bilirubin 13.2 mmol / l
Urea 4.8 mmol / l
Creatinine 0.04 mmol / l
Total protein 69.4 g / l
Sugar 4.6 mmol / l

Urinalysis:

Specific gravity 1.014
10 ml
Color light yellow, muddy
The acidic reaction
Protein 0.099%
Bile acids are not
Urate salts + +
White blood cells are 6-7 in sight
The epithelium 4-5 in sight

ECG:
Sinus rhythm
Heart rate: 60
R-R 0.70
P-Q 0.16
QRS 0.08
Electrical axis is not rejected, with a reduction in metabolism in the myocardium.

EhoKS:
The size of the cavities of the heart is normal.
The valve unit is not changed. Aortic wall is sealed with a moderately rough contours.
The walls of the left ventricle is a small muscle dyskinesia. Contractility is normal.

HbsAg: negative.

Revmoproby:
R-factor - negative.

Radiography:
Ankylosis of the facet joints and calcification of ligaments of the spine, the complete fusion of
the vertebrae - "bamboo stick".



Clinical Diagnosis

Based on the preliminary diagnosis - Ankylosing spondylitis, a central form, slowly progressive
course, activity-I. Functional failure of joints - II. Ro - III.

On the basis of laboratory and instrumental investigations:
TANK: ALT - 1.1 mmol / l
OAM: Protein - 0.099%

EhoKS: The walls of the aorta is moderately compacted with irregular contours. The walls of the
left ventricle is a small muscle dyskinesia.

Radiography:
Ankylosis of the facet joints and calcification of ligaments of the spine, the complete fusion of
the vertebrae - "bamboo stick".

Clinical diagnosis of Ankylosing spondylitis, a central form, slowly progressive course, activity-
I. Functional failure of joints - II. Ro - III.


Differential Diagnosis

1 - Rheumatoid arthritis: characterized by subcutaneous rheumatoid nodules often in the elbow
joint, serozity (adhesive pleurisy and pericarditis), ulnar deviation, a high titer of rheumatoid
factor in the serum. Symmetrical arthritis.

2 - Psoriatic arthropathy: characterized by the prevalence of skin lesions with a history of
psoriasis, arthritis, mainly affecting the distal interphalangeal joints of the hands, with rapidly
progressive bone and cartilage destruction and the development of joint deformities - the so-
called mutiliruyuschy (disfiguring) arthritis.

3 - Reactive Arthritis: characterized by the presence of the genitourinary (chlamydia,
ureoplazma), colon (Yersinia, Shigella, Salmonella) infections. Mostly vospalayutsya joints of
the lower limbs, especially the toes, where a periarticular swelling and bluish or purple-bluish
color of the skin - a finger in the form of a "sausage". Reactive arthritis is not prolonged and held
their own.

The final diagnosis

Based on the preliminary diagnosis - Ankylosing spondylitis, a central form, slowly progressive
course, activity-I. Functional failure of joints - II. Ro - III.
On the basis of clinical diagnosis - Ankylosing spondylitis, a central form, slowly progressive
course, activity-I. Functional failure of joints - II. Ro - III.
On the basis of the differential diagnosis, eliminating reactive arthritis, psoriatic arthritis and
rheumatoid arthritis put a final diagnosis:
Ankylosing spondylitis, a central form, slowly progressive course, activity-I. Functional failure
of joints - II. Ro - III.


Treatment

Sulfasalazine 0.5 tablet 1p \ d inside
Mydocalm 150mg 1tab 1p \ PO qd
Ramitidin 0.15 1tab 2p \ PO qd
Motrin 0.2 1tab 3p \ PO qd
Rr 5% glucose 200ml
Roar of potassium chloride, 4% 10ml
Pp ascorbic to-you-6 ml of 5%
Insulin in 4 pcs \ drip
Nicotine-ta 1% to 2 ml \ complete renewal
Piracetam 20% 10ml
Analgin 25% in 3 ml \ m
Dimelrol 1% 1ml
Novakain 0.25% 2ml
Roar of sodium chloride 0.9% 200ml \ complete renewal
Agapurin 5ml
Physical therapy: ultrasound, DDT, massage
LFK
Acupuncture

DIARY

09/03/2005
The general condition of the patient: Satisfactory
Consciousness: clear - answers the questions correctly without delay.
Complaints:
The patient complains of pain in the chest, the sharp limitation of movement of the cervical
spine. Pain in the right hip joint, both shoulder joints. The weakness in the lower extremities.
The patient feels weakness throughout the body, and fatigue.
Skin; wheat-colored, there is no rash, skin is clean, reduced turgor, skin moisture slightly
increased, hair growth is moderately developed.
Nail plate unchanged pink cyanosis is absent. Edema is not
detected. Pink eye mucosa. Slimy tongue and lips clean pale pink.
Pulse is the same on both the radial artery, the frequency of 60 beats per minute, regular, full,
regular, moderate fullness and height. Pulse deficit is not defined. Blood pressure is 120/80.
Rhythmic breathing frequency of 20 breaths in one minute. Respiratory movements on both sides
symmetrically involved in the act of breathing. Auscultation of the lung fields auscultated
vesicular breathing.
On palpation of the abdomen is soft and painless.


05/09/05
The general condition of the patient: Satisfactory
Consciousness: clear-answers the questions correctly without delay.
Complaints
The patient complains of pain in the chest, on the restriction of movement of the cervical spine.
Pain in the right hip joint and weakness in the lower extremities.
Weakness throughout the body, and fatigue.
Skin; wheat-colored, there is no rash, skin is clean, reduced turgor, skin moisture slightly
increased, hair growth is moderately developed.
Nail plate unchanged pink cyanosis is absent. Edema is not
detected. Pink eye mucosa. Slimy tongue and lips clean pale pink.
Pulse is the same on both the radial artery, the frequency of 70 beats per minute, regular, full,
regular, moderate fullness and height. Pulse deficit is not defined. Blood pressure is 120/90.
Rhythmic breathing frequency of 18 breaths in one minute. Respiratory movements on both sides
symmetrically involved in the act of breathing.
Auscultation of the lung fields auscultated vesicular breathing.
On palpation of the abdomen is soft and painless.

07/09/05
The general condition of the patient: Satisfactory
Consciousness: clear-answers the questions correctly without delay.
Complaints
The patient complains of limitation of movement of the cervical spine. The weakness in the
lower extremities.
Weakness throughout the body, and fatigue.
Skin; wheat-colored, there is no rash, skin is clean, reduced turgor, skin moisture slightly
increased, hair growth is moderately developed.
Nail plate unchanged pink cyanosis is absent. Edema is not
detected. Pink eye mucosa. Slimy tongue and lips clean pale pink.
Pulse is the same on both the radial artery, the frequency of 65 beats per minute, regular, full,
regular, moderate fullness and height. Pulse deficit is not defined. Blood pressure is 120/80.
Rhythmic breathing frequency of 20 breaths in one minute. Respiratory movements on both sides
symmetrically involved in the act of breathing.
Auscultation of the lung fields auscultated vesicular breathing.
On palpation of the abdomen is soft and painless.

Discharge summary

The patient Soliyev Bokhodir.
Date of admission to hospital: 28.09.2005.
Date of issue: 09/08/05.
The diagnosis on admission: Ankylosing spondylitis, central form.
Admitted to the hospital the Republican Center of Rheumatology 2 Tashkent State Medical
Institute with complaints:
- Pain in the spine, more in the neck and shoulder blades.
- At the sharp restriction of movement in the neck, can not straighten his head bent to the left or
right and there are pains.
- On the chest pain during the act of breathing
- On pain of both shoulder joints and right hip joint, aggravated by movement.
- On the morning stiffness, severe weakness overall. The patient feels weakness throughout the
body, and fatigue.
- The Fall of view.
On the basis of history: He considers himself a patient since 1978, when he got injured. After
that, the patient began to bother a lot of pain on the back of the right and left hip, which has
sharply intensified during motion-sick because of the pain he could not walk. It was treated. In
1995 there was morning stiffness, pain in the lower back, general weakness. In med.san of
TAPOVICH and was diagnosed with ankylosing spondylitis, and the patient began to regularly
take medication, physical therapy: ultrasound with diclofenac, massage. Himself regularly took
indomethacin, diclofenac. The patient's condition improved after treatment, but the disease
progressed, the pain increased and the patient with the words "spread the top", pains in the chest,
inability to breathe, in the cervical spine radiating to the back of the head, severely restricting
movement of the head to the side, curvature of the spine in the thoracic kyphosis-gain, pain in
the hip and shoulder joints in motion, limitation of movement, weakness in the lower extremities.
Of bad habits: drink alcohol, smoke.
As a child ill with mumps and measles.
On the basis of objective data
Moderately developed muscles, reduced muscle tone, pain and seals are not detectable.
Abnormal curvature of the spine-reinforced kyphosis of the thoracic spine, "pose petitioner"
flattened lordosis of the lumbar, spine pain when moving the range of motion in the shoulder and
hip joints are limited.

These laboratory-instrumental study
Complete blood count:
Hemoglobin 104 g / L
Red blood cells are 3.4 * 1012 \ n
Color index 0.9
Erythrocyte sedimentation rate of 10 mm \ h
White blood cells are 5.7 * 109 \ l
Stab 2
Segmented 66
Eosinophil 1
Lymphocyte 31
Monocyte 3

Biochemical analysis of blood:

ALAT 1.1 mmol / l
ACAT 0.6 mmol / l
Bilirubin 13.2 mmol / l
Urea 4.8 mmol / l
Creatinine 0.04 mmol / l
Total protein 69.4 g / l
Sugar 4.6 mmol / l
Urinalysis:
Specific gravity 1.014
10 ml
Color light yellow, muddy
The acidic reaction
Protein 0.099%
Bile acids are not
Urate salts + +
White blood cells are 6-7 in sight
The epithelium 4-5 in sight
ECG:
Sinus rhythm
Heart rate: 60
R-R 0.70
P-Q 0.16
QRS 0.08
Electrical axis is not rejected, with a reduction in metabolism in the myocardium.
EhoKS:
The size of the cavities of the heart is normal.
The valve unit is not changed. Aortic wall is sealed with a moderately rough contours.
The walls of the left ventricle is a small muscle dyskinesia. Contractility is normal.
HbsAg: negative.
Revmaproba:
R Factor - negative.
Radiography:
Ankylosis of the facet joints and calcification of ligaments of the spine, the complete fusion of
the vertebrae - "bamboo stick".
Treatment
Sulfasalazine 0.5 tablet 1p \ d Inside
Mydocalm 150mg 1tab 1p \ d Inside
Ramitidin 0.15 1tab 2p \ d Inside
Motrin 0.2 1tab 3p \ d Inside
Rr 5% glucose 200ml
Roar of potassium chloride, 4% 10ml
Pp ascorbic to-you-6 ml of 5%
Insulin in 4 pcs \ drip
Nicotine-ta 1% to 2 ml \ complete renewal
Piracetam 20% 10ml
Analgin 25% in 3 ml \ m
Dimelrol 1% 1ml
Novakain 0.25% 2ml
Roar of sodium chloride 0.9% 200ml \ complete renewal
Agapurin 5ml
Physical therapy: ultrasound, DDT, massage
LFK
Acupuncture
Recommendations:
1. Diclofenac 50 mg-1 Table 2 times after a meal
2. Sulfasalazine 0.5 Scheme
3. Timolin 10mkg - 1.0 mg scheme
4. Physical therapy, exercise therapy, massage
5. Spa treatment

The literary part

Ankylosing spondylitis - a chronic systemic inflammatory disease that affects the sacroiliac
joints, the spine and often - the peripheral joints. Sacroiliitis is a characteristic feature of the
disease. The name of the disease has Greek roots: ankylos, which means "crooked" (ankylosis -
fusion of the joint surfaces), and spondylos, which means the vertebra.

Etiology and Pathogenesis:
Unclear. Great importance is attached to genetic features of the immune system. Ill mostly
males. The disease usually begins at the end of the second - the beginning of the third decade of
life.

Clinic:
Clinical manifestations of ankylosing spondylitis (AS) usually develop in late adolescence or
early adulthood onset after age 40 is rare. The incidence is higher in men than in women (3: 1),
but the AU is usually more difficult to diagnose in women because of the lesser severity of
clinical symptoms and may slow the development of a radiological changes. Patients complain of
back pain with prolonged morning stiffness, and often nocturnal, which decreases with the
movements and exercises. An objective examination revealed tenderness of the sacroiliac joints,
limitation of movement in the spine and sometimes - reduction of the respiratory excursion of the
chest as a result of the defeat of edge-vertebral joints.

Extraskeletal manifestations of AC:
Helps them remember acronym of the first letters of the name of the disease:
A - Aortic insufficiency, ascending aortitis - aortic insufficiency, ascending aorta and other
cardiac manifestations such as conduction abnormalities, diastolic dysfunction and pericardial
effusion (10% of patients);
N - Neurologic - neurologic: subluxation in the atlanto-axial joint syndrome and "horse's tail";
By - Kidney - Kidney secondary amyloidosis and chronic prostatitis;
S - Spine - the spine, fracture of the cervical, spinal stenosis;
P - Pulmonary - Lung: upper lobe fibrosis, restrictive changes;
About - Ocular - eye: anterior uveitis (25-30% of patients);
N - Nephropathy - nephropathy (IgA);
D - Discitis or spondylodiscitis - discitis and spondylodiscitis (symptom Andersen).
Furthermore, 30-60% of patients develop asymptomatic microscopic colitis with localization in
the terminal lesions of the small intestine and colon.
The disease is different, but in most cases there is functionally satisfactory outcome with
preservation of disability. The factors that influence the overall prognosis include ankylosis of
the cervical spine, the defeat of the hip joints, uveitis, pulmonary fibrosis and persistently
elevated ESR. Life expectancy of patients with non-severe AS is usually not reduced.
Diagnostic criteria:
1. Pain and stiffness in the sacroiliac podzvdoshnoy areas that prodolzhayutsya more than 3
months and not be reduced to a state of rest
2. Pain and stiffness in the thoracic spine
3. Limited mobility of the lumbar spine
4. Restriction of respiratory excursion of the chest
5. The presence of iritis, iridocyclitis history or their consequences
6. Radiological evidence of bilateral sacroiliitis

The treatment program for illness Behterova
1. Mode - keep the posture, the bed should be tight.
2. NSAIDs - indomethacin and phenylbutazone (almost have a specific effect in ankylosing
spondylitis.) - 1 tablet 4 times a day.
3. Treatment with glucocorticoids - intra-articular injection of hydrocortisone with the active and
long-term arthritis.
4. Sulfasalazine treatment - is used as the reference drug, acting on the pathogenetic mechanisms
of the disease, began to use sulfasalazine 2-3 g per day for several months.
5. Treatment nonhormonal immunosuppressants - azathioprine 50-100 mg per day,
cyclophosphamide 50-100 mg per day, hlorbutin 5-10 mg per day and treatment is continued for
2-3 months.
6. Treatment of muscular spasm - izopretan administered with 0.25 g of 2-3 times a day
skutamil-C 1 tablet 3 times daily.
7. Physiotherapy, massage, physiotherapy.
8. Spa treatment.