Diagnosis

The diagnosis is made on the basis of symptoms and physical examination in combination with laboratory and X-ray findings. Internationally accepted for the diagnosis of Morbui. Bekhterev has adopted the modified New York Criteria of 1984: The problem is that reliable X-ray changes only occur after an average of 5 to 9 years.

Manifestations outside the joints are frequent and can be the first manifestation, so that early forms of Bekhterev’s disease often cannot be diagnosed. – Deep-seated back pain and stiffness for more than 3 months. Improvement through movement, but not through rest.

Restricted mobility of the lumbar spine in the sagittal and frontal plane. – Restricted breathing excursion of the thorax to <2.5cm (corrected for age and gender). – Inflammatory changes in the sacroiliac joints (sacroiliitis > grade 2 bilateral or grade 3-4 unilateral).
If three clinical criteria are met. – If only the radiological criterion without clinical criteria is met. – Diagnosis1.

Clinical criteria: Deep-seated lower back pain and stiffness for more than 3 months. Improvement by movement but not by rest. Limited mobility of the lumbar spine in the sagittal and frontal plane.

Restricted breathing excursion of the thorax to <2.5cm (corrected for age and gender). 2nd radiological criterion Inflammatory changes in the area of the sacroiliac joints (sacroiliitis > grade 2 bilateral or grade 3-4 unilateral). – Deep-seated lower back pain and stiffness for more than 3 months.

Improvement through movement, but not through rest. – Restricted mobility of the lumbar spine in the sagittal and frontal plane. – Restricted breathing excursion of the thorax to <2.5cm (corrected for age and gender).

Inflammatory changes in the sacroiliac joints (sacroiliitis > grade 2 bilateral or grade 3-4 unilateral). – Graduation1. Safe ankylosing spondylitis:if at least one clinical criterion and the radiological criterion are met.

2. probable Mb. Bekhterev:if three clinical criteria are met. If only the radiological criterion is met without clinical criteria. – If three clinical criteria are met. – If only the radiological criterion is met without clinical criteria.

Laboratory values

About 90% of patients suffering from Bekhterev’s disease have the human leukocyte antigen B27 in their blood. However, the HLA-B27 determination is not suitable as a screening test. However, if the symptoms, physical examination and radiological findings lead to suspicion of ankylosing spondylitis, a positive HLA-B27 increases the probability of diagnosis.

Increased inflammatory values in the blood, such as CRP (C-reactive protein) and an accelerated sedimentation rate (BSG), correlate with the inflammatory activity and can therefore be used to monitor the course of the disease. In mild cases, however, these can also be within the normal range. HLA determination is also performed as part of the diagnosis of ankylosing spondylitis.

The radiological changes in the area of the sacroiliac joints are of great importance for the diagnosis of ankylosing spondylitis, but are not suitable for assessing the course of the disease. Radiological signs of sacroiliitis (inflammation of the sacroiliac joint) are a blurred joint contour with sclerosis (compression of the bone) and erosions (bone dissolution) close to the joint (so-called colorful picture). In the area of the spinal column and the peripheral joints, the radiological changes are more suitable for assessing the course of the disease.

They are the result of inflammatory destruction and mostly frustrating repair procedures. The following can be observed on the X-ray image: At the spinal column, spondylodiscitis, box vertebra formation, spondylophyte formation, bony bridge formation and finally complete joint or vertebral body fusion (so-called bamboo rod). – Erosions

Sclerotherapy
Joint space narrowing
Fuzzy joint contours
Syndesmophytes (calcification of the ligaments of the spine, so that the vertebral bodies are functionally connected to each other) and
Bone spurs.