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LA SPONDILITE ANCHILOSANTE

 
LA SPONDILITE ANCHILOSANTE
 
 
 
La Spondilite Anchilosante (SpA) o spondilite anchilopoietica è tra le spondiloartriti la patologia più comune e con il decorso più severo. La SpA è una malattia reumatica infiammatoria cronica che coinvolge prevalentemente il rachide e le articolazioni sacroiliache.
Tale condizione è responsabile di dolore lombare, rigidità e progressiva riduzione della capacità funzionale del rachide con gravi conseguenze sugli aspetti socio-economici.
Nel gruppo delle malattie reumatiche infiammatorie, la SA è la diagnosi più comune dopo l’Artrite Reumatoide. La sua prevalenza è stata a lungo sottostimata. La SpA e le Spondiloartriti Indifferenziate (SA) sono i sottogruppi più comuni nei paesi occidentali, con una prevalenza compresa tra 0.2 e 1.2 %.
La SA ha un'incidenza 3 volte maggiore nel sesso maschile ed esordisce in genere in soggetti giovani con età compresa tra i 20 e i 40 anni. È 10-20 volte più frequente in parenti di primo grado di pazienti con SA,rispetto alla popolazione generale e l'aumentata prevalenza dell'antigene tissutale
HLA-B27 nei bianchi oHLA-B7 nei neri, suggerisce una predisposizione genetica, benché fattori ambientali possano svolgere un ruolo determinante nell’esordio. Si stima che il rischio potenziale di sviluppare la SA, per individui con HLA-B27 positivi, è di circa il 20%. E’ la patologia umana con la più forte associazione mai descritta con un antigene HLA: esso è rilevabile il oltreil 90% dei pazienti portatori di SpA.
 
Unodei sintomi più precoci della spondilite anchilosante è il mal di schiena a livello lombare (lombalgia) definito di tipo“infiammatorio”, ossia caratterizzato dai seguenti elementi: ha un esordioinsidioso e di lunga durata, di solito in un paziente giovane, peggiora con ilriposo notturno, causa una notevole rigidità al mattino e migliora con il movimento.
Questo dolore deve essere distinto dal comune mal di schiena, definito“meccanico”, che di solito colpisce all’improvviso soggetti anche in età avanzata, spesso dopo uno sforzo, migliora con il riposo ed è più spesso associato ad artrosi della colonna.
La lombalgia infiammatoria può comparire molto lentamente o presentarsi con intermittenza, ma se sottovalutata può portare a una progressione irreversibile del danno a livello delle vertebre.
Oltre alla colonna vertebrale, possono essere coinvolte le articolazioni sacroiliache (tra osso sacro e bacino) e le inserzioni di tendini elegamenti sulle ossa (dette “entesi”) soprattutto a livello di calcagno ecartilagini costali.
 
 

Le complicanze della spondilite anchilosante sono diverse sia per la sede in cui compaiono sia per la loro gravità.
Tra queste ricordiamo:
 
uveite:un'infiammazione dell'occhio, che si manifesta con dolore all'occhio, aumentata sensibilità alla luce, visione annebbiata;
 
difficoltà  respiratoria per il coinvolgimento delle ossa a livello toracico;
 
infiammazioni dell’aorta,che può subire alterazioni tali da coinvolgere anche la valvola aortica.
 
I farmaci di primo impiego sono gli antinfiammatori nonsteroidei (FANS), che tuttavia non modificano il decorso della malattia, mahanno solo un effetto sui sintomi.
Tra i farmaci di fondo, il più usato è la sulfasalazina. Più recentemente sonodisponibili i farmaci biologici, come gli inibitori del TNF (Tumor NecrosisFactor), che sono molto più efficaci nel controllare il dolore e sembrano essere in grado di interferire con l’evoluzione verso l’anchilosi.
La fisioterapia è un sussidio terapeutico fondamentale per migliorare lapostura e recuperare una normale motilità.
Importante anche la ginnastica respiratoria, in quanto la malattia può provocare una grave sindrome restrittiva. I pazienti devono smettere di fumare.
 
Attività fisica
L’attività fisica mirata è parte integrante nella gestione di ogni programma terapeutico nella spondilite anchilosante. Se svolto quotidianamente aiuta a mantenere una postura corretta, contribuisce a migliorare l’escursione articolare e svolge un’azione antalgica.
E’ tuttavia importante farsi guidare, soprattutto all’inizio, dal fisiatra e fisioterapista al fine di ottenere il massimo beneficio.
Si descrivono di seguito alcuni esempi esemplificativi.
 
Riscaldamento
Marciare velocemente sul posto per un minuto staccando il più possibile i piedi dal suolo e contemporaneamente portare in alto le braccia estese per 20 secondi, poi in avanti per altri 20 secondi ed infine di lato per ulteriori 20 secondi.
 
Esercizi di stretching
        1. Posizionarsi a quattro zampe. Tenere i gomiti diritti, mantenere la testa tra le spalle ed inarcare la schiena il più possibile.                                                                                  
 
 
 
        2. Alzare la testa ed incurvare la schiena il più possibile. 
 
 
 
 
       
         3. Mantenendo la testa alzata, portare il braccio destro in avanti e la gamba sinistra indietro. Tenere per 5 secondi.    Ritornare a quattro zampe e cambiare braccio e gamba.
 
 
 
 
 
 
         4. Posizionarsi di fronte ad una sedia, con il sedile morbido. Appoggiare il tallone destro sul sedile, tenendo il ginocchio diritto piegarsi il più possibile cercando di andare a toccare con entrambe le mani le dita del piede. Tenere per 6 secondi e poi riposare.
 
 
 
 
 
 
 
         5. Ripetere 2 volte, cercando di allungarsi sempre di più ogni volta. Rilassarsi dopo ogni allungamento e ripetere con la gamba controlaterale. L’esercizio si può eseguire anche da seduto appoggiando il tallone su uno sgabello.
 
 
 
 
 
 

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0 on giovedì 14 febbraio 2019 04:38
Monetary advisors enterprise is people enterprise.
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0 on venerdì 15 febbraio 2019 05:29
Contemplate investments that offer immediate annuities.
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All types of investments include sure risks.
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Thank you in your interest in Funding Recommendation.
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Now it is time to decide your specific investments.
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All kinds of investments come with certain dangers.
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And that is an funding risk price taking.
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Investors do pay direct and indirect costs.
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