A young, approximately 35-year old man named Jozef came to our outpatient’s office in Turčianske Teplice spa. The physician knew immediately, and the documentation by rheumatologist who had sent the patient proved, that the young patient’s backbone was curved by Bechterew's disease. He had been suffering from the disease for more than 10 years. Pain had begun in lower back and gradually spread to the whole spine. At first, the patient did not care much about it, however the difficulties intensified and the pain spread to loin (so-called early morning stiffness). He attended a physician several times and was sent for a special examination by a rheumatologist some time later. The rheumatologist made the diagnosis based on clinical and laboratory examination results – the Bechterew's disease.
Jozef realized that treatment was necessary after he had undergone the spa treatment for the first time, and it helped much.
Jozef started to use pain killers and anti-inflammatory drugs but he did not do any exercise at first. He was in pain, could not sleep at nights, he even could not bend forward, he could barely tie his shoelaces, he was stiffed and found it difficult to get in a car. He hesitated to admit to his friends and relatives that he had increased the doses of analgesics. Then he took a spa treatment for the first time. The treatment helped much and he realized that the physical treatment and medical exercises were important. Since then he takes a spa stay every year and he does exercise every day at home. The quality of his life improved so much that he can do his job, spends time with his family actively and does recreational sport activities. In spite of his disease and handicap he said a couple of years ago: “The disease taught me to live differently, to do exercise, swim and take spa treatments regularly. It helped me indeed.”
Bechterew's disease or ankylosing spondylitis is a system inflammatory disease of musculoskeletal apparatus. It affects spine joints, gradually causes ossification of articular capsules and a part of fibrous ring of intervertebral discs, and of adjacent fibrous tissues, too. In more than one half of cases, it also affects arm and hip joints, in approx. 20% of cases (especially of women and youth) it affects other limb joints, too. The disease develops to a full extent especially in men and it begins usually in the third decennium. It occurs in 0.2 – 0.3% of adults. The disease appears usually at rest and at night as stiffness and it wakes the diseased up. Warm-up exercise and heat brings relief. The main manifestations of disease include pain and limitation of mobility, gradual limitation of rotation and sideways movements of lumbar spine, breathing movements of chest are reduced and finally the cervical spine mobility is limited. Posture of a patient suffering from this disease is typical and thanks to such posture a physician is often able to make a diagnose right after such patient enters the physician’s office. Neck stooped forward is a typical feature, as well as rounded shoulders, straightened lumbar spine, flattening chest and posture fixed in forward bend position. Although it’s not that often, the disease can also strike other parts of body, such as eyes, heart, lungs, and it can cause compression of the spinal cord and nerve roots. The treatment includes taking pain killers and anti-inflammatory drugs aimed to moderate the manifestations of the disease. A whole range of anti-rheumatics and analgesics is available to be prescribed according to the character and intensity of the disease.
Jozef learnt how to live with the disease and how to fight it. Every year he spends at least one three-week treatment stay in the spa, where he takes baths in thermal water every day, thermotherapy in a form of warm compresses 3 times a week, classic massage 3 times a week, medical exercise in water 3 times a week, magnetotherapy, hydrotherapy and very important medical rehabilitation. He also exercises daily and swims in a pool for 45 minutes. In the evenings he meets his new friends from the spa, he does not say no to music performances and he likes dancing.
During the first week in the spa he might feel tired and pain might seem to be more intense, but then the condition improves significantly, and pain and stiffness decline.
Complex spa treatment of this disease in combination with suitable medicament treatment brings the best effects for patients.
At the end of the treatment stay, Jozef wakes up in the morning with less stiffness, he is able to bend forward and he almost manages to touch the floor with his fingertips. Pain is reduced to minimum and he can cut the pain killers dosage to a half, while the biggest benefit is that the positive effect remains several months after the spa treatment, as he proudly informs us when he arrives for another stay.
Considerable positive effect was achieved thanks to the use of appropriate natural healing sources (mineral thermal spa and thermotherapy procedures including peloid, peat and paraffin) in combination with a wide range of modern rehabilitation treatment and physical treatment possibilities. Objective observation showed that, unlike other rheumatic diseases, Bechterew's disease and the related inflammatory process can be influenced in a positive way by spa treatment. Balneotherapy is indicated for developed stages of the disease.
In spite of remarkable progress of clinical medicine, a complex spa treatment of this disease remains justifiable and irreplaceable. The aim is to prevent deformities, strengthen and tone muscles, to practise proper breathing. Daily exercise is an inherent part of life and lifestyle. We recommend sleeping on a hard bed, swimming and exercising. Although pain might limit lifestyle and treatment, prognosis is good if the disease is diagnosed early. 70 – 75% of the ill live active lives. Temporary disability to work can occur during an acute phase. Although this disease cannot be cured, it does not shorten life and it even does not deteriorate quality of life if a good daily regimen is followed, if appropriate treatment is taken and if a patient exercises daily. It is proved by Jozef and hundreds of other patients who spend a spa treatment stay and follow our advices further in daily life.
Author: MUDr. Marián Markech, MPH – Director of Health Care Division of Slovenské liečebné kúpele Turčianske Teplice, a.s.
