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Jon Erlendsson Morbus Bechterew

Morbus Bechterew - eksperten har selv sygdommen


Sygdommen:
Morbus Bechterew er en gigtsygdom, som først og fremmest angriber ryggen og leddene mel-lem korsbenet og hoftebenene i bækkenet. Det betyder smerter og stivhed i ryggen.
Årsagen til Morbus Bechterew kender vi ikke endnu. Men sygdommen er ikke smitsom, og den skyldes for eksempel ikke skader efter ulykker eller overbelastning.
Symptomerne begynder typisk at vise sig i 20-30 års alderen. Nogle har dog haft tilbageven-dende rygsmerter helt fra teenageårene. Smerter lindres ved bevægelse - derfor ofte natlige spadsereture og følgende træthed hos patienterne.

Sygdommen opstår på grund af en såkaldt reumatisk inflammation - en form for betændelse uden bakterier. Betændelsen angriber for det meste de steder, hvor sener, ledbånd og led-kapsler hæfter på knoglerne. Men også ledhinden, en slags slimhinde inde i leddene, kan blive ramt.
Der hvor diskus hæfter i kanten af ryghvirvlerne opstår der ofte betændelse - vævet nedbry-des - arvæv dannes og forkalker, således at der vokser en "krave" af knoglevæv ud fra kanten af hvirvlen, der ofte til sidst når nabohvirvlen. Det begrænser ryggens bevægelighed, hvilket i sig selv kan medføre forkalkning. En ond cirkel er startet.

Jon Erlendsson har meget lidt bevægelighed i ryggen

Diagnose:
Sygdommen har hidtil været svær at diagnostisere.
Der går ofte ret lang tid, før man kan stille diagnosen Morbus Bechterew, og det er der flere grunde til.

For det første begynder sygdommen som regel gradvist og er ofte afbrudt af gode perioder uden eller med kun få gener. For det andet findes der ikke nogen enkelt prøve, som man kan bruge til at afgøre, om en person har sygdommen, og blandt de mange, der har rygsmerter, er der kun få, der har Morbus Bechterew.
Nu giver MR scanninger håb for tidligere diagnose og dermed bedre behandling.
Årsagen til sygdommen er endnu ukendt.
Mellem 5 og 10.000 danskere lider af Morbus Bechterew,. Sygdommen er 2-3 gange hyppige-re blandt mænd.
Behandling:
Hidtil har fysiske øvelser og NSAID-præp. der primært lindrer smerterne været behandlingen,.
Med en spæd start år 2000 er man begyndt at bruge det biologiske lægemiddel TNF-alfa-hæmmere, der bremser betændelsesprocessen, lindrer smerterne og dermed er med til at sik-re knapt så trætte patienter.
Betændelsen mindskes som nævnt, men de afledte effekter over tid og bivirkninger kendes endnu ikke.

Kilde: Gigtforeningen for Morbus Bechterew

http://www.dr.dk/DR1/laegen/Programmer/2006/060216/20060216110856.htm


Morbus Bechterew er en speciel gigtlidelse, der kommer snigende tidligt i livet og rammer ryggen hos flere mænd end kvinder. Ny medicin og motion holder dog de fleste patienter i sving

– Nej, det hører til sjældenhederne, at folk dør af Morbus Bechterew, så det er en sygdom, man må lære at leve med, siger overlæge Jon Erlendsson. Og han ved noget om sygdommen, for ikke alene har han virket som reumatolog ved Horsens Sygehus i mange år; han har også selv lidt af denne specielle, inflammatoriske gigtlidelse i over 40 år.

Den nu pensionerede overlæge er også virksom i Gigtforeningen for Morbus Bechterew, der omfatter cirka 1.100 medlemmer, men det antal dækker ikke alle danskere, der har lidelsen.

– Hvor mange, der har Morbus Bechterew, er et godt spørgsmål, for dels er sygdommen ikke nem at diagnosticere og opfattes først som almindelig ondt i ryggen, så en del går nok rundt uden diagnose. Og dels går der lang tid, inden diagnosen stilles, forklarer Jon Erlendsson. Han anslår dog, at mellem en og to promille af befolkningen er ramt af sygdommen.

Tidlig debut
Karakteristisk for Morbus Bechterew er, at den dukker op tidligt i livet, det vil sige i alderen mellem 20 og 30 år, men hos nogle allerede i teenage-alderen. Og sygdommen rammer to-tre gange så mange mænd som kvinder.

– Men det tal er også usikkert, vurderer Jon Erlendsson og fortæller, hvordan han selv allerede i sin gymnasietid mærkede de første symptomer.

– Jeg følte strålende smerter ud i det ene ben. Men så kunne der gå flere måneder, hvor intet var galt. Og så er det jo ikke nemt for en læge at finde ud af, hvad der er i vejen, når der ikke optræder symptomer, siger han og fortæller, at hans symptomer efter flere år lige så stille tog til og efterhånden også omfattede morgenstivhed i ryggen og smerter i lænden.
Ikke desto mindre lykkedes det Jon Erlendsson at uddanne sig til pilot i forsvaret og flyve i seks år, inden han skiftede karriere og gav sig i kast med medicinstudiet.

– Og der var jo lange, gode perioder, hvor jeg ikke havde symptomer, husker han og påpeger, at de strålende smerter ud i benene indfandt sig skiftevis i det ene og det andet ben.

– Og det er helt typisk for Morbus Bechterew i modsætning til en mekanisk ryglidelse som for eksempel en diskusprolaps, siger han og tilføjer, at rygsmerter ved Morbus Bechterew aftager ved bevægelse, hvorfor patienter ofte må op midt om natten for at lindre sig ved at vandre lidt rundt. Den lindring vil andre rygpatienter ikke opleve.

Betændelse
Morbus Bechterew kaldes også rygsøjlegigt eller spondylitis ankylopoietica og skyldes betændelse med efterfølgende ardannelse og forkalkning i leddene mellem korsbenet og hoftebenene.

Sygdommen er i nogen grad arvelig og opstår helt typisk i bækkenets korsbåndsled og kan brede sig til rygsøjlen med nedsat bevægelighed af rygsøjlens led til følge. Med tiden vil ryggens svaj forsvinde, og ryggen krummes forover.

Hos 20-30 procent af patienterne fører sygdommen også til gigt i armenes og benenes led, der hæver og smerter, og et lignende antal patienter oplever tilmed betændelse i øjnenes regnbuehinde.

– Sygdommen skyldes altså betændelse i leddene, men årsagen til betændelsestilstanden kender man ikke, siger Jon Erlendsson, som tilføjer, at der blandt forskere hersker velbegrundet mistanke om, at sygdommen skyldes en overreaktion i patienternes immunforsvar. Men præcis imod hvad, ved man ikke.

Morbus Bechterew er dermed i familie med andre autoimmunlidelser som for eksempel psoriasis og Morbus Crohn samt Colitis Ulcerosa.

Vanskelig diagnose
Et betydeligt problem ved Morbus Bechterew er dens snigende karakter, hvor den tilmed i lange perioder kan ligge latent uden nævneværdige symptomer.

– Og sygdommen findes i alle grader, men fælles er, at der går lang tid, tit omkring syv år fra de første tegn viser sig, indtil diagnosen bliver stillet, siger Jon Erlendsson. Han tilføjer, at det forløb både betyder, at patienterne typisk går længe i usikkerhed om, hvad der er galt med dem, hvilket i sig selv er en belastning og et problem, idet betændelsesudbrud også medfører træthed. Et andet problem er, at den sene diagnose forhindrer en tidlig behandling.

– Diagnosen er vanskelig, da sygdommen ikke kan konstateres ved blodprøver, men ved røntgenundersøgelse af bækkenets knogler. Og patienten skal typisk langt ind i sygdomsforløbet, inden man kan se forandringer i knoglevævet på røntgenbilleder. Derfor er det også et stort fremskridt, at man nu kan benytte MR-scanninger, hvor man tidligt kan konstatere væskeophobninger ved leddene. En sikker diagnose kræver dog stadig røntgenkonstatering af knogleforandringer, men der arbejdes på, at MR-scanninger kan anerkendes som diagnoseform, siger Jon Erlendsson. Han tilføjer, at patienter skal have oplevet mindst tre måneders konstante smerter i lænden, før man har så megen mistanke om Morbus Bechterew, så man går i gang med undersøgelser, der kan føre til, at diagnosen stilles.

Hidtidig medicinsk behandling
Behandlingen af Morbus Bechterew relaterer sig til udbruddets form og sværhed.

– Patienter med basislidelsen i bækkenet og rygsøjle vil få NSAID-præparater, altså nonsteroide antiinflammatoriske stoffer plus eventuelt noget smertestillende, oplyser overlægen.

– Den tredjedel af patienterne, hvor også perifere led i arme og ben er angrebet, vil yderligere få sulfasalazin. Og deres ledhævelser kan behandles lokalt med injektion af binyrebarkhormon. Endelig får omkring 20 procent af patienterne regnbuehindebetændelse, som behandles med binyrebarkhormon som øjendråber eller salve, ofte suppleret med et stof, der udvider pupillerne, forklarer han.

Jon Erlendsson tilføjer, at der her er tale om den hidtidige standardbehandling, men at nogle Bechterew-patienter i de seneste år har haft afgørende god effekt af en ny medicinform, TNF-alfahæmmere.

Ny og dyr behandling
– Den medicin afprøves stadig og ser ud til at have en særdeles god effekt på mellem en tredjedel og halvdelen af patienterne, der virkelig blomstrer op; nogle fra den ene dag til den anden. Men dels kender vi ikke langtidsvirkningerne af behandlingen, og dels er den dyr, så vi indhøster her erfaringer med patienter, der ikke har et godt behandlingsalternativ og kan så vurdere effekten i forhold til at udbrede brugen af TNF-alfahæmmere i fremtiden, forklarer overlægen, som understreger, at Morbus Bechterew er en kronisk sygdom, der kræver kronisk behandling.

– Med de anførte forbehold betragter vi klart de nye TNF-alfahæmmere som en revolution i behandlingen af Bechterew-patienter, idet det er første gang, vi har en medicin, der på afgørende vis dæmper gigtbetændelsen. Vi har også håb om, at den vil kunne reducere forkalkningen, men det er endnu ikke klarlagt, siger Jon Erlendsson.

Motion og liv
Tidlig diagnose og behandling er afgørende for at holde Morbus Bechterew stangen, men i det daglige er motion en vigtig indsats for den enkelte patients velbefindende, lyder det fra Gigtforeningen for Morbus Bechterew.

Patienter får tilbudt motionsprogrammer udformet af fysioterapeuter og kan komme på motionskurser på gigthospitaler, hvor de lærer at holde rygsøjlens led i bevægelse.

– Motion er under alle omstændigheder en god ting, da det øger muskelstyrken og lindrer, men om den forebygger i sig selv er nok et spørgsmål, mener Jon Erlendsson, der fortæller, at han også selv har et motionsprogram, som han gennem mange år har fulgt.

– Men i dag er min rygsøjle helt forkalket, så nu holder jeg mig i gang med gåture, siger den 64-årige overlæge, hvis brystkasse også er blevet stiv som følge af sygdommen, hvorfor han også oplever nedsat lungefunktion.

– Så patienter med Morbus Bechterew har yderligere et godt argument for at lade være med at ryge, påpeger han og tilføjer, at en alvorlig sideeffekt af sygdommen er risiko for brud på rygsøjlen, idet osteoporose er en tidlig følgesvend til Morbus Bechterew.

– Men man kan altså leve med sygdommen, og man behøver bestemt ikke at blive invalid, siger han, hvad han også selv er et godt eksempel på.

– 70 procent af patienterne med Morbus Bechterew er i arbejde 20 år efter sygdommens udbrud, og med bedre diagnosemuligheder og ny medicin kan den statistik sikkert blive afgørende bedre, vurderer Jon Erlendsson, som har et godt liv på trods af, at sygdommen har hindret ham i at tage belastende vagter på arbejde og også de senere år har forhindret ham i for eksempel at tage en cykeltur eller løbe på ski.

– Og der er også rejser, jeg ikke kommer på. Så sygdommen har besværliggjort mit liv, men bestemt ikke spoleret det, siger han.
Fakta
Gammel sygdom
Morbus Bechterew er opkaldt efter den russiske pionér inden for psykologi og neurologi Valdimir Mikhailovitch von Bechterew, der levede fra 1857 til 1927 og blev professor i Skt. Petersborg i 1893. Her grundlagde han et psykoneurologisk institut i 1907 og arbejdede blandt andet på at beskrive reflekser ligesom hans bedre kendte kollega Pavlov, der benyttede hunde i forsøg.
Morbus Bechterew er i øvrigt ikke nogen ny sygdom, idet knoglevævsforandringer, der typisk følger af sygdommen, er konstateret hos mumier fra det gamle Ægypten, for eksempel af Ramses II, der blev 87 år og levede som en mægtig hersker.

http://www.farmakonom.dk/Nyt/Fagbladet/Artikler/Sygdom%20behandling%20og%20medicin/2006_13%20Rygrad%20til%20livet.aspx

08:17 minutes
Tags: Bechterew, Erlendsson, Jon, Morbus

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