Treatment of Chlamydial Spondylitis
ENZYME THERAPHY WITH STREPTOKINASE (SK) IN TRATMENT OF CHLAMYDIAL SPONDYLITIS, SPONDYLARTHROSIS AND ANKYLOSING SPONDYLITIS OF UROGENITAL ETIOLOGY
Janis Zalkalns, professor, RSU vice-rector, president of Latvian Enzymologists' Association
Pavels Ivdra, urologist of Riga clinical hospital "Gailezers"
Inara Ancupane, privatdocent, president of Latvian Chlamydiologists' Association

Janis Zalkalns
 Pavels Ivdra
 Inara Ancupane

The aim of the article is

 

to inform family doctors, neurolgists, urologists, therapists - rheumatoogists, vertebrologists, etc. doctors about the possibilities of treating spondylitis, spondylarthrosis and ankylosing spondylitis caused by Chlamydia trachomatis infection by SK [1].

Description

Within the period from 1981 to 2001, the Urology Ward No.11 of Riga clinical hospital "Gailezers" has introduced enzyme therapy with streptokinase to 2132 chronic prostatitis patients aged from 13 to 82 years. In cases of chronic antibiotic resistant prostatitis, paraprostatitis and other urogenital inflammations, every third patient, on average, was complaining of pains in the the neck, chest, lumbar, sacral regions, and in many cases the syndrome of skeletal pains [1].

From many infectious agents which tend to be the etiological factors for fibrosis of spinal ligaments and sclerosis, Chlamydia trachomatis, as an intracellular infection takes up a dominant position in the development of urogenital infections and complications.

The etiogenetic factor in spondilosis of urogenital origin is mainly due to the infection of antibiotic resistant chlamydia [2,3]. The relationship between spondylosis, lumbosacral pains, prostatitis, paraprostatitis and urogenital venous plexus inflammation of pelvis minor can be observed in almost 50% of patients [4,5,6,7].

The latent course of chlamydial- caused infections with a syndrome of general disorder most commonly causes difficulties for the differential diagnosis in treating late inflammatory forms and their complications [8].

Patients, not receiving the etiopathogenetic therapy, but only being guided by the dominant skeletal pain syndrome, most commonly go to the neurologist who indicates pain-relieving drugs and various symptomatic therapies.

SET therapy with Wobenzym or Wobe-Mugos is ineffective in spondylosis.

An adequate fibrinolytic enzyme therapy for prostatitis, paraprostatitis ,etc. late inflammatory forms of urogenital etiology is based mainly on streptokinase, urokinase and t-PA - tissue plasminogen activator.

When treating patients with SK for spondylitis due to chlamydial infection, it is possible to achieve the regression of the inflammatory processes of fibrosis and sclerosis.

Routine therapies indicated by urologists are effective only in the I and II alteration and exudation inflammation phases, but not in the III or IV phases as it is in the case of ankylosing spondylitis. The dominant syndromes of clinical disorders desorient not only patients but doctors as well.As a result, patients are not treated for the infectious chlamydial prostatitis and spondylitis of urogenital etiology, but are indicated only a symptomatic pain-relieving therapy [8].

The incidence of spondylitis, spondylarthrosis and ankylosing spondylitis complications depends on the translocation of the infection to the neighbouring tissues and organs (sacroileitis).

The infection from pelvis minor and the prostate through hematogenous and lymphogenous ways gets into the lumbar, chest and neck vertebrae. The early antimicrobial therapy for urogenital inflammations is effective to delay the translocation of chamydial infection and the exacerbation of spondylitis. In case of antibiotic resistance it is difficult to prognose the recovery or to provide a sustainable remission.

Analogous to males, females too may have urogenital tract chlamydial infections at the background of etiopathogenesis of spodylitis, spondylarthritis and akylosing spondylitis [9,10]. Spondylitis of urogenital etiology in its inflammation phase III - IV is manifest by longitudinal and intervertebral ligament fibrosis and sclerosis. X-ray examination visually confirms deformative spondylosis of the spine and the diagnosis of ankylosing spondylitis. Skeletal pain syndrome makes patients go to the neurologist and not to the urologist. The neurologist indicates pain-relieving and other symptomatic therapy. Not all patients are referred to the urologist timely. As a result, one has to treat the consequences of the complications, but not the cause.

If spondylitis is cliniclly and roentgenologically manifested, then conventional antimicrobial therapy due to antibiotic resistance is ineffective.

There are no literature data on long-term prognosis which could demonstrate the positive effect of medicamental therapy of ankylosing spondylitis. Antibiotic resistance is the main difficulty in cases of spondylitis as a result of urogenital chlamydial infections. Therefore in many cases the antichlamydial antibacterial therapy is ineffective.

Not receiving etiopathogenetic therapy with SK, the degenerative-dystrophic prcesses in the spinal vertebrae do not regress. Involution signs and premature aging are quickly progressing.

Regression of spinal ligament fibrosis, sclerosis and other degenerative dystrophic processes can be achieved by introducing the treatment with streptokinase (SK), urokinase (UL) and tissue plasminogen activator (t-PA) [11].

It is important at least to repeat III-IV enzyme therapy courses until the remission period is achieved showing a constant level of hypocoagulaemia. The threshold level of hypocoagulaemia has to be maintained for a longer period of time, and only then the antibiotic resistance would disappear and the inflammation regress.

Clinical case 1

Patient T. 59 yrs.old was treated for 84 bed days at the hospital Urology ward because of infectious prostatitis and the spinal neck and chest vertebral spondylitis and spondylarthritis of urogenital etiology.

Clinical diagnosis:

1) Urogenital chlamydiosis
2) Chronic clamydial prostatitis
3) Antibiotic resitance
4) Urogenital etiology of spinal deformative spondylosis and spondylarthrosis ( diagnosed microbiologically and roentgenologically)

- X-ray pictures of the spinal neck region in 2 standard projections and 2 functional X-ray pictures.
- Moderately straightened up physiological lordosis of the neck part.
- Minimum signs of destabilization Vc4-5 flexion in functional X-ray picture.
- Marked degenerative changes vC5-6-7, vertebral laminae are prolonged with subchondral sclerosis signs, with tiny dorsal and bigger ventral spondylophites. Narowed, marked intravertebral fissure vC6-C7, a less narrower intervertebral fissure vC5-C6,vC5-C7 picture of spondylarthrosis.

Conclusion

Disorder of the posture of the spinal neck part, a slight destabilization.
Intravertebral osteochondrosis, deformative spondylosis and spondylarthrosis.
X-ray picture fo the spinal thoracic part in 2 projections.
X-ray includes Th4-Th12.

Slight degenerative changes predominantly with changes in medial thoracicovertebral segments. Vertebral laminae are slightly elongated, one can see tiny,central and lateral type spondylophites vTh7-Th10.

Degenerative changes of a lesser degree are seen in Th11-Th12 and above Th7.

The patient had been ill for more than 4 years. He had been treated by different neurologists and urologists. He was complaining of frequent urination of a poor spurt every 2 hours. He noticed pains in the nape,the back between the scapula and sacrum. Libido was markedly low. Transrectal (USS) ultrasonoscopy showed crude calcinates in a transition zone on the left side which proves the III-IV phase of the prostate inflammation. Due to the antibiotic resistance, the antibacteial therapy without administration of streptokinase and urokinase has not been effective.

During 84 days of the enzyme therapy the patient received:

1. Streptokinase 5 000 - 500 000 e.u. i/v once a day, in total 10 760 000 e.u.
2. Urokinase from 25 000 - 50 000 UI once a day for 40 days, in total 1 850 000 UI.
3. Heparin 5 000 u. i/v ince a day, in total 420 000 u.

Simultaneously the patient received: Doxycyclin in capsules, Azythromycin in tablets, Erythromycin intravenously, Rocephin i/m or i/v, Zanocin i/v and other antichlamydial antibiotics in the doses permitted in Pharmacopeia. Up to now ineffective antibiotics, used concurrently with streptokinase, urokinase or t-PA, became effective. Antibiotic resistance disappeared. As a result of fibrinolytic enzyme therapy with SK and UK, the prostate fibrosis and sclerosis regressed. The skeletal pain syndrome disappeared as well.

Degenerative dystrophic changes in C5-6-7 vertebrae did not progress. The inflammation was controlled. Clinical signs of spinal deformative spondylosis and spondylarthosis decreased. A stable, sustained remission phase was achieved.

The patient feels well. Libido is stabilizing. Working abilities are getting restored.

Microbiological test control 1/2 years after the enzyme therapy could not find Chlamydia trachomatis antigen structures. The titre of chlamydial antibodies in blood was negative. The remission period is going on. The patient is cured.

It is most difficult to treat the ankylosing (chlamydial) spondylarthritis - Behterev's disease of urogenital etiology.

The enzyme therapy with strepokinase makes it possible to stop the progression of the disease, to achieve a sustained remission period and even the recovery.

Clinical case 2

Patient Igor, 41 yrs.old, ill for 7 years. He has been treated at P.Stradins University clinic, Ward No.39 within the period of 04.01.-16.01.2001 (case history No.70025).

Diagnosis:
Central form of Behterev's disease. Ankylosing spondylarthritis, activity I, stage III, functional insufficiency for the back III. Bilateral sacroileitis.

Hard work - a taxi driver. Due to disability signs and regular loss of working abilities the patient was transferred to the Doctors' expertise committee for identifying the working abilities. He was registered for 3rd disability group.

The out-patient therapy was ineffective. The disease kept progressing.

He was repeatedly hspitalized at the Urology Ward No. 11 of Riga clinical hospital "Gailezers" (Case history No.23620-01).

The patient was complaining of insomnia because of experiencing the pain in the back and ribs. He could lie only in a half-sitting position in an armchair. He mentioned the feeling of tiredness and weakness, frequent urination at night for 5-6 times; he had to urinated also during work hours that caused inconvenience. He mentiond the pains in the joints, back muscles, pain in th sacrum, lower part of the abdomen and in the whole body. The skeletal pain syndrome. To all doctors this patient seemed to be hopeless.

Microbiological tests (Dr.Ancupane) diagnosed (+) chlamydial antigen structures and Chlamydia trachomatis antibodies in blood (+++) in the titre 1:16.

Clinical diagnosis:
- Urogenial chlamydiosis.
- Ureaplasmosis.
- Chlamydial and ureaplasmatic chronic prostatitis.
- Paraprostatitis.
- Ankylosing spondylarthritis of urogenital etiology.
- Behterev's disease in III stage.
- Bilateral sacroileitis.
- Skeletal pain syndrome.
- Prostatic calcinosis.
- Hypercoagulaemia.
- Functional insufficiency of the back.

The patient was introduced an enzyme therapy course:

1) Streptokinase 50 000 - 300000 e.u. i/v once a day, for 44 days with a total SK dose 11 075 000 e.u.
2) Heparin 8 500 u. once a day i/v for 44 days = 340 000 u.
3) Antichlamydial antibiotics in the doses permitted in the Pharmacopeia.

Subjective and objective status in dynamics without any improvement. The remission period was not achieved.

In miocrobiological test control Dr.Ancupane was still diagnosing chlamydial antigen structures and Chlamydia trachomatis antibodies in blood (+++) in the titre 1:16.

The enzyme therapy with SK was continued. (Case history No. 55007, No.5073-02) The patient was repeatedly treated at the Urology Ward No.11 due to antibiotic resistance.

He had received:

1) Streptokinase 250 000 - 750 000 e.u. once a day i/v for 55 days, in total SK = 36 550 000 e.u.
2) Heparin 8 500 u. - 10 000 u. i/v x 55 = 530 000 u.
3) Antichlamydial antibiotics in the doses permitted in the Pharmacopeia.

The total course of the enzyme therapy lasted for 112 days. Streptokinase was administered for 112 days with the total SK dose 47 625 000 e.u.

As a result of repeated and longstanding enzyme therapy the skeletal pain syndrome disappeared, as well as he pain in the lumbar and sacral areas. Urination became easy, painless with a good surt.

After the treatment the prostate is of the usual size, symmetric, well-outlined, smooth, elastic, painless. A complete elimination of chlamydial antigen structures and chlamydial antibodies has been achieved. The patient feels well and is satisfied with the treatment outcome. Working abilities are restored. A sustained remission phase is achieved. The patient is cured.

Conclusions:

1. Antibacterial therapy is effective for spondylitis, spodylarthrosis of urogenital etiology only in the first 3 months.

2. Patients who have suffered from spondylitis or spondylarthritis of urogenital etiology, the prostate inflammation in the III-IV phase of connective tissue proliferation, fibrosis and sclerosis for a long time are indicated etiopathogenetic therapy by administering streptokinase, urokinase, t-PA and antichlamydial antibiotics concurrently.

3. Degenerative dystrophic changes in the spinal vertebrae began to regress only after the sanation of the focal urogenital infection (for males - prostatitis, for females - adnexitis).

4. Positive sanogenous response with a sustained remission period can be achieved by providing a constant fibrinolytic enzyme system activtion at the hypocoagulaemic threshold level. Only then the regression of spondylitis, spondylarthrosis and ankylosing spondylitis began.

5. Not diagnosing and not treating the antibiotic resistant urogenital inflamation in the pelvis minor, i.e., not eliminating the focal urogenital infection, the therapy of spondylitis, spondylarthrosis and ankylosing spondylitis is and will remain ineffective.

6. There are certain regularities in the treatment of spondylitis, spondylarthritis and ankylosing spondylitis, which have been published in "Streptokinase in gerontology" [11]. With each repeated enzyme therapy course the SK dose is decreased, but the plasminogen activity is increasing and reducing the length of next pre-relapse course.

7. To relieve the skeletal pain syndrome and prevent the fibrotic process there must be undertaken 3-5 enzyme therapy courses with SK.

8. Spondylitis, spondylarthrosis and ankylosing spondylitis of urogenital etiology is the complication of infectious pelvis minor and paraprostatitis, but not the basic disease.

Doctors who deal with the treatment of spondylitis should first of all differentiate infectious chlamydial spondylites, spondylarthrites, ankylosing spondylites from noninfectious involutions - the processes of gerontological character in the spine.

Infectious spondylites, even in cases of Behterev's disease, can be treated with good results. Involution noninfectious spondylitis is, in general, a separate problem.

Literature:

  1. J.Zalkalns, P.Ivdra, A.Zilevica, G.Purmalis, I.Ancupane, I.Geldners.
    Possibilities of enzyme therapy in pain syndrome sedation in patients with infectious spondylosis of urogenital origin and spondylarthrosis (01.05.07) http://www.expo.lv/gailes/pain-syndrome.htm    

  2. Leirisalo Repo M.
    Therapeutic aspects of spondyloarthropathies - a review Department of Medicine, Helsinki University Central Hospital, Finland.
    1:Scand J. Rheumatol 1998; 27(5): 323 - 8  http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?CMD=Text&dB=PubME

  3. Lange U., Berliner M, Weidner W, Schiefer HG, Schmidt KL.
    Federlin K (1996) Ankylosierende Spondylitis und Urogenital-infektion: Urologische Infektiagnostik und Korrelation mit rheumatologischen Befunden. Z.Rheumatol 55:249-255

  4. Ball GV (1993) Ankylosing spondylitis. In: McCarty DJ, Koopmann WJ
    (eds) Arthritis and allied conditions. 12th edn.Lea and Febiger. Philadelphia, pp.1051-1060

  5. Moll JMH, Wright V (1973) New York clinical criteria for ankylosing spondylitis:
    a statistical evaluation. Ann Rheum Dis. 32:354-363

  6. Spinillo A., Gorini G., Regazetti A., Seta F de, Nicola S., Zara C. (1994)
    Asymptomatic genitourinary chlamydia trachomatis infection in women seropositive for
    human immunodeficiency virus infection. Obstet Gynecol 83(6): 1005-1010

  7. P. Ivdra, J.Zalkalns, A.Zilevia, I.Ancupane, I.Geldners, E.Baumanis
    Multidisciplinary problems in choosing proteolytic enzymes and their
    activators for enzyme therapy of antibiotic-resistant and urogenital chlamydiosis.
    Riga, Latvian http://www.expo.lv/gailes/enzyme.htm

  8. J.Zalkalns, P.Ivdra, A.Zilevica, I.Ancupane
    Specificity of enzyme therapy in treatment of late inflammatory forms of prostatitis. (02.0301)
    http://www.expo.lv/gailes/enzyme1.htm

  9. U.Lange, M.Berliner, M.Ludwig, H.G.Schiefer, J.Teichman, W.Weidner, K.L.Schmidt
    Ankylosing spondylitis and infections of the female urogenital tract.
    Rheumatol Int (1998) 17:181-184, Springer-Verlag 1998

  10. M van der Paardt, J C van Denderen, A J C van den Brule, S A Morre,
    I E van der Horst-Bruinsma, P D Bezemer, B A C Dijkmans
    Prevalence of Chlamydia trachomatis in urine of male patients with
    ankylosing spondylitis is not increased. Ann Rheum Dis 2000; 59 300 - 302

  11. J.Zalkalns, P.Ivdra, I.Hartmane,
    Streptokinase in Gerontology. Prevention and treatment of male premature ageing by streptokinase (SK)
    http://www.expo.lv/gailes/gerontology.htm


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