Ankylosing crestitis is a disease with inflammation of the sacroiliac joints and crestal attachment points as the main symptoms. Its etiology is unclear, with the crest as the main lesion site, often involving the sacroiliac joints, causing crestal ankylosis and hip stiffness, some patients may also be accompanied by eye, lung, muscle and bone lesions, and is an autoimmune disease.
1. Clinical manifestations
Ankylosing crestitis has an insidious onset, and there may be no obvious clinical symptoms in the early stages, just the stiffness of the lower back and limited movement after waking up in the morning, but it gradually eases after activity.
Most patients with ankylosing crestitis have arthropathy, and most of them first invade the sacroiliac joints and then progress upward to the cervical spine, and may also invade the peripheral joints. The pain is relieved by activity or painkillers. As the disease worsens, the pain decreases, but the joint becomes stiff, the range of motion decreases, and the crest develops a retroflexion deformity.
2.Auxiliary examination
(1) Orthopantomogram of the pelvis and whole crest orthopantomogram
X-rays are of great importance for the diagnosis of ankylosing crestitis. 98% to 100% of cases have X-ray changes of the sacroiliac joint at an early stage. The early X-ray manifestation is sacroiliac arthritis, and the lesion usually starts in the lower and middle part of the sacroiliac joint, which is bilateral. The X-ray diagnostic criteria of sacroiliac arthritis are divided into 5 stages: grade 0 is normal sacroiliac joint, stage I is suspected sacroiliac arthritis, stage II is sacroiliac joint with blurred edges, slight sclerosis and small invasive lesions, no change in joint space, stage III is moderate or progressive sacroiliac arthritis with one (or more) changes: sclerosis of the proximal joint area, narrowing/widening of the joint space, bone destruction or partial ankylosis, stage IV is complete joint fusion or ankylosis with or without sclerosis.
(2) CT scan of the pelvis
It can show the sacroiliac joint gap very clearly and understand whether there is narrowing, destruction or fusion of the sacroiliac joint.
(3) Pelvic magnetic resonance imaging
It can understand whether there are inflammatory changes in the sacroiliac joint at an early stage.
(4) Laboratory examination
White blood cell count is normal or elevated, blood sedimentation and C-reactive protein may be increased. 90% to 95% of AS patients are positive for HLA-B27.
3.Treatment
To control inflammation, reduce or relieve symptoms, maintain normal posture and optimal functional position, and prevent deformity. Comprehensive treatment is required, including physical therapy, physiotherapy, medication and surgical treatment.
a. Physical therapy is beneficial for various chronic diseases, and is more important for AS. It can maintain the physiological curvature of the crest and prevent deformity. Maintain thoracic mobility and normal whistling function. Maintain bone density and strength, prevent osteoporosis and limb wasting muscle atrophy, etc.
b.Physiotherapy can generally be used as heat therapy, such as hot water bath, tub bath or shower, mineral spring spa bath, etc., to increase local blood circulation, relax muscles, reduce pain, facilitate joint activities, maintain normal function and prevent deformity.
c. Drug treatment
It has anti-inflammatory and pain-relieving effects and reduces stiffness and muscle spasm.
d.Surgical treatment
For severe crestal hump and deformity, osteotomy and orthopedic surgery can be performed after the condition is stabilized.