I. Form of onset of disease
Ankylosing spondylitis is generally insidious in its onset, and there may be no clinical symptoms in the early stages. Some patients may show mild systemic symptoms in the early stages, such as weakness, wasting, chronic or intermittent low-grade fever, anorexia, and mild anemia. Due to the lightness of the disease, most of the patients cannot go to the specialist in time, so that the disease cannot be detected at an early stage, resulting in delay and loss of the best treatment time.
The initial clinical manifestations of some patients are quite similar to acute rheumatic fever, or large joint swelling and pain, or accompanied by prolonged low-grade fever and weight loss, and it is not uncommon to have high fever and acute inflammation of peripheral joints as the first symptoms.
Individuals with initial symptoms resembling tuberculosis, including low-grade fever, night sweats, weakness, fatigue, weight loss, anemia, and sometimes unilateral hip inflammation, are easily misdiagnosed as tuberculosis.
When this occurs, the possibility of ankylosing spondylitis should be considered if anti-tuberculosis treatment is ineffective and the patient responds well to nonsteroidal anti-inflammatory drugs such as anti-inflammatory pain.
It is worth noting that some patients develop the disease immediately after an occasional trauma, cold or damp, or gastrointestinal or respiratory tract infection, at which point the attention of medical workers, patients, and their families should be drawn to the fact that the disease should not be taken lightly, and if the diagnosis cannot be confirmed at that time, it should be closely observed and followed up regularly with a view to early diagnosis and timely treatment.
The disease has a clear tendency to gather in families. Therefore, we recommend that blood relatives or children of patients with ankylosing spondylitis should be highly alert and closely monitored for signs of disease onset in order to facilitate early diagnosis, early treatment, and improved prognosis. In particular, young men who have a family history of ankylosing spondylitis with knee swelling and pain as the first symptom and no typical mid-axis joint lesions should be highly suspicious of the possibility of ankylosing spondylitis and strive for early diagnosis and treatment.
In patients with ankylosing spondylitis, HLA-B27-positive patients account for more than 90% and negative patients account for less than 10%. HLA-B27-negative patients have a relatively late onset, a less common tendency for familial clustering, and a milder mid-axis joint lesion.
The first symptoms
1. Low back pain.
Low back pain is the most common symptom of ankylosing spondylitis and is one of the indicators of disease activity. The location of the pain includes the lower back, lower back and lumbosacral region. Because ankylosing spondylitis primarily affects the medial joints and the majority of lesion trends are from the bottom up, sacroiliac joint and lumbar spine involvement is seen in almost all patients with the disease, with an incidence of more than 90%. Early inflammation of the sacroiliac joint is usually insidious, so early lumbar pain only manifests as lumbosacral discomfort or vague pain, and some patients only have episodes after exertion, with intermittent or alternating soreness on both sides, or as deep hip discomfort.
In some other patients, there may be trauma or other triggers, showing sudden onset of lumbosacral pain, severe pain unable to move, or accompanied by fever, resembling mechanical lumbago or acute inflammatory changes, and the pain can be relieved or disappeared after several days of bed rest. This condition can occur repeatedly and has a tendency to gradually worsen. Initially, the site of pain is often located in the lumbosacral region, which may be unilateral, and then gradually progresses to bilateral. When the pain is severe, it may radiate to the iliac crest, pubic symphysis, bilateral ratty creek, sciatic tuberosity and the back of the thigh, and the pain may be suddenly aggravated by the pull of coughing, sneezing, bending and other movements.
With the further development of the disease, the hidden pain or intermittent pain may turn into persistent lumbosacral soreness, stabbing pain and deep hip pain or unspeakable soreness and swelling discomfort in the lumbar, sacral and hip areas, which is heavier at night and affects sleep, and even wakes up in pain during sleep, and often has to get out of bed to relieve the pain. In the morning or when the patient holds a posture for a long time, the pain will be aggravated by the stiffness of the lower back, and will be relieved after a little activity. Some patients are afraid of wind and cold in the lumbar region, and often prefer to add more clothes and blankets, and the pain is aggravated by wind and cold and humidity, and reduced by warmth and heat. When the pain is severe, the patient cannot get out of bed and has difficulty turning over. Resting pain at night is one of the indications of disease activity.
Generally speaking, low back pain or stiffness cannot be relieved by rest, but appropriate activity can alleviate the symptoms instead, which is a characteristic of inflammatory low back pain and can be distinguished from mechanical low back pain according to this. The latter is aggravated by activity or exertion, and rest can relieve the symptoms. However, when the pain is so severe that it cannot be moved, this feature is often concealed and needs to be distinguished carefully in clinical practice.
In some patients, low back pain or discomfort is not taken seriously. The patient only shows lumbar stiffness or lumbar muscle pain, or paravertebral pressure pain is easily confused with rheumatic polymyalgia, myofasciitis, fibromyalgia neuralgia or psychogenic pain; when there is unilateral hip or posterior thigh pain, it is easily misdiagnosed as sciatica or lumbar muscle strain. Ankylosing spondylitis hip and leg pain generally rarely radiates below the knee joint.
2, morning stiffness.
Morning stiffness is a feeling of stiffness in the early morning, which can be relieved by activity, and is one of the indicators of disease activity and one of the common symptoms of early ankylosing spondylitis.
When patients with ankylosing spondylitis get up early in the morning, or stand up after a long period of lying and sitting, the lumbosacral area often feel stiff and uncomfortable, unfavorable activities, sometimes need to hold something to borrow to move, after a period of activity, this stiffness will gradually reduce, ease or disappear. In mild cases, the duration is short, but in severe cases, it can last all day.
In addition to activities, local massage, hot compresses and hot baths can also relieve morning stiffness. Morning stiffness is not only in the lumbosacral region, but also in other joints of the spine and the whole body.
3, tendon, ligament bone attachment point pain.
The characteristic pathological change in ankylosing spondylitis is inflammation of the attachment points. The attachment point is the attachment of muscles, ligaments and bones or joint capsule. Inflammation of the attachment points is a non-bacterial inflammation of the tendon ends. This inflammation can lead to pain and swelling of the tendon ligaments. Since the attachment points are all around the joint, they often cause periarticular swelling.
Attachment point lesions can be seen in cartilaginous or bicompartmental joints, especially in less mobile joints, such as the sacroiliac joints and the articular processes of the spine. Inflammation of the attachment points in many areas can cause clinical symptoms. Inflammation of the attachment points commonly occurs at the thoracic rib junction, cervical spine spinous process, thoracic spine spinous process, lumbar spine spinous process, iliac crest and anterior and posterior iliac spine, femoral and tibial ramus, sciatic tuberosity, pubic symphysis, medial and lateral tibial condyles, plantar fascia, and Achilles tendon attachment points of the heel.