Ankylosing spondylitis is a chronic inflammatory disease with a high prevalence in young men. The typical manifestations are limited spinal movement, low back pain, reduced symptoms after activity, increased back pain after rest, and in severe cases, possible hip damage and severe kyphosis deformity. As a rheumatic disease that can cause disability, it is extremely harmful to young people. But anyone who has studied philosophy knows that everything has a process from quantitative to qualitative change. This is also the case with ankylosing spondylitis, which sends out various warning signs to alert people that I’m coming, and that if people ignore it, it will go wild and cause serious consequences, depending on how long it’s been neglected. The following are common warning signals: 1, low back pain, low back stiffness for more than 3 months, can not be relieved by rest Patients with low back pain most commonly enter the following three paths: (1) after the lumbar spine X-ray, CT examination, and even MRI examination did not find abnormalities, it is considered to be lumbar muscle strain, let patients undergo physical therapy, part of the people have improved, as a lumbar muscle strain, did not pay attention to it again, the result of lumbar pain with the extension of time As a result, with the extension of time, the symptoms of lumbar pain reappeared and got worse than before. As a result, after turning to the orthopedics, Chinese medicine and acupuncture departments of major hospitals, they came to the rheumatology department and realized that the lumbar strain they thought they had had was something else. (2) After lumbar spine X-rays, CT examinations, and even MRI examinations, it was found that the lumbar disc was bulging or herniated, and when it was seen that surgery was not suitable, medicine (anti-inflammatory and analgesic) or plasters were taken, or traction and physiotherapy and acupuncture were applied. The anti-inflammatory and analgesic medication was good at the beginning, but got worse after stopping it. Or the physiotherapy and acupuncture were effective at the beginning, but not afterwards. After a few years, it came to the rheumatology department, only to be discovered that it was not a simple lumbar disc lesion. (3) The lumbar pain was mild, and only a little lumbar soreness or a slight stiffness was found in the morning when I was about to get up, and there was no discomfort from working during the day, so I did not pay attention to it. After a few years, the back pain occurs after sleeping until the second half of the night, and then they come to the doctor. A part of people who seek medical attention enter the two paths mentioned above, and a part of people are lucky to enter the fourth path and find out the condition soon. (4) Low back pain, self-taught about the possible causes of low back pain, came to the rheumatology department for screening, and the condition was quickly detected. Internationally and nationally, ankylosing spondylitis is essentially diagnosed with a delay, meaning that it is diagnosed long after the onset of the disease, with statistics showing it is 6-7 years after the onset of the disease before it is diagnosed by a physician. 2, unilateral or bilateral hip pain, no obvious history of trauma or sprain Often hip pain will be thought of as sciatica. This should also be carefully distinguished. The most commonly involved joint in ankylosing spondylitis is the sacroiliac joint, which is a joint formed by a palm-sized sacrum and two sides of the ilium above the tailbone of our body. The manifestation of sacroiliac arthritis is pain in the hip on both sides. Therefore, when hip pain occurs, you need to carefully check what the cause of the pain is. In the first article above, when low back pain is mentioned, sometimes people do not see any abnormality in the lumbar spine X-ray, so they are reluctant to examine it further. In fact, low back pain does not necessarily mean that the cause of pain is in the lumbar spine; there may be inflammation in the sacroiliac joint area that causes pain in the lower back. Sacroiliac joint examination is a more meaningful examination instead. 3, recurrent knee or ankle joint swelling and pain, joint effusion, no obvious history of trauma, history of infection Meet many young patients with lower limb joint pain, bring many checklists such as check rheumatoid factor, anti-nuclear antibody, anti-cyclic citrullinated peptide antibody (anti-CCP antibody) negative, come to ask the doctor, how are all negative, is not no rheumatic disease. There are actually many types of rheumatic diseases, and the arthritis that occurs in different types of rheumatic diseases is generally different. For example, rheumatoid arthritis, mostly small joints such as the second joint of the finger joints and metacarpophalangeal joints, wrist joints, etc., swelling and pain, morning stiffness, a long course of the disease will also appear joint deformation, this disease can appear rheumatoid factor, anti-nuclear antibodies, anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) and other positive; gout onset is often a single joint of the lower limbs red and swollen, the skin is hot, painful, blood tests can often find high blood uric acid. Easy to ignore is the spinal arthritis (typical disease ankylosing spondylitis). Some people with ankylosing spondylitis do not necessarily start with back pain, but may also have swelling and pain in the joints of the lower extremities such as the knee, ankle and heel. This is the condition that is most likely to be misdiagnosed. This subset of patients eventually develops significant low back pain gradually as the disease progresses. Now, our research data shows that 30-40% of patients start with arthralgia (what we call arthritis) as the initial manifestation and only later develop low back pain and are eventually diagnosed with ankylosing spondylitis. There are also patients who come to the doctor with lower extremity joint pain, but fail to mention the fact that they have low back pain because it is not obvious, and it is often only when the doctor asks about it that they find out that some of them have had low back pain for two or three years (brief back pain every morning when they wake up). This warns us that the possibility of ankylosing spondylitis should be carefully investigated for joint pain in the lower extremities. 4, spinal pain, stiffness, and even limited functional activity, without a clear history of trauma or sprain This article, it should be said, is at the stage of more typical disease manifestations. However, a part of the people who visit the doctor, if they see a specialist in rheumatology, will enter the first two paths in the first article, and a small number of people enter the fourth path in point 1 above. All of these eventually get diagnosed, it’s just the length of delay in diagnosis that varies, right? 5. Recurrent iritis This is as mentioned in point 3 above Ankylosing spondylitis may not necessarily start as low back pain, the earliest manifestation of ankylosing spondylitis can also be iritis in some cases. Most of these patients start out in the ophthalmology department. Some knowledgeable ophthalmologists may refer patients to a rheumatologist to check for ankylosing spondylitis or spondyloarthritis. More patients may simply take eye drops and medication for a few days to improve and then not pay attention until the next attack and then go to the ophthalmologist. Until the low back pain is obvious, only like the first mentioned above into such as a different path. 6, no cough and other respiratory symptoms, no history of trauma chest pain and girdling sensation, restricted thoracic movement This is also caused by the involvement of the thoracic rib joints and restricted thoracic movement at a later stage. 7. Sudden onset of pain, swelling, and activity dysfunction in large joints of the spine and extremities This sudden onset of joint swelling and pain may be in the knee joint, or ankle joint, either shortly after a trauma, or shortly after a diarrhea or a cold. It’s joint swelling and pain usually does not present with joint redness and swelling, and this gout occurrence is easily distinguished. For this kind of sudden joint swelling and pain, patients usually will not see the wrong department and will seek medical attention promptly. If you are aware of the above warning signs and seek medical attention in a timely manner, it may be of great benefit to improve your condition, or at least reduce the chance of disability.