1.What is ankylosing spondylitis? Ankylosing spondylitis is a systemic disease with chronic inflammation of the sacroiliac joints and spine, also involving the hip, knee, ankle, and thoracic rib joints. The characteristic pathological changes are inflammation of tendons and ligamentous attachments. Common symptoms are low back stiffness or pain, chest pain, heel pain, heavy at night, and can be relieved by activity. Late stages can can occur with spinal ankylosis, deformity and even severe dysfunction. Ankylosing spondylitis is divided into two types: one is the central axis type, as described above; there is also a type called peripheral type, which is dominated by inflammation of the hip, knee and ankle joints. Inflammation of the attachment point (the point of attachment between muscle or tendon and bone) is the pathological basis of the disease. Inflammation of the attachment point causes pain, and inflammation of the attachment point causes bone destruction, bone redundancy formation, and ankylosis due to the bone connection between joints. HLA-B27 is a gene that remains unchanged throughout life, with a 5% positive rate in the normal population, which means that most HLA-B27-positive patients have the gene and do not necessarily have ankylosing spondylitis, but rather, some ankylosing In contrast, some patients with ankylosing spondylitis are HLA-B27 negative. 2. How is ankylosing spondylitis treated? The goal of treatment for ankylosing spondylitis is to control inflammation, relieve symptoms, and prevent ankylosing deformities of the spine, hip, knee, ankle, and other joints. Since it is difficult to reverse the disease in patients with advanced disease, the key to treatment is early diagnosis and early treatment. The main drugs used to treat ankylosing spondylitis are: (1) non-steroidal anti-inflammatory drugs, which have anti-inflammatory and pain-relieving effects and inhibit the formation of bone redundancies and bridges to varying degrees, thereby inhibiting and delaying the effects of joint ankylosis. (2) Glucocorticoids, which are not recommended for routine use. (3) Long-acting chronic anti-rheumatic drugs, used to control the development of the disease, including lurasulfapyridine, methotrexate, thalidomide and raglan polysaccharide, etc. (4) Tumor necrosis factor antagonists, biological agents developed and applied in recent years, have become one of the powerful means of controlling the progression of ankylosing spondylitis, which has greatly improved the prognosis of the disease. Axial ankylosing spondylitis on the long-acting chronic anti-rheumatic drugs are ineffective, advocating the application of biological agents for treatment, attachment pointitis caused by heel pain, chest pain to the long-acting chronic anti-rheumatic drugs represented by the salazosulfapyridine, effective drugs are non-steroidal, hormonal and biological agents. Ankylosing spondylitis peripheral type with involvement of knee, ankle and hip joints alone is effective against chronic long-acting anti-rheumatic drugs, as in the treatment of rheumatoid arthritis. The disease is stable for 3-6 months after the drug can be considered discontinued, and in the event of a relapse is treated again. 3.In what cases does ankylosing spondylitis require glucocorticoid therapy? Glucocorticoids cannot affect the course of ankylosing spondylitis, so long-term use can do more harm than good, especially not in medium to high doses for a long time. Glucocorticosteroids may be used in the following cases to help improve the inflammatory response and reduce the disease rapidly: (1) When allergy to non-steroidal anti-inflammatory drugs or non-steroidal anti-inflammatory drugs cannot control the symptoms, glucocorticosteroids may be given in small doses for a short period of time. (2) In patients with severe peripheral arthritis who are resistant to non-steroidal anti-inflammatory drugs, glucocorticosteroids can be injected locally into the joint cavity or administered systemically, and the systemic administration should be in small to medium doses, and the dose should be gradually reduced to discontinued after the long-acting chronic anti-rheumatic drugs take effect. (3) When combined with extra-articular damage, such as iridocyclitis and pulmonary involvement, glucocorticoid therapy is required.