There is no cure for ankylosing spondylitis (AS) and no effective therapy to stop the progression of the disease. The goal of AS treatment is to control inflammation, reduce or alleviate symptoms, maintain normal posture and optimal functional position, and prevent deformity. To achieve these goals, the key is early diagnosis and early treatment with a combination of measures, including patient and family education, physical therapy, physiotherapy, medication and surgical treatment.
I. Non-surgical treatment of ankylosing spondylitis
(A), science education, physical therapy and physiotherapy
1.Science education
(1) Educate patients and family members about the nature of the disease, its course, the measures used and the prognosis, and obtain their understanding and cooperation.
(2) Pay attention to maintaining normal posture and mobility in daily life, such as sleeping without pillows or using thin pillows, sleeping on a hard wooden bed, taking a supine or prone position, lying prone for half an hour in the morning and evening every day; insisting on labor and sports activities within one’s ability; paying attention to posture at work to prevent spinal curvature and deformity, etc.
(3) Understand the side effects of drugs, learn to adjust the dose of drugs and deal with the side effects of drugs, in order to cooperate with treatment
2.Physical therapy
Physical therapy can maintain the physiological curvature of the spine to prevent deformity; maintain the mobility of the thorax to maintain the normal respiratory function; maintain bone density and strength to prevent osteoporosis and limb wasting muscle atrophy, etc.
(1) Deep breathing
Every morning and before bedtime, deep breathing exercises are routinely performed. It can maintain the maximum mobility of the thorax and good respiratory function.
(2) Cervical spine exercise
The head and neck can be turned forward, backward, left and right, as well as head rotation movement to maintain the normal mobility of the cervical spine.
(3) Lumbar spine exercise
Daily lumbar exercises, forward bending, backward bending, lateral bending and left and right rotation of the torso to maintain the normal mobility of the lumbar spine.
(4) Limb exercise
Swimming is not only good for limb movement, but also helps to increase lung function and keep the spine in physiological curvature, which is the best whole body exercise.
According to the individual situation to take the appropriate exercise mode and the amount of exercise, the beginning of the muscle joint pain or discomfort, but after a short rest can be recovered. If the new pain lasts for more than 2 hours and cannot be recovered, it indicates that the exercise is excessive and the exercise volume should be reduced or adjusted appropriately.
3.Physical therapy
Heat therapy to increase local blood circulation, relax muscles, reduce pain, facilitate joint movement and maintain normal function.
(II) Drug therapy
[Basic therapy
The drugs for AS treatment can be divided into three categories:
1. Drugs that inhibit disease activity and affect disease progression, such as salazosulfapyridine. It is suitable for active AS, AS with peripheral arthritis and newly discovered AS.
2.Non-Zithromax anti-inflammatory drugs are suitable for patients with severe pain and stiffness at night, and can be taken at bedtime.
3.Analgesics and muscle relaxants
Such as analgesic new, prednisolone and muscarinic, often used for long-term application of non-Zithromax anti-inflammatory drugs are ineffective.
Commonly used clinical drugs]
1, non-steroidal anti-inflammatory drugs (NSAIDs) have anti-inflammatory and pain relief, reduce stiffness and muscle spasm. Divided into three categories.
(1) COX1, COX2 simultaneous inhibition such as fotarine, ibuprofen, fenbid, etc. Ibuprofen 0.1g, 3 times a day orally.
(2) COX2 specific inhibitors such as Mobic.
(3) Selective COX2 inhibitors Celecoxib (Celebrex); Refecoxib, 12.5/25mg, once daily orally, is the drug of choice commonly used today. It avoids side effects such as gastrointestinal reactions, kidney damage, and prolonged bleeding time.
For pregnant and lactating women, ibuprofen is generally preferred.
2.Sulfasalazine (SSZ) SSZ is an azo compound of 5-aminosalicylic acid (5-ASA) and sulfasalazine (SP), which has been used for the treatment of AS since the 1980s, with the dose starting from 0.25g 3 times a day and increasing by 0.25g per week to 1.0g 3 times a day for maintenance. The efficacy of the drug increases with the duration of administration, and the effective rate of administration is 71% for six months, 85% for one year and 90% for two years. Patients’ symptoms improved, laboratory indices and radiological signs progressed or stabilized. Side effects are mainly gastrointestinal symptoms, skin rash, blood and liver function changes, but they are rare. It is advisable to check the blood picture regularly during the drug administration.
3, methotrexate (MTX) reported efficacy is similar to SSZ, small dose shock therapy is once a week, the first 2.5-5mg, and then increase 2.5mg per week to 10~l5mg per week maintenance. The efficacy of oral and intravenous dosing is similar. Side effects include gastrointestinal reactions, bone marrow suppression, stomatitis, hair loss, etc. Check liver function and blood picture regularly during medication, and avoid drinking alcohol.
4. Adrenocorticotropic hormone (CS) is not normally used, but when acute iritis or peripheral arthritis is not treated with NSAIs, CS can be given locally or orally. 17 and 59 cases of acute active AS that were not treated with other drugs were treated with methylprednisolone 1000mg/dose and 375mg/dose IV for 3 days, respectively. The high-dose group was slightly more effective and had a significant effect on pain control and improvement of spinal activity.
5, thunderbolt polyglucoside (Trirpterygium wilfordii hook, code T2) Domestic initial use of thunderbolt before the treatment of AS, with anti-inflammatory and analgesic effect, daily with 12% thunderbolt tincture 15-30ml, divided into three times after meals. After the disease is controlled (about 3-6 months), the maintenance amount is changed to 5~lOml daily or every other day. 20mg of semi-pure product of Radix et Rhizoma Polygoni, taken orally 3 times daily, has better efficacy than the preparation and is convenient to take. Side effects include gastrointestinal reactions, leukopenia, menstrual disorders and reduced sperm vitality, etc., which can be recovered after stopping the drug.
(C) Chinese herbal medicine and radiotherapy and other measures
Chinese medicine
The first soup has the effect of dispelling wind and removing dampness, relaxing the tendons and channels, activating blood and fixing pain, and nourishing the liver and kidneys. It is suitable for the early stage of ankylosing spondylitis. The main ingredients of the soup are the following Qiang Ji Ning No. 2 Soup:It has the function of tonifying the liver and kidney, strengthening the tendons and bones, nourishing the blood and activating the blood, dispelling wind and dampness, and relieving pain. It is suitable for early and late stages of ankylosing spondylitis. For Qi deficiency, add Astragalus and Radix Codonopsis; for blood deficiency, add Radix Paeoniae Alba and Radix Rehmanniae; for internal heat in Yin deficiency, add Radix Rehmanniae, Radix Ginseng, Dendrobium and Rhizoma Polygonatum; for kidney Yang deficiency, add Radix Aconiti and Radix Bupleurum; for phlegm and stagnation of blood, add Radix Nanxing, Radix Ginger and Sempervis, Frying Shanjia, Bupleurum, Di Long, Scorpion and Centipede.
External treatment method
1, deep X-ray irradiation Deep X-ray and radium radiation therapy for early AS patients to reduce symptoms, its can reduce pain, relieve muscle spasm. Improve function has a certain effect, the recent remission rate can reach 80-96%, generally in accordance with the lumbar, thoracic, cervical spine and a case of sacroiliac joint each 2.0Gy radiation dose treatment. However, it cannot stop the progress of the disease, and there is a risk of inducing aplastic anemia, leukemia and transverse myelitis, so it is only used in cases where various conventional therapies are ineffective.
2.Bracing Intermittent use of various braces is of some significance in the prevention and correction of various deformities.
3, traction When the joint deformity has not developed to bony ankylosis, give appropriate traction measures, for the prevention and control of spinal and joint deformity has a certain effect.
4, acupuncture therapy Most of the points on both sides of the spine, such as the large vertebrae, body column, spine, kidney Yu, lumbar Yu, lumbar Yangguan and other points, combined with sciatic nerve pain, the use of ring jump, sciatic points, Wei Zhong, Chengshan and other points. Choose 4 to 5 points each time, once a day.
5.Massage therapy
The purpose is to dredge the meridians, increase the range of joint movement and improve the nutritional status of muscles and skin. For patients who are bedridden and have osteoporosis in the late stage, massage therapy should be gentle and mild, not rough to prevent fracture.
(F) Other treatment
Pulmonary lesions are mainly symptomatic treatment, prevention and treatment of secondary infection, cardiac lesions such as aortic valve closure insufficiency is serious, aortic valve replacement surgery; for severe conduction block can be installed artificial pacemaker.