The culprit of the “living mummy”: ankylosing spondylitis Recently, Jay Chou’s friend Liu Hong mentioned Jay Chou’s medical history for the first time during a recording session, saying that many fans know he has ankylosing spondylitis, but they just don’t know how painful it is. “He often can’t lie down like a normal person and thus has to sleep sitting up. Sometimes I knock on the door and he has to walk from his bed to the door for almost ten minutes, not because his home is so big, but because he walks very slowly.” This is a disease that makes the “Asian King” unable to “straighten his back and do his job” and struggle to move, and also makes many celebrities unable to sit and lie down, such as Cai Shaofen, Zhang Jiayi and so on. What kind of disease is ankylosing spondylitis? Why do people with the disease act as if they are “living mummies”? The newspaper went into the Department of Rheumatology and Immunology at Long March Hospital and asked Wu Xin, deputy director, to talk about those things about ankylosing spondylitis. The actual “immortal cancer” – heritable Wu Xin introduced ankylosing spondylitis is a combination of the words “ankylosis” and “spondylitis”, often referred to by patients as “immortal cancer”. “It is a chronic progressive systemic inflammatory disease that affects mainly the mid-axis joints, such as the sacroiliac joints, hip and spine. Typical clinical manifestations are inflammatory back pain, asymmetric peripheral arthritis, tendon and ligament attachment points inflammation and iridocyclitis. In advanced stages, there is ankylosis, stiffness, and deformity of the spine, resulting in severe functional impairment. Currently, the prevalence of ankylosing spondylitis in China is 0.3%. The age of onset is usually between 10 and 40 years, with the peak age of onset being 20-30 years, and rare after 40 years and before 8 years of age. The ratio of men to women is 2-3:1, with more men than women, and the disease is more severe than in women. Epidemiological investigations have revealed that genetic and environmental factors play a significant role in the development of ankylosing spondylitis. Studies have confirmed that the onset of ankylosing spondylitis and the human leukocyte antigen HLA-B27 are closely related, and there is a clear familial tendency to develop the disease. For example, the heritability of ankylosing spondylitis is as high as 97% in identical twins, and more than 95% of patients with ankylosing spondylitis are HLA-B27 positive. So, with “Chow’s” wife, Kun Ling, on the verge of giving birth, will their baby also inherit ankylosing spondylitis? Wu Xin said that ankylosing spondylitis is a disease caused by a combination of genetic, environmental and immune factors. Although more than 95 percent of people with ankylosing spondylitis are HLA-B27-positive, only about 5 percent of those who are HLA-B27-positive develop ankylosing spondylitis. This suggests that there are still other factors involved in its development, such as intestinal infections, which are currently well studied. However, it is worth noting that people who are HLA-B27 positive or have a family history of ankylosing spondylitis are at a correspondingly increased risk of developing the disease. Early symptoms – mostly insidious Ankylosing spondylitis is a chronic progressive rheumatic disease that is characterized by chronic inflammatory involvement of the spine itself and its accessory tissues, but can also involve peripheral joints, internal organs, and other tissues, severely affecting the patient’s normal life. Because the pain it causes is difficult to distinguish from other back pain, and is especially easily confused with pain produced by sports injuries in young people, patients may remain undiagnosed for years after the onset of symptoms. According to epidemiological surveys, patients with ankylosing spondylitis in China have an average delay of six years from the first appearance of symptoms to the first diagnosis by a doctor. Wu Xin suggests that ankylosing spondylitis generally has an insidious onset and progresses slowly. Patients may begin with discomfort in the lower back, starting with unilateral or intermittent stiffness and vague pain, and then gradually developing into bilateral, persistent back pain and stiffness, especially at night when the pain is obvious and even affects sleep, requiring movement to the floor to reduce pain before sleeping again. In severe cases, patients may find it difficult to get out of bed. The pain of ankylosing spondylitis is often characterized by worsening after rest and decreasing after activity. In some patients, the pain may not manifest in the lower back, but in the hips or hips unilaterally or bilaterally. And some simply present with swelling and pain in unilateral or bilateral joints of the lower extremities such as the knee and heel. In the later stages of development, patients will exhibit ankylosis of the spine. About one-third of patients with ankylosing spondylitis will develop hip arthropathy. Notably, hip joint lesions are more common in patients with a younger age of onset, and are characterized by restricted movement and often functional impairment, some of which can result in long-term bed rest, inability to walk, or even disability. According to the results of the study on the treatment status of patients with ankylosing spondylitis with hip involvement in China, nearly half of the doctors found that patients with untreated hip involvement progressed from hip involvement to disability within 5 years. In addition to hip involvement, the onset of ankylosing spondylitis can involve the eyes, cardiovascular system, lungs, and neuromuscular system. Acute anterior uveitis or iridocyclitis with pain, tearing, and photophobia in the eyes is the most common manifestation. Therefore, once the above symptoms persist for up to three months, especially in young men, the possibility of ankylosing spondylitis should be highly suspected and should be seen as soon as possible to achieve early diagnosis, early treatment, improved quality of life and a better prognosis. Comprehensive treatment – the most feasible Wu Xin introduced drug therapy is the core part of ankylosing spondylitis treatment. Nonsteroidal anti-inflammatory drugs, or anti-inflammatory and analgesic drugs, help relieve pain and stiffness. Anti-rheumatic drugs such as salbutamol and methotrexate can reduce inflammation and slow or stop the progression of the disease. In addition, the advent of biologics has opened a new chapter in the treatment of ankylosing spondylitis. Biological agents mainly act on inflammatory cytokines to inhibit the production of excessive inflammatory cytokines in patients with ankylosing spondylitis, thereby relieving disease symptoms and blocking bone destruction and ankylosis. This is also the current international and domestic guidelines for the treatment of ankylosing spondylitis, which propose drugs with clear therapeutic effects. Second, patients who take reasonable self-care can likewise control their symptoms and improve their prognosis. For example, the primary concern at rest is to maintain proper posture, and one should sleep on a hard bed in a supine position, avoiding positions that promote flexion deformity. The use of pillows should be discontinued once the lesion has invaded the upper thoracic and cervical spine in an upward direction. Any physical activity that causes persistent pain should be avoided; regular height and thoracic measurements and self-testing of lumbar spine mobility; keeping height records is a good measure to prevent early spinal curvature that is not easily detected and compression fractures due to osteoporosis. Similarly, patients with chest wall lesions should stop smoking immediately. In addition, regular exercise and movement is an equally important part of the treatment of ankylosing spondylitis. Active and assisted joint exercises can reduce joint pain and stiffness and increase muscle strength; exercises to strengthen the back and neck can help maintain and improve posture; and deep breathing and aerobic exercises can help maintain the elasticity of the thorax. For patients with ankylosing spondylitis, the exercise program, intensity and duration should vary with the course of the disease and the site of involvement. For example, patients with advanced ankylosing spondylitis who have developed a hunchback, spinal ankylosis and limited chest expansion should pay more attention to back exercises and chest expansion exercises; while for patients with early ankylosing spondylitis, joint and spinal mobility is better, you can do exercises such as aerobics, swimming, Tai Chi, yoga and so on. However, it should be noted that yoga must control the amount of exercise suitable for the condition and characteristics of the disease. Patients with ankylosing spondylitis should not participate in sports such as marathons, stair walking, flat support. Exercise principles are: exercise should start slowly, choose the most energetic, the least pain. The amount of exercise should be such that the pain does not increase the next day. Continuity of exercise is more important than the intensity of exercise.