Ankylosing spondylitis is a systemic inflammatory disease that primarily involves the bilateral sacroiliac joints, spinal joints, peripheral joints and periarticular tissues. The main clinical manifestation is commonly pain in the lower back (or low back), hip joint or multiple large joints of the lower extremities at rest. The onset of the disease is mostly insidious and slow. Initially, there is no typical clinical specificity, and laboratory tests have little positive information, so it is often easy to cause leakage and misdiagnosis.
I. What is seronegative spondyloarthropathy?
Seronegative spondyloarthropathies include a group of interrelated multisystemic inflammatory diseases, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease arthritis, and juvenile undifferentiated spondyloarthropathy. Most of them have the following common features.
1, most patients have negative serum rheumatoid factor.
2, no rheumatoid subcutaneous nodules.
3, spinal pain or asymmetric, predominantly lower extremity joints arthritis.
4.X-ray examination shows sacroiliac arthritis.
5.There is a tendency of family aggregation.
6.Most patients are positive for HLA-B27 by serology.
II. What is HLA-B27?
HLA-B27 is a serologically determined allele of the human leukocyte antigen (HLA) B locus and is one of the classical human major histocompatibility complex gene products. Since the discovery of the close association between ankylosing spondylitis and HLA-B27 in the early 1970s, it has been successively found to be associated with a number of other spondyloarthropathies such as reactive arthritis, psoriatic arthritis, and juvenile spondyloarthropathies. However, HLA-B27 itself is not a required pathogenic factor for any of these diseases, nor does it trigger any of the spondyloarthropathies. Approximately 95% of patients with ankylosing spondylitis are serologically positive for HLA-B27, and a certain number of patients with ankylosing spondylitis are serologically negative for HLA-B27. Therefore, the HLA-B27 test cannot be used as a diagnostic criterion for these diseases, but only as a reference standard.
What are the clinical manifestations of ankylosing spondylitis?
Ankylosing spondylitis is mostly insidious in its onset, with recurrent episodes, constant aggravation, and gradual destruction of the spine and joints, which in some patients can lead to different degrees of disability impairment and seriously affect the quality of life and work. Ankylosing spondylitis should be suspected in the following clinical situations.
1. intermittent episodes of pain and stiffness in the low back and/or sacroiliac region (more pronounced in the morning and at night). As the disease progresses, the pain often worsens at night, making it difficult to sleep or even to turn over, which can be relieved by getting up and moving around. Later, the pain and stiffness gradually develop into persistent pain and stiffness.
2.Pain in joints and parts of the knee, hip, ankle, heel, etc. without obvious causes, or redness, swelling and tenderness.
3.Unexplained foot pain, sternal shank or sternal rib pain.
4.Sciatica in adolescents.
5.No obvious low back pain, but gradually appearing reduced range of thoracic extension, or inflexibility of low back turning laterally, with more difference in mobility than the same age.
6. Painless and non-itchy inflammation of the conjunctiva.
Fourth, what are the extra-articular manifestations of ankylosing spondylitis
1, tendon telangiectasia Inflammation of tendons or ligaments at the attachment site of bone and its adjacent tissues, manifested as heel and sole pain, thoracic and sternal pain, iliac bone, pubic bone, sciatic bone, tibial tuberosity and other parts of the redness, swelling and pain.
2. Eye damage About nearly one-third of patients with ankylosing spondylitis develop inflammation of the conjunctiva, which manifests as painless, non-itchy conjunctival/ or iris-ciliary congestion, mild edema, etc.
3, cardiac lesions Less severe patients will have enlarged heart, valve closure insufficiency, conduction disorders, or have myocarditis or endocarditis, with symptoms such as chest tightness, chest pain, and breath-holding.
4, pulmonary manifestations Some advanced patients will appear diffuse infiltrative inflammatory disease of both lungs and appear interstitial fibrosis changes in the lungs, lung function is significantly reduced. The manifestation is shallow and rapid breathing, shortness of breath, or repeated coughing and coughing sputum.
5, renal damage Less common, mainly amyloidosis or IGA nephropathy.
V. What are the causes of ankylosing spondylitis?
The causative factors of ankylosing spondylitis are not yet fully understood, but most studies have shown the following etiological factors to be relevant.
(1) Genetic factors Most patients with ankylosing spondylitis have familial aggregation (multiple onset), and about 95% or more of ankylosing spondylitis have HLA-B27 gene carriage.
(2) Infectious factors In clinical studies, it was found that most patients with ankylosing spondylitis have recurrent episodes of intestinal or urinary inflammation, mainly associated with Klebsiella and Chlamydia infections.
VI. What are the main tests done for ankylosing spondylitis?
The diagnosis of ankylosing spondylitis relies on a rheumatologist with extensive clinical experience, combined with the patient’s clinical symptoms, physical examination, and radiographic imaging. Because it is a seronegative spondyloarthropathy, blood tests can only be used as a reference for differential diagnosis. The most practical and credible tests are physical examination and radiographs, especially CT or MRI (magnetic resonance imaging) which can better show early or ultra-early bone inflammatory changes and joint destruction.
Seven, how to distinguish ankylosing spondylitis from rheumatoid arthritis?
Ankylosing spondylitis and rheumatoid arthritis are two completely different diseases. They have some similarities in symptoms, but most of the clinical manifestations and pathological damage are different, and there are also differences in treatment.
(1), ankylosing spondylitis There is a clear tendency of family onset, more males than females, and the onset is mostly seen in adolescents. The clinical manifestations are mainly pain in the spine, low back and large joints of the lower extremities, and less often redness, swelling and pain in the upper extremities and small joints. There are few joints involved at the same time, showing asymmetry. The inflammatory damage of the sacroiliac joints is present at an early stage and gradually moves up the entire spine. In the late stage, patients have deformities such as hunchback or spinal ankylosis, and the cervical spine is also involved, affecting the whole body with difficulty in movement. Most patients are emaciated and have a flattened thorax. Some patients develop ocular iris and ciliary tract infection. X-rays show inflammatory changes in the sacroiliac joints. Rheumatoid factor is negative.
(2), rheumatoid arthritis The onset of the disease is more common in women, most of the onset of middle-aged and elderly women. The small joints of the extremities are mainly swollen and painful, and multiple joints are involved. Upper extremity more than lower extremity joints, symmetrical onset. Some patients have rheumatoid nodules, interstitial lung fibrosis and pleuritic changes. The sacroiliac joints are barely involved. In the advanced stage, patients have deformities of the fingers and extremity joints, and the radiographs show erosive bone and joint destruction. Most of the rheumatoid factor is positive.
Eight, how is ankylosing spondylitis treated?
Because the cause of ankylosing spondylitis is not yet known, there is no curative drug available. However, for early and mid-stage patients, as long as they are treated early with Chinese and Western drugs, the majority of patients can be well controlled or achieve clinical cure. In terms of western medicine treatment, at present, it mainly includes non-steroidal anti-inflammatory drugs (anti-inflammatory and analgesic drugs) and slow-acting anti-rheumatic drugs (disease control drugs).
(1) Non-steroidal anti-inflammatory drugs (NSAIDs) These drugs have the effects of anti-inflammatory and pain relief, reducing limb pain, stiffness and joint swelling. They have fast onset of action and are mainly used to control and relieve clinical symptoms. There are dozens of NSAIDs (non-steroidal anti-inflammatory drugs), divided into six major groups.
Salicylates such as aspirin
Indoleacetic acid such as anti-inflammatory pain, sulindac
Propionic acids such as ibuprofen
Myristic acid such as Fotalin
Ciclovir, such as inflammatory pain ciclovir, meloxicam
Pyrazolones such as nabumetone
(2) Slow-acting anti-rheumatic drugs (also known as disease-controlling drugs) are mainly used to control the progress of the disease and prevent the destruction of limbs and joints and disabilities. Commonly used are salazosulfapyridine, hydroxychloroquine, methotrexate, and leflunomide. However, the clinical effect of these drugs has not achieved the ideal effect. And there are more adverse reactions, such as gastrointestinal discomfort, anemia, hair loss, liver and kidney function damage, etc.
(3) Chinese herbal medicine Through clinical practice, it has been proven that the treatment of ankylosing spondylitis with Chinese herbal medicine does have good efficacy. Chinese medicine believes that this disease is due to congenital deficiencies, acquired loss of nourishment, liver and kidney deficiency, tendons and bones weakness. The external causes of wind, cold and dampness block the meridians, resulting in the essence, Qi, blood and fluid can not moisten the whole body. As the saying goes, “the supervisory vein is empty, the liver and kidney are deficient, the liver is weak, and the kidney is deficient, the bones are impotent”. This disease is mainly due to kidney deficiency and empty Governor, feeling external evil as the standard, because the kidney is the origin of the innate, the main bone marrow, the kidney is full of bone marrow, tendons and bones strong; the Governor’s Vessel is interspersed through the waist, the general supervision of the Yang, kidney deficiency and empty Governor can not encourage the Wei Yang Qi to protect the body against evil. If the wind, cold, dampness of the evil invade the body, then paralysis of the meridians, Qi and blood is not smooth, tendons and bones without nourishment and disease. This is similar to the theory of human genetic configuration or variation, infection and environmental factors that trigger the disease, as proposed by modern medicine. According to this mechanism, the “Rejuvenation Pill” developed by our hospital is a pure Chinese medicine preparation with no obvious toxicity or side effects, and AS patients have good compliance after taking it and can insist on long-term use, which has good effects in treating early and middle stage AS patients and effectively controlling the progress of the disease, especially in protecting bone joints and promoting bone repair.
(4) Biological agents With the application of biological drugs in clinical practice, the specialized field of rheumatology has also carried out a lot of useful exploration, and the treatment of ankylosing spondylitis has also achieved certain efficacy. At present, most of them are chosen for patients who are refractory and do not respond well to commonly used drugs. Because biological drugs are expensive and have a long course of treatment, they do not have a curative effect. Therefore, there are not too many cases of selection.
Do I need surgery for ankylosing spondylitis?
In the early stages of ankylosing spondylitis, pain and swelling in the lower back, double g or peripheral joints are the main symptoms, which are best treated with medication to relieve the symptoms and control the progress of the disease. Patients in the late stages without systematic treatment develop hunchback curvature of the spine, ankylosis and stiffness, narrowing and loss of space in the large joints of the lower limbs, especially the hip joints, joint ankylosis, and unfavorable lateral movement. If the patient’s life, work and study are affected by obvious disabilities, or even if he or she is bedridden for a long time and needs to be taken care of by others, surgical treatment such as artificial joint replacement is an option, and surgical correction of severe spinal deformities is also feasible, but such surgical treatment is generally carried out only in larger hospitals.
10. Do patients with ankylosing spondylitis need to exercise?
Patients with ankylosing spondylitis, whether early or late, should actively engage in a variety of activities that contribute to their health, including sports and fitness exercises. As long as you are able to do so, and you can recover quickly after exercise. For example, various ball games, swimming, running, brisk walking, tai chi, aerobics, dancing, etc. can be participated in. On the basis of systematic and effective treatment (insisting on taking medication), functional exercise through active cooperation with physicians can maintain the best functional state of the diseased spine and joints, enhance the strength of muscles, ligaments and tendons around the spine and limb joints, and increase lung capacity. This prevents or reduces the occurrence of physical disability and guarantees a higher quality of life.