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Abstract: A 36-year-old second-trimester mother presented to the rheumatology department with low back pain. Upon understanding, the patient underwent imaging at a local hospital, which suggested the presence of sacroiliac joint lesions, and combined with her symptoms, a preliminary diagnosis of spondyloarthritis was made. After coming to our hospital, after various examinations, it was clear that the patient had ankylosing spondylitis and was in the active phase of ankylosing spondylitis. Therefore, the patient was given a combination of Chinese and Western medicine therapy, and the patient’s symptoms were significantly reduced, and the disease was controlled and did not recur.
Basic information】Female, 36 years old
Disease Type】Inflammation of the spine (ankylosing spondylitis)
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of consultation】September 2019
Treatment plan】Intravenous infusion (adalimumab injection) + oral western medicine (etoricoxib tablets) + oral Chinese medicine tonics (Niubizi, Eucommia, Baji Tian, Epimedium, Zhi Mu, Bazhen Tang)
Treatment period】3 months
Treatment effect] The symptoms were significantly reduced and did not recur
I. Initial consultation
A 36-year-old woman came to the clinic, reporting symptoms of low back pain with stiffness after giving birth to her second child, which existed for more than half a year. However, spondyloarthritis also includes psoriatic arthritis, infectious arthritis, and ankylosing spondylitis, among which ankylosing spondylitis can also manifest as imaging changes. Since the patient already has a sacroiliac joint lesion, it is recommended that the patient have a new CT of the sacroiliac joint, or an MRI, in order to clarify whether the patient is suffering from ankylosing spondylitis.
II. Treatment history
After examination, the MRI results suggested that the patient had significant sacroiliac arthritis, the rheumatic triad suggested that the anti-C-reactive protein and blood sedimentation were higher than normal, and the HLA-B27 test showed positive, so it was clear that the patient was in the active phase of ankylosing spondylitis. The preferred regimen for the treatment of ankylosing spondylitis is biologic adalimumab injection combined with NSAIDs, such as etoricoxib tablets, to rapidly reduce inflammation and improve the patient’s symptoms of joint pain and morning stiffness.
However, since the patient still suffers from wind, fear of cold, easily recurring pain and low resistance, which affects the patient’s normal life, herbal tonics are given at this time for adjuvant treatment. According to the patient’s symptoms, as well as tongue and pulse, the patient was identified as having kidney deficiency and coldness in the governor with blood stasis, and was given to tonify the kidney and strengthen the governor, invigorate blood circulation, and regulate qi and blood, mainly using nux vomica, eucommia, bacopa monniera, epimedium and other kidney tonics to help Yang, with Zhi Mu to restrain the warm and dry nature, and also using ginseng, atractylodes, white poria, angelica, Chuanxiong, white peony, rehmannia and licorice, that is, Bazhen Tang, to regulate qi and blood.
III. Treatment effect
After 3 months of treatment, the patient’s low back pain with stiffness was significantly improved, and the fear of cold was also better than before treatment. The results of the MRI indicated that the joint inflammation was eliminated, the joint space was clear, and all indicators were normalized. Six months after stopping the medication, the patient came for a review and reported that her fear of cold was significantly reduced and her low back pain did not recur, indicating that the medication was effective.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient still needs to pay attention to the following points.
1. In life, avoid being in a cold and humid environment for a long time, pay attention to keeping warm, pay attention to the room temperature, and open the windows often for ventilation. At the same time, develop regular work and rest habits, avoid staying up late, ensure sufficient rest time, and advise patients to sleep on a hard bed. Patients should also maintain a good standing and sitting posture, walking to maintain an upright position, avoid hunching back, so as not to lead to spinal curvature.
2. In terms of diet, eat more fresh vegetables and fruits, such as cabbage and apples, and more grains such as wheat, barley, oats, corn, millet, etc., for a balanced diet. However, patients should pay attention to avoid eating spicy and irritating, greasy food, such as chili, hot pot, fatty meat, etc. They should also avoid drinking irritating beverages, such as wine and coffee.
V. Personal insight
In this case, the patient developed ankylosing spondylitis just after the birth of her second child, and although the treatment process was more tortuous, she finally received the correct and standardized care, and eventually had a better treatment. Ankylosing spondylitis usually presents with symptoms of low back pain and morning stiffness, and sacroiliac arthropathy on imaging, so you should visit the rheumatology department as soon as possible with these symptoms.
The treatment of this case of ankylosing spondylitis patient used a combination of NSAIDs, combined with herbal medicine, in which NSAIDs can inhibit new bone formation, prevent bone destruction and stabilize the patient’s condition. The combination of NSAIDs can inhibit new bone formation, prevent bone destruction, and stabilize the patient’s condition, while Chinese herbal medicine can reduce the side effects of western medicine, thus improving the patient’s quality of life.