Ankylosing spondylosis is a disease in which inflammation of the sacroiliac joints and spinal attachment points is the main symptom. It shows a strong association with HLA-B27. Certain microorganisms (e.g. Klebsiella) have common antigens with the susceptible person’s own tissues and can trigger an abnormal immune response. It is a chronic inflammatory disease characterized by fibrosis and ossification of the large joints of the extremities, as well as the intervertebral disc rings and adjacent connective tissue, and joint ankylosis. Ankylosing spondylitis belongs to the category of rheumatic diseases and is a type of seronegative spondyloarthropathy. The cause of this disease is not clear, but it is a chronic disease with the spine as the main lesion site, involving the sacroiliac joints, causing spinal ankylosis and fibrosis, resulting in varying degrees of eye, lung, muscle and bone lesions, and is an autoimmune disease.
It is likely that the disease is caused by environmental factors (including infection) based on genetic factors. Genetic factors play an important role in the development of AS. It is generally believed that there is a direct relationship with HLA-B27, and the prevalence of AS in HLA-B27-positive individuals is 10%-20%. Immune factors are also a cause, and it has been found that 60% of AS patients have increased serum complement, most cases have IgA-type rheumatoid factor, and serum C4 and IgA levels are significantly increased. Trauma, endocrine, metabolic disorders and metabolic reactions are also suspected to be pathogenic factors.
1.Clinical manifestations
(1) Pain and discomfort in the lower back and/or spine, groin, buttocks or lower extremities, or asymmetric peripheral oligoarthritis, especially lower extremity oligoarthritis, with symptoms lasting ≥ 6 weeks.
(2) Nocturnal pain or morning stiffness is evident.
(3) Relief after activity.
(4) Heel pain or other tendon attachment point disease.
(5) Current or past history of iridocyclitis.
(6) Family history of AS or HLA-B27 positivity.
(7) Rapid relief of symptoms with NSAIDs.
2.Imaging or pathology
(1) Bilateral x-ray sacroiliitis ≥ stage III.
(2) Bilateral CT sacroiliac arthritis ≥ stage II.
(3) CT sacroiliac arthritis less than grade II, MRI examination is feasible. If it shows cartilage destruction, paracartilage edema and/or extensive fat deposition, especially if the enhancement intensity of the joint or paracartilage is >20% and the enhancement slope is >10%/min on dynamic enhancement examination.
(4) If the pathological examination of sacroiliac joint shows inflammation.
3.Diagnosis
AS can be diagnosed if the first clinical criterion and three of the others are met, as well as any of the imaging and pathological criteria.
4.Medication
(1) Non-steroidal anti-inflammatory drugs have anti-inflammatory and pain-relieving effects and reduce stiffness and muscle spasm. The side effects are gastrointestinal reactions, kidney damage, and prolonged bleeding time. Special attention should be paid to pregnant and lactating women.
(2) Sulfasalazine SSZ is an azo compound of 5-aminosalicylic acid and sulfasalazine, which has been used for the treatment of AS since 1980s. side effects are mainly gastrointestinal symptoms, rash, blood picture and liver function changes, but they are rare. It is advisable to check the blood picture and liver and kidney function regularly during the drug use.
(3) Methotrexate has been reported to have similar efficacy to SSZ. The efficacy of oral and intravenous dosing is similar. Side effects include gastrointestinal reactions, bone marrow suppression, stomatitis, hair loss, etc. Regular check of liver function and blood picture is recommended during the use of the drug, and avoid drinking alcohol.
(4) Adrenocorticotropic hormone is generally not used to treat AS, but in acute iritis or peripheral arthritis when treatment with NSAIDs is ineffective, CS can be used for local injection or oral administration.
(5) Radix polyglycoside domestic initially used Radix tincture for AS, has anti-inflammatory and analgesic effect, better efficacy than tincture, easy to take. Side effects include gastrointestinal reactions, leukopenia, menstrual disorders and reduced sperm vitality, etc., which can be restored after stopping the drug.
(6) Biological agents such as tumor necrosis factor antagonists (such as Yicep, adalimumab, etc.) is currently the best choice for the treatment of AS and other spinal joint diseases, those who have the conditions should try to choose.
5.Surgical treatment
Severe spinal hunchback and deformity can be corrected after the condition is stabilized, and lumbar spine deformity can be corrected by vertebral osteotomy. For cervical 7 thoracic 1 osteotomy can correct the serious deformity of cervical spine.