Ankylosing spondylitis belongs to the category of rheumatic diseases and is one of the seronegative spondyloarthropathies. Studies have shown that the cause of the disease is not very clear, the spine is the main lesion of the chronic disease, the lesion mainly involves the sacroiliac joint, causing spinal ankylosis and fibrosis, resulting in bending, walking activity is limited, and can have varying degrees of eye, lung, muscle, bone lesions, but also autoimmune disorders, so it is also an autoimmune disease.
The main features of AS are inflammation and ossification of the lumbar, cervical and thoracic spinal joints and ligaments, as well as the sacroiliac joints, often involving the hip joint, and inflammation of other peripheral joints. Ankylosing spondylitis is actually a very ancient disease, with evidence of ankylosing spondylitis found in the bones of ancient Egyptians thousands of years ago. 2000 years ago, Hippocrates, a famous Greek physician, described a disease in which people with the disease had pain in the sacrum, spine, and cervical spine.
AS is common in young people between 16 and 30 years of age, and is more common in men, with a rare first onset after age 40, accounting for about 3.3% of cases. The disease starts insidiously, progresses slowly, and has mild systemic symptoms. In the early stage, there is often lower back pain and morning stiffness, which decreases after activity, and can be accompanied by low fever, fatigue, loss of appetite, wasting and other symptoms. The pain is intermittent at the beginning and develops into persistent after several months and years. Later, the inflammatory pain disappears, and the spine is partially or completely straightened from the bottom up, resulting in hunchback deformity. In female patients, peripheral joint invasion is more common and progresses more slowly, and the spinal deformity is less severe.
1. Etiology and pathology
The etiology of AS is not known. The incidence of the disease is low, more males than females, and there is a significant family history, so patients with AS are considered to have a genetic component. Studies have shown that AS is closely related to HLA-B27, and that the development of ankylosing spondylitis is directly related to HLA-B27.
The underlying pathology is a primary, chronic, vascular cataract-destructive inflammation, mainly of the synovium, joint capsule, tendons, and bone attachment points of ligaments. Ossification is secondary to the repair process.
2, manifestations of arthropathy around ankylosing spondylitis
About half of the AS patients have transient acute peripheral arthritis, and about 25% have permanent peripheral joint damage. It generally occurs more often in large joints, and more in the lower extremities than in the upper extremities. The rate of peripheral joint involvement has been estimated to be 40% for the hip and shoulder, 10% for the knee and ankle, 5% for the foot and wrist, and rarely for the hand. The main manifestations are activity limitation, flexion contracture, muscle atrophy, and joint ankylosis.
3.Diagnosis
(1) X-ray examination is of great importance to the diagnosis of AS. Most cases have X-ray changes of the sacroiliac joint at an early stage, which is an important basis for the diagnosis of the disease. The typical X-ray manifestation is the bamboo-like change of spine and the change of pelvic closed hole morphology.
(2) Laboratory tests
a Blood sedimentation will increase accordingly, C-reactive protein will be significantly higher, immunological tests will show different manifestations, and serum creatine phosphokinase is often elevated.
b More than 90% to 95% of AS patients are HLA-B27 positive.
4.Treatment
The purpose of treatment is to relieve pain and prevent deformity, to perform functional exercises, and to maintain the movement function of the spine. Physical therapy is effective, and physical therapy is effective and important for patients with AS.
Drug therapy is divided into 3 types.
(1) drugs to control the activity of the disease and influence the progress of the disease, such as sulfasalazine, methotrexate, and now the latest “biological agents” with significant efficacy.
②Non-steroidal anti-inflammatory drugs are suitable for patients with severe pain and stiffness at night, and can be taken at bedtime.
③Analgesics and myorelaxants such as analgesic new, prednisolone myosuprine, often used for long-term application of non-steroidal anti-inflammatory drugs are ineffective.
Patients with AS who have significant joint deformities and functional limitations may be considered for arthroplasty and artificial joint replacement to improve function.