Ankylosing spondylitis is a spondyloarthritis syndrome that affects mainly the lumbar and thoracic spine as well as the sacroiliac joints and is associated with immune disorders and genetic factors, with a strong association with HLA-B27.
The main course of ankylosing spondylitis is inflammation of the joints and tendons
1. Manifestations of joint lesions
(1) Sacroiliac arthritis: one of the earliest symptoms in about 90% of AS patients is inflammation of the sacroiliac joint
(2) Lumbar spine lesions
(3) Thoracic spine lesions: back pain, chest pain, hunchback deformity, and reduced thoracic expansion compared to normal
(4) Cervical spine lesions: a few patients first present with cervical spondylitis, with pain in the cervical spine, and the lesion may progress to cervicothoracic kyphosis, with significant restriction of head movement
(5) Peripheral joint lesions: About half of the patients with AS have transient acute peripheral arthritis, and about 25% have permanent peripheral joint damage. It usually occurs in large joints, more in the lower extremities than in the upper extremities.
2.Extra-articular manifestations
(1) Cardiac lesions: aortic valve lesions are more common
(2) Eye lesions: 25% of AS patients have conjunctivitis, iritis, uveitis or uveitis
(3) Ear lesions: 29% have chronic otitis media
(4) Pulmonary lesions: A small number of patients with AS may develop irregular fibrotic lesions in the upper lung lobes.
(5) Neurological lesions: due to spinal ankylosis and osteoporosis, cervical dislocation and spinal fracture may occur, causing spinal cord compression; if intervertebral discitis occurs, it may cause severe pain; the cauda equina syndrome may occur in the late stages of AS, resulting in neurogenic pain in the lower limbs or buttocks; loss of infection in the sacral nerve distribution area, weakened Achilles tendon reflex and motor dysfunction in the bladder and rectum.
Diagnostic criteria for ankylosing spondylitis
Relying primarily on clinical manifestations and radiographic evidence.
① The duration of lower back pain lasts for at least 3 months, and the pain improves with activity but is not relieved by rest;
②Lumbar spine movement is limited in anterior-posterior and lateral flexion directions;
③Thoracic extension is less than normal for the same age and sex;
④Bilateral sacroiliac arthritis grade II-IV, or unilateral sacroiliac arthritis grade III-IV. (X-ray examination is of great importance for the diagnosis of AS, about 98% to 100% of 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 diagnosis of AS can be confirmed if the patient has ④ and any 1 of ①-③ respectively.
Note: The incidence of the disease is about 20% in HLA-B27-positive people, and the remaining 80% do not develop the disease. HLA-B27-negative does not necessarily mean that ankylosing spondylitis does not occur, and it cannot be assumed that HLA-B27-positive is ankylosing spondylitis.
Treatment of ankylosing spondylitis
The goal of AS treatment is to control inflammation, reduce or alleviate symptoms, maintain normal posture and optimal functional position, and prevent deformity. The key to achieving these goals is early diagnosis and treatment with a combination of measures, including patient and family education, physical therapy, physical therapy, medication and surgical treatment.
The current principles of treatment for ankylosing spondylitis are exercise, non-steroidal anti-inflammatory and analgesic drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs) when necessary.
1. Stable phase, mild symptoms, exercise, anti-inflammatory and analgesic drugs
Exercise is the most basic treatment. The basic principle of exercise is to do it every day consistently, especially before going to bed to make soft and stretching exercises to prevent spinal deformation. Exercise should be gentle, aerobic and gradual, avoiding sports that may cause violent impact, such as wrestling, rugby, etc. The best exercises are swimming and soft gymnastics, tai chi, yoga, moderate sit-ups and push-ups are also good exercises for spondylitis.
2.Mild inflammation, only the spine is invaded
Anti-inflammatory painkillers, consider using immunomodulators
3.Moderate to severe inflammation or peripheral arthritis or extra-articular invasion
Anti-inflammatory painkillers plus immunomodulators, steroid local injection
4.Severe inflammation and ineffective treatment
Steroid pulse therapy, anti-tumor necrosis factor therapy.