Ankylosing spondylitis is commonly known as hunchback; that is, patients who have had ankylosing spondylitis in the past are prone to hunchback; the incidence of ankylosing spondylitis in China is about 0.3%, and men are more likely to develop it than women. The development of ankylosing spondylitis is closely related to a gene called “HLA-B27”. In China, 90% of patients with ankylosing spondylitis are positive for HLA-B27. Therefore, in patients with suspected ankylosing spondylitis, we routinely check for HLA-B27 to collaborate on the diagnosis. The most likely site of accumulation of ankylosing spondylitis is the sacroiliac joint, which is the location of the buttocks.
Symptoms of ankylosing spondylitis: The most common and characteristic early symptoms are: morning stiffness and pain in the lower back. Low back pain is an extremely common symptom in the general population, however, but most low back pain is mechanical non-inflammatory back pain, while ankylosing spondylitis is indeed inflammatory pain.
How do you distinguish between non-inflammatory and inflammatory low back pain? It is generally accepted that at least 4 of the following 5 items are met.
1. age of onset < 40 years.
2, insidious onset, that is, it develops slowly.
3, symptoms improve after activity, such as feeling much easier after getting up in the morning and moving around.
4, aggravated at rest, that is, the more rest the more uncomfortable.
5. Nocturnal pain (gets better after waking up).
Of course, some patients with atypical manifestations of ankylosing spondylitis may have their first symptoms as painful discomfort in the knee or shoulder joints or in the neck.
Diagnosis of ankylosing spondylitis: It is mainly based on symptoms, such as the presence of inflammatory low back pain, along with CT and MRI tests of the sacroiliac joints, HLA-B27 tests, blood sedimentation and C-reactive protein tests, etc.
Treatment of ankylosing spondylitis: There are two very important aspects of the treatment of ankylosing spondylitis own exercise and drug control. These two aspects of the treatment process work together to achieve the best results.
Self-exercise (which may account for more than 40% of the overall effectiveness).
1, preferably, sleep on a hard bed, and sleep in the supine position, with a short pillow; when walking, try to keep your head up and chest up. Maintain a normal posture of the spine.
2, in the acute phase of the onset, that is, when the joint pain is very strong, it is best not to exercise. When the joint is not so painful, you can exercise properly, but not strenuous exercise. The best way to exercise, of course, is to swim. If the conditions allow, you must insist on swimming. If the conditions are not allowed, you can play Tai Chi, or do exercises.
Drug treatment.
1, non-steroidal anti-inflammatory drugs, has never been the drug of choice for ankylosing spondylitis, because of its cheap price, significant efficacy, in the early, middle and late stages of ankylosing spondylitis can be used, are effective.
2, biological agents, which we often call TNF-α antagonists, efficacy can be said with magic, many patients use the next day, the effect is obvious, the symptoms are obviously relieved. But the price is more expensive, not every patient can afford.
3.Lorazepam tablets, leflunomide, thalidomide and methotrexate and other anti-rheumatic drugs, all have certain efficacy. But it needs to be synergized with NSAIDs and biological agents, etc.
Surgical treatment: If the joint deformity is severe, surgery is required, and I hope that none of the patients will go to this step of surgery.
Finally, a word about the prognosis of ankylosing spondylitis. Many of our patients, after treatment, are basically similar to normal people. As long as you adhere to your treatment, listen to your doctor, and combine exercise and treatment, the vast majority of ankylosing spondylitis can be effectively controlled. Many patients do not need to take medication until later in life.