Overview.
AS is a chronic inflammatory, progressive and self-limiting disease that starts in the sacroiliac joint and mainly affects the sacroiliac, spine and hip joints.Spinal ankylosis and flexion deformity occur in the affected spine division.The exact cause is unknown, but it is associated with infection, genetics, moisture and cold, autoimmune dysfunction, and other factors.AS is a systemic disease with chronic inflammatory lesions mainly in the mid-axis joints and is a serum It is a seronegative spondyloarthropathy. The prevalence of AS is about 0.3%.
The average age of onset of AS is 32.7 years. The onset of the disease is insidious, and the initial pain is usually vague in the buttocks, sacroiliac joints or posterior thighs, which is difficult to locate. Lower back pain and discomfort are the most common symptoms of the disease. It is worse in the morning and relieved after activity. The involvement of the spine restricts the movement of the spine, and the involvement of the cribriform joints restricts the movement of the thorax. During the active phase, there may be pain and pressure in the sacroiliac joint, pubic symphysis, spinal spine, iliac crest, greater trochanter, sciatic tuberosity, tibial tuberosity, and heel tuberosity. More than half of them have peripheral joint pain and dysfunction, mainly affecting the hip and shoulder joints. The swelling and pain have a wandering character. During the active phase of the lesion, there is a positive correlation between pain in the lower back and hip and erosion on CT of the sacroiliac joint.
Pathology.
The characteristic change in AS pathology is ligamentous attachment telangiectasia (enthesopathy), where the primary site of the lesion is inflammation of the attachment of the ligament and joint capsule, the tendon end, resulting in ligamentous osteophyte (syndesmophyte) formation, vertebral squared changes, destruction of the vertebral endplates, Achilles tendinitis, and other changes. Because the tendon end is a metabolically active site, at least during the growth phase, it is an important area for the development of AS in early childhood, and it remains unknown why the tendon end is preferred.
Synovial changes in the joints surrounding AS are characterized by granulomatous synovial fire. There is infiltration of macrophages, lymphocytes and plasma cells around the small synovial vessels, thickening of the synovium, and after months or years, granulation tissue formation in the affected synovium. There is obvious calcification and ossification of the soft tissues around the joints, and ligamentous redundancies can be formed at the ligamentous attachments, which continuously extend longitudinally and become two direct bony bridges adjacent to the vertebral body, and calcification of the paravertebral ligament and the anterior vertebral ligament, making the spine “bamboo-like”.
As the lesion progresses, there is a significant tendency for ossification in and around the joints. In the early stages, the ligaments, fibrous rings, intervertebral discs, periosteum and trabeculae are invaded by vascular and fibrous tissue and replaced by granulation tissue, leading to destruction of the entire joint and sclerosis of the adjacent bone; after repair, fibrous and bony ankylosis of the joint eventually occurs, with vertebral osteoporosis, muscle atrophy and thoracic kyphosis. Inflammation of the vertebral cartilage endplates and intervertebral disc margins eventually causes local ossification.
Cardiac lesions are characterized by invasion of the aortic valve, thickening of the aortic adventitia, shortening due to fibrosis but not fusion, and enlargement of the aortic annulus, sometimes with fibrosis reaching inferior to the basal part of the aorta. Occasionally, pericardial and myocardial fibrosis is seen, and histology reveals chronic inflammatory cell infiltration of epicardial vessels and endarteritis; the middle elastic tissue of the aortic wall is destroyed and replaced by fibrous tissue, and fibrotic tissue that invades the atrioventricular bundle causes atrioventricular block.
The lung lesion is characterized by patchy inflammation of the lung tissue with infiltration of round cells and fibroblasts, which progresses to interalveolar fibrosis with vitelliform changes.
Diagnostic criteria
(1) The earliest common diagnostic criteria for ankylosing spondylitis were proposed at the Rome Conference in 1961 and are known as the Rome criteria, which were revised at the New York Conference in 1966 and are known as the New York criteria.
X-ray sacroiliac arthritis grading.
Grade O: normal. grade 1: suspicious changes. grade 2: mildly abnormal, with limited erosion and sclerosis seen, but no change in the joint space. grade 3, markedly abnormal, with moderate or progressive sacroiliac arthritis with one or more of the following changes: erosion, sclerosis, narrowing of the joint space, or partial ankylosis. Grade 4: Severe abnormality; complete joint ankylosis.
(1) Diagnosis.
(1) Restriction of lumbar spine movement in three directions: forward flexion, back extension, and lateral bending;
②History of low back pain or presenting symptoms;
③thoracic mobility less than 2.5 cm measured at the 4th rib space.
(2) Grading.
Definite ankylosing spondylitis
1, bilateral grade 3 to 4 sacroiliac arthritis plus one or more clinical criteria;
2, unilateral grade 3 to 4 or bilateral grade 2 sacroiliac arthritis plus item l or item 2 + 3 clinical criteria.
Possible ankylosing spondylitis: Bilateral grade 3 to 4 sacroiliac arthritis without clinical criteria.
(2) Modified New York criteria, 1984
(1)Diagnosis
①Clinical criteria
1.Lower back pain and stiffness for more than 3 months, with improvement in activity and no improvement at rest.
2.Limitation of lumbar frontal and sagittal movement.
3.Thoracic mobility is lower than that of normal people of corresponding age and sex.
②Radiological criteria.
Bilateral sacroiliac arthritis at or above grade 2 or unilateral sacroiliac arthritis grade 3 to 4.
(2) Grading
1, definitely ankylosing spondylitis: meet the radiological criteria and more than 1 clinical criteria.
2.Probable ankylosing spondylitis: 3 clinical criteria are met. Meets radiological criteria without any clinical criteria (other causes of sacroiliac arthritis should be removed).
This criterion improves the sensitivity of the diagnosis of ankylosing spondylitis, but the clinical determination of grade 3 x-ray sacroiliitis is not easy and ignores the early symptoms of the disease, so it is not as satisfactory.
The above diagnostic criteria all emphasize low back pain, limited lumbar motion, limited thoracic motion, and sacroiliac arthritis, and the diagnosis of this disease is not difficult as long as these points are noted. In male adolescents, any acute or chronic pain and stiffness in the low back and lower back should be suspected, and early X-ray examination of the sacroiliac joint must be performed to clarify the diagnosis. Combined with X-ray CT imaging diagnosis can be clearly diagnosed
(5) European and American Spondyloarthropathy Study Group criteria: inflammatory spinal pain or symmetry and synovitis predominantly in the joints of the lower extremities, with any of the following additional items, namely
1, positive family history
2, psoriasis
3, inflammatory bowel disease
4.Urethritis, cervicitis or acute diarrhea within 1 month before arthritis ;
5.Bilateral alternating pain in the hip
6.Tendon terminal disease
7, sacroiliac arthritis.
Ankylosing spondylitis auxiliary examination
The white blood cell count is normal or elevated, with a slightly increased proportion of lymphocytes. A few patients have mild anemia (orthocytic hypochromic), and the hematocrit may be increased, but there is little correlation with disease activity, whereas C-reactive protein is more significant. Serum albumin is decreased, alpha1 and gamma globulins are increased, serum immunoglobulins IgG, IgA and IgM may be increased, and serum complement C3 and C4 are often increased. Alkaline phosphatase is elevated in about 50% of patients, and serum creatine phosphokinase is often elevated. Serum rheumatoid factor is negative. Although more than 90% to 95% of patients with AS are positive for LHA-B27, LHA-B27 is not generally relied upon for the diagnosis of AS, and LHA-B27 is not routinely examined and cannot be used to sequentially screen patients. The diagnosis mainly relies on clinical manifestations and radiographic evidence.
X-ray examination is extremely important for the diagnosis of AS, and X-ray changes of the sacroiliac joint are present early in about 98% to 100% of cases, which is an important basis for the diagnosis of the disease.
The X-ray manifestations are similar in primary AS and in spondylitis secondary to inflammatory bowel disease, Reiter syndrome, psoriatic arthritis and other concomitant spondylitis, but the latter is asymmetrical ankylosis. Bone and osteochondritis can occur at the attachment of ligaments, tendons, and bursae, most often in the heel bone, sciatic tuberosity, and iliac crest. Similar radiographic changes may occur in other peripheral joints.
If early X-rays are negative, radionuclide scans, computed tomography and MRI are feasible to detect early symmetrical sacroiliac joint lesions. It must be noted, however, that a simple posterior anterior radiograph is generally sufficient to diagnose the disease.
In summary: the diagnosis is based on symptoms, joint signs, extra-articular manifestations, and family history.
I. Symptoms
Patients with low back pain are suffering from mechanical, non-inflammatory pain. Most patients with this disease have inflammatory pain. Inflammatory pain manifestations: 1 back discomfort occurs before the age of 40, 2. slow onset 3. symptoms for more than 3 months 4. back pain with morning stiffness 5. back discomfort decreases or disappears after activity
Four of the above five items support inflammatory pain.
II. Physical examination
At the beginning, the sacroiliac joint and paravertebral muscle pressure pain, and then the pressure pain range is widened; the lumbar curve is weakened, the activity of the spine in all directions is first or disappeared, the range of thoracic movement is reduced, and the cervical curve is weakened or disappeared. Examination methods: double foot against the wall test, requiring both feet and the occiput can touch the wall for normal, otherwise for strong spondylitis; thoracic expansion test; pelvic separation test, 4-character test positive.
Third, X-ray performance.
The early X-ray manifestation is sacroiliac arthritis, and the lesion usually starts in the lower and middle part of the sacroiliac joint, which is bilateral. The lesion usually starts in the middle and lower part of the sacroiliac joint and is bilateral. It invades the iliac side at first and then invades the sacral side. A patchy or lumpy bony side may be evident. Subsequently, the entire joint may be invaded, with jagged edges, subchondral osteosclerosis, osteophytes and narrowing of the joint space. Finally, the joint gap disappears and bony ankylosis occurs. Most of them develop from the sacroiliac joint upwards, but a few of them develop from the neck downwards. In the early stage, the pain in the sacroiliac joint is not obvious on X-ray. Later, the margins of the sacroiliac joint are blurred and slightly dense, and the joint space is widened, and the articular cartilage and joint surface are destroyed. Irregularity of the joint space appears, and in the late stage stiffness and complete disappearance of the joint space is observed.
Sacroiliac arthritis under X-ray easy-to-use button is approximately classified into 5 levels of diagnostic criteria: level 0 for normal sacroiliac joint, level I for suspected sacroiliac joint inflammation on both sides; level II for blurred sacroiliac joint margins, slight sclerosis and minor erosion lesions, and mild narrowing of joint cavity; level III for sclerosis on both sides of sacroiliac joint, blurred joint margins, and erosion lesions with disappearance of joint cavity; level IV for complete joint fusion or ankylosis with or without residual Sclerosis.
The most characteristic X-ray of the spine is the early manifestation of square change and decalcification of the vertebral body, and only later do the bamboo changes of the spine and the retroflexion deformity of the spine appear. The square shape of the vertebral body is caused by bone growth at the ligamentous attachments at the anterior and inferior margins of the vertebral body, and the new bone growth causes the square shape of the vertebral body. Bamboo-like changes: seen in the middle and late stages of the disease, due to the formation of bony bridges on both sides of the adjacent vertebral body by the new bone flab, the bridges between the vertebral bodies in the orthoptic view resemble bamboo joints. 3 ossification zones run through the spine from top to bottom. The ossified articular processes on both sides and the intermediate spinous processes and ossified supraspinous and interspinous ligaments are present. Posterior convexity deformity of the spine: advanced disc lesions, narrowing of the intervertebral space and loss of normal physiological curvature.
It has also been suggested that the X-ray manifestation of spinal lesions is early generalized osteoporosis, blurring of the vertebral tuberosities and vertebral trabeculae (decalcification), destructive erosion of the upper and lower corners of the vertebrae at the incidental part of the intervertebral disc fibrous ring, the vertebral body is “square vertebrae”, and the normal anterior curvature of the lumbar spine disappears and becomes straight, which may cause compression of one or more vertebral bodies. The normal anterior curvature of the lumbar spine is lost and straightened, which may cause compression fractures in one or more vertebrae. Lesion development to the thoracic and cervical intervertebral joints, calcification of the interdiscal space, calcification of the fibrous ring and anterior longitudinal ligament, ossification, formation of ligamentous redundancy, so that adjacent vertebrae together, forming intervertebral bone bridge, the most characteristic “bamboo-like spine”.
Laboratory tests: fast sedimentation, normal or elevated white blood cell count, slightly increased lymphocyte ratio, a few patients have mild anemia (orthocytic hypochromic), sedimentation may increase, but the correlation with disease activity is not significant, while C-reactive protein is more meaningful. Serum albumin is decreased, alpha1 and gamma globulins are increased, serum immunoglobulins IgG, IgA and IgM may be increased, and serum complement C3 and C4 are often increased. Alkaline phosphatase is elevated in about 50% of patients, and serum creatine phosphokinase is often elevated. Serum rheumatoid factor is negative. Although more than 90% to 95% of AS patients are LHA-B27 positive, LHA-B27 is not generally relied upon to diagnose AS, and LHA-B27 is not routinely tested and cannot be used to screen patients sequentially. The diagnosis mainly relies on clinical manifestations and radiological evidence.
Clinical manifestations: mainly low back pain, low back stiffness and loss of lumbar movement function. Later, there is respiratory-digestive and circulatory dysfunction caused by hunchback deformity.
There is also literature that the main symptoms are pain, swelling, morning stiffness, numbness, fever, sweating, impaired spinal joint mobility, and ankylosing deformities of the spinal joints.
The initial site of ankylosing spondylitis is mostly in the lumbosacral region, and 100% of patients also have sacroiliac joint pain. The main lesion of this disease is in the spine, in the low back. Initially, the back feels slightly painful, stiff, and unable to sit for long periods of time. If the disease continues to develop, it can produce cold limbs, bending difficulties, and even ankylosis. If the disease is not controlled, it can lead to spinal ankylosis, hunchback, inability to lean over, upright forward vision, and can even involve the kidneys, heart, and lungs. It can also produce iritis.
Clinical Classification
(1) Obvious type
①Acute onset.
Usually seen in adolescents, more males than females. Sudden onset of lumbosacral pain, sometimes more severe, sometimes up to the chest and neck, sometimes down to the heel of the thigh, and even limited mobility, unable to take care of themselves. In addition, the patient is depressed and irritable for a long time, with irritable heart, dry mouth and tongue, dry and astringent stool, or fever and bad chills, or low fever, with light white or light yellow tongue coating and string pulse.
②Relief period.
The end of the acute attack period and the reduction of symptoms do not mean that the disease is cured. This period should be treated with residual symptoms and should not leave the root of the disease.
(2) Occult type.
In the early stage, there may be a state of not wanting to eat, fatigue, emaciation and anemia, and a few may have low fever and arthralgia, as if first suffering from rheumatic fever or tuberculosis, which is usually not serious so it often fails to attract attention. The disease may occur after trauma, overexertion or infection, which is the cause.
Overview of clinical symptoms.
AS is common in young people aged 16 to 30 years, and is more common in males, and is rare in those who first develop it after the age of 40, accounting for about 3.3%. 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 is relieved after activity, and may 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 bottom to top, with hunchback deformity. In female patients, peripheral joint invasion is more common and progresses more slowly, and the spinal deformity is less severe.
The majority of AS patients have arthropathy, and most of them first invade the sacroiliac joint and later progress upward to the cervical spine. In a few patients, the cervical spine or several spinal segments are invaded at the same time, and the surrounding joints may also be invaded. In the early stage, there is inflammatory pain in the joints, accompanied by muscle spasm around the joints and a feeling of stiffness, which is obvious in the morning; it may also be manifested as night pain, which is relieved by activities or painkillers. As the disease progresses, the joint pain decreases, while the movement of each spinal segment and joint is restricted and deformed, and in advanced stages the entire spine and lower limbs become strongly bowed and flexed forward.
(1) Sacroiliac arthritis: About 90% of AS patients first present with sacroiliac arthritis. Later, it develops upward to the cervical spine and manifests as recurrent lumbar pain, lumbosacral stiffness, intermittent wai or alternating lumbar pain on both sides and hip pain on both sides, which may radiate to the thighs without positive signs and negative extension and leg lift test. However, direct pressure or extension of the sacroiliac joint can cause pain, so it is not like sciatica. Some patients have no symptoms of sacroiliac arthritis and only abnormal changes are found on X-ray. About 3% of the AS cervical spine is involved at the earliest and later progresses down to the lumbosacral region, while 7% of the AS has several spinal segments involved at the same time.
(2) Lumbar spine lesions: when the lumbar spine is involved, most of them show restricted lower back anterior and lumbar activities. The lumbar anterior flexion, buckling base peculiar to the moisture scythe Liao Wei brake (11) cup guide hiring lies hiring stand stirrup about ∪ ration imitation dangerous slow deceitful wake up∥ entertainment
(3) thoracic spine lesions: when the thoracic spine is involved, it manifests as back pain, anterior and lateral thoracic pain, and the most weapon a hunchback deformity. If the rib spine joint, sternal stalk joint, sternoclavicular joint [19, 20] and intercostal cartilage joint are involved, there is a bundle of chest pain, restricted thoracic expansion, and chest pain is aggravated when inhaling and coughing or sneezing. In severe cases, the thorax remains in the state of exhalation, and the thoracic expansion is reduced by more than 50% compared with normal people, so that it can only be assisted by abdominal breathing. Due to the reduction of thoracic and abdominal cavity capacity, it causes cardiopulmonary and digestive dysfunction.
(4) Cervical spine lesions: A few patients first present with cervical spondylitis, with pain in the cervical spine first, radiating along the neck to the head and arms. The neck muscles start with spasm and later atrophy, and the lesion progresses to cervicothoracic posterior convexity deformity. Head movement is significantly restricted, often fixed in a forward-flexed position, unable to supinate, lateral bend or rotate. Severe cases can only see a small piece of ground in front of their toes, and cannot raise their heads to look flat.
(5) Peripheral arthropathy: About half of the patients with AS have transient acute peripheral arthritis, and about 25% have permanent peripheral joint damage. It usually occurs more often in the large joints and more in the lower extremities than in the upper extremities. According to some statistics, the rate of peripheral joint involvement is 40% for the hip and shoulder, 15,5 for the knee, 10% for the ankle, 5% for the foot and wrist, and very rarely for the hand. The General Hospital of the People’s Liberation Army reported that in 80 cases of AS, the involvement rate of the hip joint was 100%; limitation of movement (64%), flexion contracture (38%), muscle atrophy (25%), and joint ankylosis (37%) were the main causes of disability in AS patients; 94% of the hip symptoms appeared within 5 years after the onset of the disease, suggesting that if the hip joint is not involved in the first 5 years of AS, the possibility of later involvement is It is unlikely that the hip joint will be involved in the first 5 years of AS.
When the shoulder joint is involved, the pain is more obvious when the joint activity is restricted, and the activities such as combing the hair and lifting the hand are restricted. When the knee joint is involved, the joint is compensated for bending, which makes walking, sitting and standing more difficult in daily life. It rarely affects the elbow, wrist and foot joints, and is even rarer when it affects some of the joints.
In addition, the pubic symphysis can also be involved, and the upper edge of the pelvis, the sciatic tuberosity, the greater trochanter of the femur and the heel of the foot can be affected.
There may be symptoms of osteoarthritis in the pelvic rim, sciatic tuberosity, greater trochanter of the femur, and heel of the foot. In general, peripheral arthritis can occur before or after spondylitis, and local symptoms are not easily distinguishable from rheumatoid arthritis, but there are fewer remaining deformities.
The extra-articular manifestations of AS mostly appear after spondylitis, and occasionally extra-articular symptoms occur months or years before skeletal muscle symptoms.AS can invade multiple systems throughout the body and is associated with a variety of diseases.
(1) Cardiac lesions: Aortic valve lesions are more common, and according to autopsy, about 25% of AS cases have aortic radiculopathy, and cardiac involvement can be clinically asymptomatic or significant. About 1% of the cases have varying degrees of aortic valve incompetence; about 8% have heart block, which can coexist with aortic valve incompetence and occur alone, or in severe cases, complete atrioventricular block and A.I.S. syndrome. Angina pectoris can occur when the lesion involves the coronary artery opening. Rarely, aortic aneurysms, pericarditis and myocarditis occur. Patients with AS with combined heart disease are generally older, have a longer medical history, more spondylitis and peripheral joint lesions, and more pronounced systemic symptoms. gould et al. examined the cardiac function of 21 patients with AS and found that the cardiac function of AS patients was significantly lower than that of the control group.
(2) Ocular lesions: On long-term follow-up, 25% of AS patients had conjunctivitis, iritis, uveitis or uveitis, the latter occasionally complicated by spontaneous anterior chamber hemorrhage. The latter may occasionally be complicated by spontaneous anterior chamber hemorrhage. Iriditis is prone to recurrence and increases in incidence the longer the disease is present, but is not related to the severity of spondylitis, which is common in those with peripheral arthropathy and may occur in a few cases before spondylitis. Ocular disease is often self-limiting, sometimes requiring treatment with corticosteroids, and in some cases can lead to glaucoma or blindness without proper treatment.
(3) Ear lesions: Gamilleri et al. reported that chronic otitis media occurred in 1/2 of 42 patients (29%) with AS, which is 4 times more than normal controls, and, in AS patients with chronic otitis media, there were significantly more extra-articular than in AS patients without chronic otitis media.
(4) Pulmonary lesions: A small number of patients with AS may be complicated by speckled irregular fibrotic lesions in the upper lobe of the lung, manifested by coughing, shortness of breath, or even hemoptysis, and may be accompanied by recurrent episodes of pneumonia or pleurisy. x-ray examination shows diffuse bilateral fibrosis in the upper lobe of the lung, which may have cyst formation and parenchymal destruction, similar to tuberculosis, and needs to be differentiated.
(5) Neurological lesions: due to spinal ankylosis and osteoporosis, cervical dislocation and spinal fracture can easily occur and cause spinal cord compression; if intervertebral discitis occurs, it causes severe pain; late AS can invade the cauda equina and cauda equina syndrome occurs, which leads to neurogenic pain in the lower limbs or buttocks; loss of infection in the sacral nerve distribution area, weakened Achilles tendon reflex and motor dysfunction such as bladder and rectum.
(6) Amyloidosis: It is a rare complication of AS. Among 35 cases of AS, routine rectal mucosal biopsy was reported to find amyloid deposits in 3 cases, mostly without specific clinical manifestations.
(7) Renal and prostatic lesions: compared with RA, renal impairment rarely occurs in AS, but IgAD nephropathy has been reported. the significance of AS complicated by chronic prostatitis is higher than in the control group is unknown.
Differential diagnosis.
I. Differentiation from lesions of the sacroiliac joint-like.
(1) rheumatoid sacroiliac arthritis, often with bilateral onset, often with different degrees of lesions, invading the upper part of the sacroiliac joint, with reduced bone cortical density on the joint surface and small capsular bone defects under the joint, surrounded by varying degrees of sclerotic bands.
(2) Septic sacroiliac arthritis develops unilaterally in the sacroiliac joint, with early swelling of the joint capsule, widening of the joint space, followed by osteoporosis, coexistence of bone destruction and hyperplasia, and calcification of the soft tissue around the bony joint.
(3) Tuberculous sacroiliac arthritis often develops unilaterally, with early blurring of the joint surface, widening of the joint space, and an area of bony destruction in the anterior and inferior 13 sacral and iliac bones, with indistinct margins of the destruction cavity, residual small bone fragments in the corresponding soft tissues, scattered speckled high-density calcification and dead bone. With regard to the fine granular or “gritty” dead bone, it may be a calcified spot of dry cool material, or it may be a real “gritty” dead bone. The joint space is narrowed, and cold abscesses or sinus tracts are formed around the joint.
(4) Dense iliac osteitis, which occurs in women and is often associated with pregnancy, has a triangular shaped bony dense shadow on the pars interarticularis of the iliac surface, which is wide at the top and narrow at the bottom, with indistinct lateral margins.
Second, and can occur or cause ankylosing spondylitis and sacroiliac joint lesions differential diagnosis.
1, lumbosacral joint strain. Chronic lumbosacral joint strain is persistent and diffuse lumbago, with the heaviest lumbosacral pain, no restriction of spinal movement, and no special changes on X-ray. Acute lumbosacral joint strain, the pain is aggravated by the activity, and can be relieved after rest.
2.Osteoarthritis. Often occurs in the elderly, characterized by bone and cartilage degeneration, hypertrophy, synovial thickening, damaged joints such as the weight-bearing spine and knee joints are more common. The spine is often involved in chronic low back pain as the main symptom, easy to confuse with AS; but the disease does not occur joint ankylosis and muscle atrophy, no systemic symptoms, X-ray manifestations of bone superfluous generation and narrowing of the vertebral space.
3.Forestier disease (age-related ankylosing bone hypertrophy). The spine also occurs continuous bone superfluous, similar to the bamboo-like changes of the spine of AS, but the sacroiliac joint is normal, and the small intervertebral joints are not invaded.
4, tuberculous spondylitis. Clinical symptoms such as spinal pain, pressure, stiffness, muscle atrophy, hunchback deformity, fever, rapid blood sedimentation, etc. are similar to AS, but X-ray examination can be used to differentiate. In tuberculous spondylitis, the vertebral margins are blurred, the intervertebral space is narrowed, the anterior wedge is changed, there is no ligamentous calcification, sometimes there is a shadow of paravertebral tuberculous pustules, and the sacroiliac joint is unilaterally involved.
5, rheumatoid arthritis. It has been confirmed that AS is not a specific type of RA, there are many differences between the two can be distinguished. RA is more common in women, usually first invade the small joints of the hands and feet, and bilateral symmetry, sacroiliac joints are generally not involved, such as the invasion of the spine, most only invade the cervical spine, and no paravertebral ligament calcification, rheumatoid subcutaneous nodules, serum RF is often positive, HLA-B27 antigen is often negative.
6, enteropathic arthropathy ulcerative colitis, restrictive enteritis or enterogenic fat metabolism disorder (Whipple) can occur spondylitis, and enteropathic arthropathy involved joints and x-ray changes and AS similar and not easy to distinguish, so you need to look for intestinal symptoms and signs to differentiate. Ulceration of the colonic mucosa, edema and bloody diarrhea in ulcerative colitis; abdominal pain, nutritional disorders and fistula formation in restrictive enterocolitis; steatorrhea and acute wasting in Whipple’s disease all contribute to the diagnosis of the primary disease. The rate of HLA-B27 positivity in enteropathic arthropathy is low, and IgG in intestinal perfusion fluid is increased in patients with Crohn’s disease, while IgG in intestinal perfusion fluid is basically normal in patients with AS.
7, Reiter syndrome and psoriatic arthritis both diseases can occur spondylitis and sacroiliac arthritis, but spondylitis generally occurs later, lighter, less calcification of paravertebral tissues, ligamentous bone superfluous to non-marginal type (calcification of fibrous tissue outside the fibrous ring), the formation of partial bone bridges between two adjacent vertebrae and AS bamboo-like spine is different.
8, tumor tumor can also cause progressive pain pain, a comprehensive examination is required to make a clear diagnosis in order to rabbit misdiagnosis.