Definition.
Ankylosing spondylitis is a chronic progressive disease that primarily affects the sacroiliac joints, spondylolisthesis, paraspinal soft tissues and peripheral joints, and may be associated with extra-articular manifestations. In severe cases, spinal deformities and joint ankylosis may occur.
Clinical manifestations.
1, the age of onset is mostly 15-30 years old, more males than females.
2, the onset of insidious, gradually appear hip or lower back pain and morning stiffness, especially at night when prolonged lying or sitting for a long time, turning over difficulties, but after activity to reduce. With the progression of the disease from the sacroiliac joint to the lumbar spine, thoracic and cervical spine development, the corresponding parts of pain, activity restrictions or spinal deformity.
Peripheral joint lesions may appear, mostly in the knee, hip, ankle and shoulder joints, with occasional involvement of the elbow and small joints of the hand and foot, and attachment point inflammation may occur.
4. Physical signs: positive “4” sign, positive schober test, thoracic mobility less than 5cm, occipital wall distance greater than 0cm.
5, extra-articular manifestations: including acute anterior uveitis, cardiovascular system lesions, pulmonary parenchymal lesions and neurological lesions, IgA nephropathy and amyloidosis, etc.
How to diagnose.
Patients with inflammatory low back pain with or without lumbar spine and thoracic mobility disorders are clearly diagnosed after combining sacroiliac arthritis, spine imaging, HLA-B27, inflammatory markers, and excluding diseases that may cause similar clinical manifestations.
How to treat: There is no radical cure. A combination of non-pharmacological, pharmacological, and surgical treatments should be used to relieve pain and stiffness, control or reduce inflammation, maintain good posture, prevent deformation of the spine or joints, as well as correct deformed joints if necessary, in order to improve and enhance the patient’s quality of life.
1. Non-pharmacological treatment
(1) Patients should carefully and uninterruptedly perform physical exercise to obtain and maintain the best position of the spinal joints, strengthen the paravertebral muscles and increase lung capacity, which is no less important than drug therapy.
(3) The posture of standing should be maintained with chest up, abdomen tucked in and eyes flat in front as much as possible. Sitting position should also keep the chest upright. One should sleep on a hard bed and take more supine positions to avoid positions that promote flexion deformity. Pillows should be short and should be discontinued once upper thoracic or cervical spine involvement occurs.
(4) Reduce or avoid physical activities that cause persistent pain. Measure height regularly. Keeping height records is a good measure to prevent early spinal curvature that is not easily detected.
(5) Select necessary physical therapy for painful or inflamed joints or other soft tissues
2. Drug treatment
(1) Non-steroidal anti-inflammatory drugs (NSAIDs): rapidly improve the patient’s low back pain and stiffness, reduce joint swelling and pain and increase the range of motion.
(2) Glucocorticoids: Long-term oral glucocorticoids are not recommended, but can be applied locally, such as intra-articular injections or local injections at attachment points.
(3) Disease improvement drugs (DMARDs): DMARDs can be considered when NSAIDs cannot control the disease satisfactorily, when patients tolerate NSAIDs poorly, or when patients have more extra-articular symptoms, e.g., salbutamol, methotrexate, leflunomide, thalidomide.
(4) Biological agents: such as etanercept, infliximab, adalimumab. Fast onset of action and good efficacy. It can greatly relieve the pain, dysfunction and decreased mobility caused by inflammation, but cannot effectively inhibit new bone formation, so biological agents should be applied as early as possible in the disease.
3.Surgical treatment.
Such as artificial total hip replacement, spinal vertebral body osteotomy to correct deformity, etc.
Prognosis: The disease can be characterized by mild or moderate episodes of acute spondylitis alternating with periods of near or complete quiescence, and is a chronic progressive disease. Long-term follow-up is indicated. If treated appropriately, the disease may be non-disabling or very mildly disabling, and the patient may be able to participate in normal work with an unaffected quality of life. In a small number of patients, the disease is difficult to control and may become progressive and disabling. The prognosis for patients with refractory iritis and secondary amyloidosis is poor.