(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Ankylosing spondylitis is a chronic disease characterized by spinal lesions that manifest mainly as low back pain and morning stiffness, which worsen after activity and decrease after rest. A 46-year-old male was deeply troubled by this disease, so he came to our hospital and was discharged from the hospital after 1 week of using the biological agent recombinant human type II tumor necrosis factor receptor antibody fusion protein for injection, as well as diclofenac sodium extended-release tablets and celecoxib capsules, which significantly reduced the pain in the low back.
Basic information】Male, 46 years old
Disease Type】Ankylosing spondylitis
Hospital】The First Hospital of China Medical University
Date of consultation】January 2022
Treatment plan】Medication (recombinant human type II tumor necrosis factor receptor-antibody fusion protein for injection, diclofenac sodium extended-release tablets, celecoxib capsules, hydrocortisone injection, acetylcysteine granules, calcium vitamin D chewable tablets, alfa osteoporosis softgels)
[Treatment period] 1 week of hospitalization, review after 3 months of discharge
Effectiveness of treatment】Significant reduction of low back pain, stable condition
I. Initial consultation
The patient, male, 46 years old, reported that more than 20 years ago, he had low back pain with no obvious cause, no joint pain in the extremities, no fever, aggravated after rest and relieved after activity, and was diagnosed as “ankylosing spondylitis” in a foreign hospital and given symptomatic treatment (details unknown), but still had recurrent low back pain and limited activity, and then was hospitalized in our department for several times for treatment with Isep. The patient was admitted to the hospital for further treatment and was given a CT examination of the chest, which showed that the curvature of the thoracic spine was straightened. Since the onset of the disease, the patient has been clear, mentally competent, able to eat, and has normal bowel movements.
II. Treatment history
After taking medical history and auxiliary examinations such as blood sedimentation, blood biochemistry and chest CT, it was clear that the patient had ankylosing spondylitis. After communicating with the patient and his family about the drugs that might be used and the effects of drug treatment, the patient and his family agreed to the drug treatment plan. For ankylosing spondylitis, the patient was given the biologic agent recombinant human type II tumor necrosis factor receptor-antibody fusion protein for injection, as well as diclofenac sodium extended-release tablets and celecoxib capsules, which can achieve anti-inflammatory, analgesic, and joint swelling relief effects. Patients are also advised to perform appropriate rehabilitation exercises, which can assist in relieving their discomfort symptoms. In addition, hydrocortisone injection and acetylcysteine granules were given to treat the symptoms of cough and sputum of the patient.
III. Treatment effect
The patient’s low back pain worsened before treatment, and the pain was severe in the morning, accompanied by coughing and coughing sputum, and slightly breath-holding. After symptomatic treatment with hydrocortisone injection and acetylcysteine granules for 1 week, the symptoms of cough, coughing and breath-holding improved, and physical examination: stable breathing and low breath sounds in both lungs. After using recombinant human type II tumor necrosis factor receptor antibody fusion protein for injection, as well as diclofenac sodium extended-release tablets and celecoxib capsules for 1 week, the patient’s low back pain was significantly reduced, and the patient was discharged from the hospital for convalescence.
IV. Precautions
After the patient’s condition improved, my worried mood was relieved. For the patient’s better recovery, I did not forget to emphasize to the patient that the following points should be noted in life.
1. Patients should be reviewed regularly at the hospital after discharge, and it is recommended that they should be reviewed once every 3 months. If there is any aggravation of back and leg pain, morning stiffness, etc. during this period, seek medical attention promptly.
2, after discharge from the hospital, follow the doctor’s prescriptions for medication, on time and in accordance with the dosage, do not increase or decrease the dosage or replace new medication on your own.
3. Pay attention to the correction of bad behaviors, maintain the correct posture of sitting, standing and lying, avoid stretched legs, sleeping on pillows, etc.
V. Personal insight
In this case, the patient’s main symptoms are aggravation of low back pain and severe pain in the morning. As these symptoms are more common in many orthopedic diseases, they should be differentiated from the following diseases in order to avoid omission and misdiagnosis.
1, osteoarthritis: often occurs in the elderly, characterized by bone and cartilage degeneration, hypertrophy, synovial thickening, damaged joints to the weight-bearing spine and knee joints are more common, involving the spine is often chronic low back pain as the main symptom, and ankylosing spondylitis easily confused, 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, can be ruled out.
2, tuberculous spondylitis: clinical symptoms such as spinal pain, pressure, stiffness, muscle atrophy, hunchback deformity, fever, rapid blood sedimentation and other similar to ankylosing spondylitis, but X-ray examination can be distinguished. 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 sacral joints are unilaterally involved.
Therefore, if low back pain is present, it is difficult for the patient to diagnose it on his own, and he should, as in the case of this article, promptly visit a hospital and be treated with the help of a physician.