Ankylosing spondylitis (AS) is a disease of unknown etiology that is associated with genetic and immune factors. It is characterized by the involvement of mainly medial joints such as the spine, sacroiliac joints and a few large joints, with joint ankylosis and deformity, and varying degrees of involvement of the eyes, lungs, cardiovascular and renal organs.
I. Clinical manifestations
1. The onset of the disease is slow, mostly occurring in men under 40 years old, with young adults being the majority. The incidence ratio of men to women is about 3:1.
2, lower back pain and lumbar stiffness, and slowly extend upward from the sacroiliac region, or from the cervical spine downward to the sacroiliac joints, and eventually cervical and thoracolumbar stiffness.
3.Large joints are more common than hip joints, with pain and claudication, and joint ankylosis in the late stage.
4.Severe spinal deformity appears in the late stage of the disease, and it takes about 6~10 years from the onset to the ankylosis deformity. Surgical correction is often required in cases with ankylosis of the hip joint.
5. Pain caused by inflammation of the attachment points of tendons/ligaments and bone is one of the characteristics of the disease and is called tendonitis.
Occasionally, there are extra-articular lesions, such as eye diseases, prostatitis, aortic lesions, etc.
Physical examination
1.Limited lumbar movement, positive Schöber test.
2.Limited thoracic expansion, inability to lift the rib cage during inspiration or pain associated with it.
3.Pressure pain in the hip or positive “4” test.
4.Tendon and bone attachment pressure pain.
5.Limited movement such as hip joint may occur when the hip joint is involved.
6.Later stages of the lesion have kyphosis and spinal joint ankylosis.
Laboratory tests
1.Blood sedimentation may be increased or normal, and rheumatoid factor is generally negative.
2, more than 90% to 95% of patients are HLA-B27 positive, but HLA-B27 negative cannot exclude AS.
3, X-ray manifestations: 100% should have sacroiliac joint inflammatory manifestations such as joint space narrowing, small cystic changes or bone erosion, osteosclerosis and bony ankylosis, calcification of spinal ligaments and fiber ring; late stage of the entire spine is bamboo-like, and there is a retroflexion deformity of the spine; hip joint has narrowing of the space, bone erosion, cystic changes and bony ankylosis and other changes.
IV. Treatment
The combination of non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying drugs (DMARDs) is used.
(I) NSAIDs
Use one of the following drugs, as appropriate.
1.Diclofenac sodium (Fotarine, Daphne, Intacrine, etc.): 100-150mg daily, divided into 2-3 oral doses.
2.Ibuprofen (Fentanyl): 0.3~0.6g, 2 times daily, orally.
3. Enteric anti-inflammatory pain tablets: 25mg, 1 tablet 3 times a day, orally.
4.Nimesulide (Emmerich): 0.1g, 2 times daily, orally.
5.Naproxen: 0.25g, 3 times daily, orally.
6.Nedimetholone (Relifen): 1000mg orally every night.
7.Meloxicam (Mupirocort, Maijer, etc.): 15mg, 1 time daily.
8.Celecoxib (Celebrex): 200mg, 2 times a day. It is a COX-2 inhibitor.
If the above drugs are ineffective for 4 weeks, the dose can be increased or the variety can be changed appropriately. If there is gastrointestinal reaction, according to the situation, you can change to suppositories, or add gastric mucosal protective agents, acid suppressants, such as oral aluminum thioglycollate tablets, 3~4 times daily, 500mg each time; or ranitidine, 150mg each time, twice daily. It can also be changed to COX-2 inhibitor.
(B) Change the condition of drugs
1.Sulfasalazine (SSZ): 0.5g, twice daily; increase 0.25g/d to 2g/d per week, orally.
2. Methotrexate (MTX): 7.5mg, 1~2 times a week, orally. Pay attention to the possible toxic side effects.
3.Tumor necrosis factor (TNF) antagonist: Infliximab (Rick) is a human-mouse chimeric monoclonal antibody to TNFa, 3~5mg/kg, intravenous, once every 4 weeks, need to be combined with methotrexate. etanercept (Yicep) is a humanized soluble TNF receptor P75:Fc fusion protein, subcutaneous injection 25mg, twice a week.
4.Thalidomide (Response Stop): The initial dose is 50mg per day, increasing by 50mg every 10 days to 200mg per day, divided into oral doses.
5.Reglanoside tablets: 10mg per tablet, the initial dose of 10mg each time, 3 times daily, if necessary, increase to 60mg daily, 3 months as a course of treatment. Generally used only for those who are ineffective in the above treatment, no more than 2 courses of treatment. Note that there are adverse effects on the reproductive system.
(C) Other treatments
1.Physiotherapy, hot compresses, etc. to improve the symptoms.
2.Prevent or correct deformity with orthopedic brace or traction device.
3, adhere to health care exercise to slow down the spinal ankylosis.
4.Severe deformity requires surgical treatment: human artificial joint replacement, spinal osteotomy orthopedic surgery, etc.
5, viper antithrombin: 0.5 units added to 5% GNS 500ml VD, 1 time / day, every 14 days for a course of treatment, skin allergy test before use.
6, hip arthritis can be considered intra-articular injection 153Sm-Citrate-HA or radiotherapy.