1. What is ankylosing spondylitis (AS)? Li Ning, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University
Ankylosing spondylitis is a chronic progressive inflammatory disease that primarily affects the spine and involves the sacroiliac and peripheral joints, and is strongly associated with HLA-B27. It is a chronic inflammatory disease characterized by lesions of the large joints of the extremities, as well as fibrosis and ossification of the intervertebral disc rings and adjacent connective tissue, and joint ankylosis.
2. Is ankylosing spondylitis rheumatoid?
Ankylosing spondylitis is a rheumatic disease. Because it can also affect peripheral joints and is similar to rheumatoid arthritis in terms of clinical, radiological and pathological manifestations, it has long been viewed as a variant of rheumatoid arthritis, called “rheumatoid spondylitis”. In view of the fact that patients with ankylosing spondylitis do not have IgM rheumatoid factor and that it differs markedly from rheumatoid arthritis in its clinical and pathological manifestations, in 1963 the Society of Rheumatology finally decided to separate the two diseases and replace “rheumatoid spondylitis” with “ankylosing spondylitis”. The name “ankylosing spondylitis” replaced “rheumatoid spondylitis”.
3. Are there many people with ankylosing spondylitis?
It is estimated that 4 million people in China have ankylosing spondylitis, with an incidence rate of between 0.1% and 0.4%. Young people are vulnerable to ankylosing spondylitis, with the onset usually occurring between the ages of 20 and 30. Because the pain caused by ankylosing spondylitis is difficult to distinguish from other common causes of back pain, patients may remain undiagnosed and untreated for years after the onset of symptoms, resulting in significant disability.
4. Can ankylosing spondylitis be cured?
Ankylosing spondylitis cannot be completely cured and often affects the patient’s normal life and work, and a few patients may develop severe spinal and joint deformities. The disease can also be effectively controlled or delayed to improve the quality of life.
5. Does ankylosing spondylitis have a significant impact on my life?
Ankylosing spondylitis often affects young adults, and patients are often at an important stage in their education and work life. The severity of the disease varies greatly in clinical manifestations. In some patients, the disease continues to progress repeatedly, and within one to two years, significant spinal ankylosis and hunchback deformation can occur, and some patients with severe hip involvement can become bedridden for a long time; while some patients can also remain relatively stationary for a long time and can work and live normally.
6. Does HLA-B27 positivity necessarily mean ankylosing spondylitis?
The incidence of ankylosing spondylitis is closely related to HLA-B27. The rate of HLA-B27 positivity in the normal population varies greatly by race and region, with about 6% to 8% of people in China being positive. The HLA-B27 positivity rate of AS patients in China is about 90%, and other data show that the prevalence of AS is 4% in the patient’s family line and up to 11%-25% in the first-degree relatives of HLA-B27-positive AS patients, suggesting that HLA-B27-positive patients or those with a family history of AS are at increased risk of the disease. However, approximately 80% of HLA-B27-positive individuals do not develop AS, and approximately 10% of AS patients are HLA-B27-negative, suggesting that other factors are involved in the pathogenesis, such as intestinal bacteria and intestinal inflammation.
7. Is ankylosing spondylitis always hereditary?
There is no conclusive evidence that ankylosing spondylitis is a genetic disease, but 90% of people with ankylosing spondylitis have a genetic component. Therefore, ankylosing spondylitis is a disease with a strong genetic link. The development of ankylosing spondylitis is directly related to HLA-B27. Since the HLA system, like blood group antigens, is genetically determined, heredity is an important cause of the development of ankylosing spondylitis. The incidence of the disease is about 20% in HLA-B27-positive people, and the remaining 80% do not suffer from the disease, indicating that there are other causative factors besides genetic factors.
8. Does ankylosing spondylitis have any effect on fertility?
Some of the medications used to treat ankylosing spondylitis have an effect on the gonads, and it is best for women with ankylosing spondylitis to stop taking medication for more than six months before deciding to have children, so that the quality of their fertility is not affected. If the condition worsens, a small amount of hormone therapy can be used, which not only provides control of the condition, but also promotes fetal lung maturation in the later stages of pregnancy. However, it is important to note that some medications may increase the rate of miscarriage and cause fetal abnormalities, so patients should be under the guidance of a physician. The patient with ankylosing spondylitis should try to use a cesarean section, if the patient has ankylosis of the hip joint must choose to perform a cesarean section, never choose normal normal normal birth.
9. What are some things that people with ankylosing spondylitis should pay attention to in their lives?
① Make it a habit to exercise every day. In principle, exercises that allow the joints to move, such as swimming, aerobics, and dancing, are fine. Exercises that do not move the spine, such as bicycling, or sports that involve impact and contact, such as judo and basketball, should be avoided.
② Maintain a good posture of standing and sitting, do deep breathing, chest expansion, torso straightening and other movements to strengthen back muscles and abdominal flexibility on a regular basis.
③ Avoid excessive stress or bending of the spine.
④ Avoid excessive weight bearing, stress or bending of the spine to avoid aggravation of the lesion. Try to avoid maintaining a posture for a long time (such as lying on the sofa to watch TV, or prolonged Internet access).
⑤ When you wake up in the morning with a stiff back, you can take a hot bath or apply a hot compress to reduce the symptoms.
⑥ Quit smoking and drinking to avoid aggravating the condition.
⑦ Pay attention to dietary hygiene, drink more water, eat more vegetables and fruits, and try to avoid holding urine and constipation.