As you can see from the introduction of ankylosing spondylitis, this disease is a common, highly prevalent, and complex condition. The following is a detailed description of ankylosing spondylitis, which is known as the “cancer that never dies”.
Ankylosing spondylitis is a chronic inflammatory disease. It mainly affects the sacroiliac joints, spinal prominences, paraspinal soft tissues and peripheral joints, and may be accompanied by extra-articular manifestations. According to recent reports, the ratio of men to women is 2:1 to 3:1, and the disease is slower and less severe in women. The age of onset is usually between 13 and 31 years, with rare onset after 30 years of age and before 8 years of age.
Causes.
It has been shown that the development of ankylosing spondylitis is closely related to the human to cell antigen (HLA-B27) and has a clear tendency to run in families. The genetic factors are influenced by environmental factors (including infection) and other aspects of the disease. Genetic factors play an important role in the development of ankylosing spondylitis. Immune factors also play a role in the etiology. Endocrine, trauma, metabolic disorders and allergic reactions are also suspected as pathogenic factors.
Clinical manifestations.
1. Initial symptoms The early onset is insidious and may be without any clinical symptoms. Some patients may show mild systemic symptoms in the early stages, such as malaise, wasting, prolonged or intermittent low-grade fever, anorexia, and mild anemia. The most common symptom is low back pain, which may also start from peripheral arthritis.
2. Typical joint manifestations Patients gradually develop pain and stiffness in the low back or sacroiliac region, wake up in the middle of the night with pain, have difficulty in turning over, and get up in the morning or after sitting for a long time, the stiffness in the low back is obvious, which is relieved after activity or taking pain medication. Some patients feel dull pain in the buttocks or severe pain in the sacroiliac region, occasionally radiating to the periphery. The pain may be aggravated by coughing, sneezing, or sudden rotation of the lower back. In the early stage of the disease, the pain is mostly intermittent on one side, and after a few months, the pain is mostly bilateral and persistent. As the lesion progresses from the lumbar spine to the thoracic and cervical spine, pain, restricted movement or spinal deformity will appear in the corresponding area.
Systemic manifestations After the appearance of spondylitis and joint symptoms, other systemic symptoms may appear. It invades multiple systems throughout the body and is associated with a variety of diseases. For example, aortic valve lesions are more common cardiac lesions, eye lesions such as iritis and uveitis, and later stages of ankylosing spondylitis may also invade the cauda equina, causing cauda equina syndrome, resulting in neurogenic pain in the lower extremities or buttocks, weakened Achilles tendon reflexes and motor dysfunction such as bladder and rectum.
Imaging manifestations.
Radiographic manifestations are diagnostic in nature. Early X-rays show sacroiliac arthritis with jagged joint edges, osteophytes, narrowing of the joint space, and eventually loss of the joint space and the occurrence of bony ankylosis.
X-rays of the spine may also show a typical “bamboo-like spine” with osteoporosis and squareness of the vertebral body, blurring of the vertebral tuberosities, calcification of the paravertebral ligaments, and formation of bony bridges.
How to diagnose ankylosing spondylitis?
I. Clinical manifestations
① soreness and discomfort in the lumbar spine or spine, sacroiliac region, buttocks or lower extremities, or asymmetric peripheral arthritis, especially arthritis of the lower extremities, with symptoms lasting ≥ 6 weeks.
(ii) nocturnal pain or morning stiffness is obvious.
③ pain relieved by activity.
④ heel pain or tendon attachment point disease.
⑤ history of onset of iridocyclitis.
(vi) family history of ankylosing spondylitis or HLA-B27 positivity.
(vii) Non-steroidal anti-inflammatory drugs (NSAIDs) can significantly relieve symptoms.
II. Imaging or pathology
① Bilateral X-ray sacroiliac arthritis ≥ stage III.
(ii) Bilateral CT sacroiliac arthritis ≥ stage II.
③Sacroiliac joint pathological examination shows inflammation.
III. Diagnosis
Ankylosing spondylitis can be diagnosed if the clinical criteria (①) and three of the other items are met, as well as any of the imaging or pathological criteria.