Ankylosing spondylitis

Ankylosing spondylitis

Ankylosing spondylitis (Bechterew’s disease) is a rheumatic disease. There is an inflammation of joint capsules. The inflammation is accompanied by a gradual stiffening of the inflamed joint. Usually, it involves the joints of the back. But the knees, hips, and pelvis can also be affected. The Latin name for the disease is ankylosing spondylitis. The disease generally starts between the ages of 15 and 35 and affects about 1% of the population. Slightly more common in men.

Ankylosing spondylitis definition

Ankylosing spondylitis (AS) is a systemic disease of unknown cause, mainly chronic inflammation of the axial joints. It mainly affects the sacroiliac joints, hip joints, intervertebral joints, and costo-vertebral joints. Sacroiliac joint disease is the most common. About 1/3 of patients can see symptoms of peripheral joints, and may also involve multiple organs such as eyes, heart, and lungs. The main pathological changes are the calcification of joints and surrounding tissues, ligaments, and intervertebral discs. The characteristic pathological changes are lesions of tendons, ligaments, and bone attachment points. The common symptoms are stiffness or pain in the back and back. In the late stage, spinal stiffness and deformity can occur, leading to severe functional impairment. If AS is not complicated by other rheumatic diseases, it is called primary; sacroiliitis complicated by psoriatic arthropathy, inflammatory bowel disease, or Reiter’s syndrome is secondary.

The disease is more common in young men, with a male to female ratio of 5:1. Males have severe symptoms and progress rapidly, but there is no difference in the positive rate of HLA-B27 between male and female patients. Female patients have the following characteristics: the age of onset is generally later than that of men, about 27 years old; the onset is more common in peripheral joints, especially the incidence of knee joint involvement is higher than that of men, but the hip joint is less involved; pubic symphysis involvement is more common than men. The degree of disease, teratogenicity, and loss of self-care of the axial joints are less severe than those of men; there is significantly more anemia than men, and immunoglobulin abnormalities are more common than men; the disease is milder and the prognosis is better.

Ankylosing spondylitis causes

What are the Ankylosing spondylitis causes? The causes of ankylosing spondylitis are not yet clear but are known to be an immune system disease. The body’s immune system attacks its own body tissues, resulting in symptoms of joint inflammation occurs. Gene is one cause immune problems, particularly within the body who has called HLA-B27 gene have a greater chance of illness. In every 10 patients. Testament, there was nine have HLA-B27 gene. In addition, environmental stimuli (such as a bacterial infection) may be among the reasons. The etiology is not yet clear, and may be related to the following factors:

   1. Genetic factors: Since the correlation between HLA-B27 and AS was determined in 1973, it is now known that AS has a significant genetic predisposition, and 85%-95% of AS patients are HLA-B27 positive. Among the children of AS patients who are HLA-B27-positive, 32% are HLA-B27-positive. The disease has obvious familial clustering. Western reports have reported that the first-degree relatives of patients with this disease are 20-40 times more likely to have this disease than the average person, and there are also reports that their first-degree relatives have a prevalence rate of 35%.

   2. Infectious factors: At present, two types of infections are mainly believed to be related to AS: intestinal infections and chronic urogenital infections. Intestinal bacteria, especially Klebsiella pneumoniae (KP) infection is closely related to AS. The disease is often associated with prostatitis, seminal vesiculitis, and ulcerative colitis. The pelvic infection spreads to the sacroiliac joints through the lymphatic route and then spreads to the spine through the spinal venous plexus. Into the circulation of the human body, symptoms of peripheral joints and uveitis may occur.

   3. Autoimmunity: 60% of AS patients have increased blood complement, IgG type rheumatoid factor, increased levels of C4 and IgA, and immune complexes in the blood.

   4. Other: There are trauma, environment, endocrine, and other factors.

Ankylosing spondylitis symptoms

1. Onset form

The onset is generally insidious. Some patients have a history of waist, hip sprain or urinary tract, or intestinal infection before the onset, but most patients have no obvious cause. There may be symptoms such as low-grade fever, anorexia, fatigue, and weight loss in the early stage, but they are generally not serious except for children. A few cases may have a long-term low-grade fever and joint pain, which resemble rheumatic fever. Individual cases resemble tuberculosis at first, manifesting as fever, night sweats, fatigue, weight loss, anemia, and monoarthritis of the hip, but anti-tuberculosis treatment is ineffective.

2. First symptom

(1) Low back pain:

Low back pain or discomfort is the most common symptom, with an incidence of about 90%. The initial low back pain is mostly unilateral, but most eventually develop bilateral low back pain. The locations are in the waist, hip, and hip joints. Severe pain is often located in the sacroiliac joint. The pain can radiate to the hip and posterior thigh, but it is rare to radiate below the knee joint. Symptoms are mild at the onset, often intermittent dull pain or soreness, and then gradually develop more persistent and severe pain. Some patients have severe nocturnal pain and difficulty turning over, which can cause the patient to wake up painfully during sleep, even after getting out of bed before going back to sleep. Pain can be aggravated by coughing, sneezing, deep breathing, bending, turning around, and other actions that involve the lower back.

(2) Morning stiffness:

It is a common early symptom of ankylosing spondylitis and one of the disease activity indicators. The patient wakes up early and feels that the waist is stiff, and the waist is limited in flexion, extension, lateral bending, and rotation. After exercise, a hot compress, hot bath can also relieve the stiffness. In severe cases, it can last all day.

(3) Inflammation of the attachment points of tendons and ligaments:

Due to the inflammation of attachment points in the sternocostal joints, stalk-thoracic joint, and other parts, patients may experience chest pain, which worsens when coughing or sneezing and can be misdiagnosed as pleurisy, pericarditis, atypical angina, etc. Due to the limited thoracic expansion during inhalation, mild and moderate thoracic mobility may also be reduced in early cases. However, due to abdominal breathing compensation, the ventilatory function is rarely impaired, and tendon attachment lesions can also be seen in the costo-thoracic connection, spinal process, iliac crest, greater trochanter, ischial tubercle, tibial tubercle, and heel. As an early manifestation of the disease.

(4) Peripheral joint symptoms:

Approximately 45% of the patients in our country start with peripheral arthritis. 24% to 75% of patients have the peripheral joint disease at the beginning or during the course of the disease. It was found that peripheral joint involvement of this disease is related to HLA-A11, DR4, and DR7. Children with ankylosing spondylitis are more common with peripheral arthritis as the first symptom. Asymmetry, few or single joints, and arthritis of the large joints of the lower limbs are characteristic of peripheral arthritis of the disease. Peripheral joints are more common in the large joints of the lower limbs such as hips, knees, and ankles, but also large joints of the upper limbs such as shoulders and elbows. The small joints of the fingers and toes are less common.

Except for the hip joints, arthritis or joint pains of knees and other joints are mostly temporary, rarely persistent and destructive, and cause little or no joint damage and disability, which are different from rheumatoid arthritis. one. Hip joint involvement accounts for 38% to 66%, and the lesions are often more serious. Generally, the younger the onset, the higher the incidence of hip joint involvement and the worse the prognosis. Most are bilaterally affected, and 94% of hip symptoms begin within the first 5 years of onset. As the age of onset increases, the incidence of hip joint involvement also decreases, and the severity also decreases. During the period of synovitis, there may be a pain, limited mobility, subsequent destruction of cartilage and bone, joint fibrous or bony ankylosis, contracture of the hip joint, compensatory knee flexion, and the patient can see a duck step state.

3. Typical manifestations

Low back pain, morning stiffness, restricted movement in all directions of the lumbar spine, and reduced thoracic mobility are typical manifestations of ankylosing spondylitis. Especially during disease activity. The symptoms of low back pain in this disease are not relieved by rest, but the symptoms are relieved by activities. Some patients also stiff back in the afternoon or evening.

Early lesions are mostly confined to the sacroiliac joint and lumbar spine. As the disease progresses, inflammation can expand to the thoracic and cervical spine. It is called “ascending expansion”, and this is how most patients expand. As the disease progresses, the entire spine may undergo bottom-up rigidity: first, the lumbar lordosis curve disappears; then the thoracic kyphosis becomes kyphotic deformity; as the cervical spine is involved, the movement of the cervical spine is restricted, and the patient’s posture changes to the head Bend forward, flattened the chest, protruded abdomen, and finally restricted movement in all directions of the spine. There is also a small number of patients whose spinal lesions start from the thoracic spine, and then extend from the thoracic spine to the lumbar spine and sacroiliac joints. This is called “downward expansion” and is more common in female patients. In the late stage of AS, the inflammation basically disappears, so the pain and morning stiffness are not obvious, and there is still a pain in some parts where inflammation is still active, and the joint deformity and rigidity are mainly formed, forming the typical manifestations of the end of AS: lumbar spine physiology The curvature disappears, the kyphosis is prominent in the kyphosis, the thorax is often fixed in the exhalation state, the cervical kyphosis fixes the head in the forward flexion, and the hip and knee joints are flexed. When the patient stands upright, he can only see a limited section of the road in front of him due to his body and head leaning forward.

As the thoracic expansion can induce pain during inhalation, breathing restriction can occur, especially after strenuous activity. However, due to abdominal respiration compensation, ventilatory dysfunction is rarely caused. Infringement of the cervical spine is manifested as neck pain and stiffness, the pain can radiate to the head, and there can be spasm of the neck muscles. The atlas and axis can be in a subluxated state, and neck rotation can cause pain to worsen. Due to the rigidity of the entire spine, it is very difficult for the patient to balance himself when changing the posture, and trauma is prone to occur, and the trauma is likely to be the cause of the sudden increase in pain at this stage.

However, only a small number of patients have the above symptoms. After proper treatment and functional exercise, most patients (about 80%) have lesions confined to the sacroiliac joints and part of the spine and even life-long confinement to the sacroiliac joints. They can take care of themselves and be competent for long-term General work.

4. Extra-articular manifestations

   Ankylosing spondylitis, as a systemic chronic inflammatory disease, can also affect other organs.

   (1) Systemic symptoms: more common in the early stage, generally not serious, mainly manifested as fatigue and weight loss. Generally speaking, the systemic symptoms of patients with axial joint symptoms are mild; while those with more severe peripheral joint involvement have more prominent systemic symptoms.

   (2) Ocular manifestations: acute uveitis or iritis may occur. The longer the course of the disease, the more likely it is to attack. In some cases, iritis occurs before symptoms appear on the spine or peripheral joints. There is a certain relationship between the onset of iritis and the activity of AS, and it is common in patients with peripheral joint symptoms. It is acute, mostly unilateral, manifested as photophobia, pain, tearing, etc. Physical examination showed congestion around the cornea and iris edema, such as iris adhesion, pupil contraction and irregular edges can be seen. Slit-lamp examination revealed a large amount of exudation and corneal deposition in the anterior chamber. Each attack lasts about 4 to 8 weeks, usually without sequelae, but often relapses. Severe conditions can cause visual impairment or even blindness.

   (3) Cardiovascular manifestations: Approximately 30% of patients with AS can affect the heart, but less than 1/3 of them have clinical symptoms, which are more common in those with peripheral joints and systemic manifestations. Valvular disease and conduction disorders are more common, including ascending aortitis, subaortic fibrosis, aortic regurgitation, mitral valve prolapse, mitral regurgitation, dilated cardiomyopathy, atrioventricular conduction block Stagnation, and bundle branch block, dilated cardiomyopathy, and pericarditis. Among them, aortic insufficiency is the most common, and some patients can hear diastolic murmurs in the second auscultation area of ​​the aortic valve.

According to statistics, 3.5% of patients with ankylosing spondylitis developed aortic valve insufficiency after 15 years and 10% after 30 years. The incidence of aortic valve insufficiency increased with age, course of the disease, and the incidence of peripheral arthritis except for hip and shoulder joints. . Conduction disorders are also more common, accounting for 3/4 of heart disease changes, of which atrioventricular block is the most common, and occasionally complete atrioventricular block or with A-S syndrome. There are far more men than women, and the incidence of patients in European and American countries is higher than that in my country and Japan.

   (4) Pulmonary manifestations: common in the later stage of the disease, generally occurring in patients with a course of more than 20 years. Due to the abdominal respiration compensation, although thoracic expansion is limited, most patients will not experience severe breathing difficulties. There may be no obvious clinical symptoms, cough, sputum, chest tightness, shortness of breath, and even hemoptysis, most of which are manifestations of upper pulmonary fibrosis. With the development of the disease, the thoracic movement is restricted, and fibrosis, cystic change, and even cavitation of the upper lungs, especially the lung apex, may occur. X-ray examination shows that the upper field of both lungs has a dense patchy shadow, which may have cystic change or even cavitation, which is similar to the X-ray appearance of tuberculosis. Opportunistic infections are often combined in the late stage to make the disease more complicated. Rare lung manifestations include thickened pleura adhesions, blurred hilum and diaphragm, and striped lung dysplasia.

   Progressive fibrosis and bullous changes of the upper lung have received increasing clinical attention. The incidence is different in various reports, about 1.3% to 10%. Most of the initial symptoms are not obvious, often found in the X-ray chest routine examination. The imaging features of the upper lung are cord-like or patch-like shadows, with cystic changes or even cavities, and most of them involve both lungs. But the degree is inconsistent, and it is often difficult to distinguish from tuberculosis. Tuberculin test, sputum bacterial examination, and bronchopulmonary tissue biopsy if necessary to confirm the diagnosis.

   Later, due to the ossification of the spine-costal and sternocostal joints, the rib cage became stiff and the back of the sternum was tender. The chest radiograph showed stenosis and fusion of the sternoclavicular joint, fusion of the ribs, vertebral body, and transverse process. Inspiratory rib lifting was weakened or even absent. At this time, the patient needs to breathe compensated by the diaphragm, but abdominal breathing increases the pressure in the abdominal cavity, and some patients may develop an inguinal hernia.

   (5) Nervous system manifestations: After the appearance of spinal rigidity in AS patients, severe osteoporosis is generally complicated. Therefore, it is very easy to develop fractures and minor trauma can also be caused. Spine fractures are most likely to occur in the cervical vertebrae, especially in the fifth to seventh cervical vertebrae, which can cause paraplegia and even death, and are the complication with the highest mortality rate. Patients with neck, back pain, or numbness after trauma should consider the possibility of spinal fractures.

Spontaneous atlantoaxial subluxation. In mild cases, neck and back pain or numbness can be seen. Severe neck pain can radiate to the orbital, temporal, and occipital regions, with or without spinal cord compression. Chronic progressive cauda equina syndrome is a rare and important complication of late ankylosing spondylitis, which manifests as urethral and anal sphincter insufficiency, accompanied by pain and painful loss of thigh and buttocks, and gradually develops into urinary and stool incontinence, impotence, and occasionally loss of Achilles tendon reflex may occur. In some patients, neurological symptoms such as lower limb soreness, numbness, and paresthesia may occur during the course of the disease, or accompanied by muscle atrophy. Myelography did not reveal spinal stenosis or compression injury, and the posterior lumbosacral arachnoid diverticulum was often seen. The cause is not clear, and it may be caused by chronic arachnoiditis.

   (6) Urinary system manifestations: Renal diseases are rare, mainly IgA nephropathy and renal amyloidosis, with proteinuria. Some patients have chronic prostatitis.

See also, Rheumatoid arthritis

5. Physical symptoms of ankylosing spondylitis

There are not many signs of early ankylosing spondylitis. It can be seen that the waist is flat, the sacral spinal muscles are significantly spasming, and one or both sides of the sacroiliac joints, lumbar spinous processes, and paravertebral muscles are tender in the early positive signs of the disease. Later, it can be seen that the lumbar lordosis disappears, the movement of the spine is restricted in all directions, the extension of the thorax is reduced and the cervical kyphosis is reduced. People who are positive in the following tests should be taken seriously:

   (1) Iliac crest compression test: test the patient on his back, place the examiner’s hands on both sides of the patient’s anterior superior iliac spine, press the pelvis hard if there is pain in the sacroiliac joint, it is positive.
   (2) Pelvic lateral pressure test: The patient lies on his side, and the examiner directly presses the upper iliac crest with both hands. It is positive for those with sacroiliac pain.
   (3) Direct compression test of the sacroiliac joint: The connection of the bilateral posterior superior iliac spine is equivalent to passing through the sacroiliac joint at the level of the second sacrum, and the person who directly presses here causes pain is positive.
   (4) Gaehslent test (Gaehslent test): The patient lies on his side, the lower leg is straightened, the opposite leg is flexed, and both hands hold the knees of the flexed side leg, making the thighs close to the chest. The examiner holds the patient’s sacroiliac area with one hand and pulls the patient’s side thigh with the other hand to make it hyperextension. Those with sacroiliac pain are positive.
   (5) “4” test: The patient lies on his back, with one leg straight, the other leg bent, and the foot on the opposite thigh. The examiner presses the iliac crest of the straight leg with one hand and holds the bent knee with the other hand to move up and down. Pain occurs in the sacroiliac area during the following pressure, which indicates a disease of the flexed sacroiliac joint.
   (6) Suspended leg push knee test: The patient lies on one end of the examination table with his legs suspended in the air, one leg is bent at the hip and the knee is bent, and the other is straight with the hip and the knee bent. The examiner holds the knee under the bent leg with one hand and pushes toward the shoulder; with the other hand, presses the knee on the other leg and presses it back. If the sacroiliac joint is involved, pain occurs.
   (7) Schober test: The patient is in an upright position, and the iliac crest level on the midline of the back is marked as 0, and then two marks are made 10cm upward and 5cm downward respectively. Ask the patient to bend with straight legs and measure the distance between the two marks. Those less than 4cm are abnormal, suggesting that the lumbar spine has decreased mobility.
   (8) Inspection of spine activity measuring instrument: The measuring instrument is composed of two 42cm long metal rods, one end is slidably connected, and the other end is curved 35 at 12cm. , One end is connected with 180. Protractor. During the examination, place the end with a protractor on the sacrum so that the fulcrum is at the level of the intervertebral disc of the 5th lumbar vertebra/the 1st sacral vertebra; place the first thoracic vertebrae on the other end, and then make the patient bend forward (keep both knees upright) and record the angle change. <400 is abnormal. The same method can determine the range of extension and lateral flexion.
   (9) Examination of thoracic expansion: The patient stands upright and measures the level of the fourth intercostal space (the lower border of women’s breasts). The difference in chest circumference between deep inhalation and deep exhalation is abnormal. Those less than 2.5cm are abnormal.
   (10) Pillow-to-wall distance: Make the patient stand upright against the wall, with both heels against the wall, legs straight, back against the wall, chin closed, eye level, and measure the horizontal distance between the occipital tubercle and the wall. Normally, it should be 0; >0 means that the occipital part cannot touch the wall, which is abnormal.
   (11) Finger-to-ground distance: The patient stands upright, bends over, stretches his arms, and measures the distance between his fingers and the ground. Means-to-ground distance increases are abnormal.

See also, Knee problems (traumatic)

Ankylosing spondylitis diagnosis

1. Early diagnosis can refer to the following New York diagnostic criteria revised in 1984:
   (1) Clinical criteria
   ①Low back pain lasts for at least 3 months and can be relieved after exercise.
   ②Limited movement of the lumbar spine in vertical and horizontal directions.
   ③The thoracic activity is less than that of normal people of the same age and sex.
   (2) The X-ray changes of sacroiliac joints are stage
   1: normal sacroiliac joints.
   Grade I: suspicious or very mild sacroiliitis.
   Grade Ⅱ: Mild sacroiliitis (fuzzy joint edges, hardening of the near-articular area, a slight narrowing of the joint space).
   Grade Ⅲ: Moderate sacroiliitis (the joint edges are obviously blurred, the area near the joint is hardened, the joint space is significantly narrowed, and the bone destruction is obvious).
   Grade IV: Sacroiliac joint fusion or complete rigidity, with or without sclerosis.
   Diagnosis criteria: having unilateral grade Ⅲ to Ⅳ or bilateral grade Ⅱ to Ⅲ sacroiliitis, plus at least one of the three clinical criteria can be diagnosed with AS.

   2. In view of the destructive nature of AS, the early diagnosis of AS is particularly important. In order to reflect the understanding of the early manifestations of the disease and the progress of diagnostic techniques in recent years, new diagnostic criteria have been proposed.

Diagnosis plan as follows:

(1) Medical history:

①Sore and discomfort in waist and hip, or peripheral arthropathy of other causes that occurred before the age of 40;

②Insidious onset;

③With night pain and morning stiffness;

④No symptoms after rest Relief, can be improved after activity;

⑤Last 6 weeks or more.
   (2) Signs:

  • ① positive examination of the sacroiliac joint;
  • ② manifestations of enthesitis.

   (3) Laboratory examination:

  • ① Serum rheumatoid factor is negative;
  • ② Antinuclear antibody is negative;
  • ③ HLA-B27 is positive.

   (4) Radiological examination: bilateral sacroiliitis of grade ≥Ⅱ.
   Diagnosis:

①According to 4 items (or more) of the medical history, and 10 positive radiological examinations, ankylosing spondylitis can be diagnosed;

②If the history of 4 items (or more) is met, and the X-ray examination of sacroiliitis is uncertain or normal, CT can be used Examination, if CT sacroiliac arthritis ≥ Grade II, ankylosing spondylitis can be diagnosed;

③Four items (or more) in the medical history, and X-ray and CT sacroiliac joints are normal or uncertain, with signs ≥1 item/experiment Laboratory examination ≥ 2 items, for possible ankylosing spondylitis, X-ray examination or CT scan should be followed up.

   3. The AS diagnostic program proposed by the 2001 National Ankylosing Spondylitis Symposium:
   (1) Clinical manifestations:

  • ① Pain and discomfort in the waist and (or) spine, groin, buttocks or lower limbs, or asymmetric peripheral oligoarthritis, especially It is oligoarthritis of the lower limbs, with symptoms lasting ≥6 weeks;
  • ②night pain or morning stiffness ≥0.5 hours;
  • ③relief after exercise;
  • ④heel pain or other tendon attachment diseases;
  • ⑤current symptoms or past history of iridocyclitis;
  • ⑥ Family history of AS or HLA-B27 positive;
  • ⑦ Non-steroidal anti-inflammatory drugs (NSAID) can quickly relieve symptoms.

   (2) Imaging or pathology:

①Bilateral X-ray sacroiliac arthritis ≥ Grade III;

②Bilateral CT sacroiliitis ≥ Grade II;

③If CT sacroiliac arthritis is less than Grade II, MRI can be performed. Such as cartilage destruction, para-articular edema, and/or extensive fat deposition, especially those with joint or para-articular enhancement intensity> 20%, and the enhancement slope> 10%/min;

④ those with inflammation of the sacroiliac joint.
   Diagnosis: AS can be diagnosed if it meets the clinical criteria item 1 and 3 of the other items, as well as any of the imaging and pathological criteria.

Ankylosing spondylitis test

Some patients say that the key to ankylosing spondylitis is treatment, but many people forget the pre-treatment check. According to the patient’s description, because many patients do not understand the disease, when the patient finds the symptoms in the early stage, he subconsciously thinks that it is overwork, or it is When treating rheumatoid arthritis, there is no effect, not to mention, it also delays the best treatment period. Therefore, a comprehensive examination is particularly important for the patient. Then, what specific examinations should the patient do? Get up and find out.

See also, Hurt back at work

01. Serology

HLA-B27 is a human leukocyte antigen and an important reference factor for the diagnosis of ankylosing spondylitis. Scientific research statistics: In ankylosing spondylitis patient population, the probability of HLA-B27 positive is as high as 90%. HLA-B27 positive people have a much greater chance of developing ankylosing spondylitis than HLA-B27 negative people. But there are also some patients with rigidity that are negative for HLA-B27.

  Therefore, HLA-B27 positive does not necessarily cause ankylosing spondylitis, and HLA-B27 negative does not necessarily cause ankylosing spondylitis. Therefore, HLA-B27 positive cannot be diagnosed as ankylosing spondylitis, but the chance of suffering from ankylosing spondylitis is higher than ordinary people. Positive blood HLA-B27 is an important criterion for ankylosing spondylitis, but it is not the only diagnosis criterion.

02. Sacroiliac joint x-ray

  Sacroiliitis is a branch of osteoarthritis in arthritis. Most sacroiliitis is not a single disease but caused by other diseases. For example, many patients with ankylosing spondylitis manifest as sacroiliitis at the beginning of the onset. Therefore, when there are symptoms of sacroiliitis, consider whether there is the possibility of suffering from ankylosing spondylitis. Through the X-ray detection of sacroiliac joints, the pathological changes in the joints can be seen more clearly.

03. Special inflammation test

  Ankylosing spondylitis is a type of disease that progresses alternately between acute and chronic aseptic inflammation. Therefore, in the investigation of the disease and understanding the progress of the disease, in addition to the routine serological and imaging examinations. It is also necessary that the TMT inflammation special detection technology is adopted to capture the subtle temperature difference between the normal part and the inflammation part, and generate a thermal imaging map, so as to accurately locate the degree and depth of inflammation. Good to guide the doctor to accurately remove inflammation in the follow-up treatment.

  The pathological changes of ankylosing spondylitis can cause microcirculation disorders at the lesions, hypoxia in the tissues, inaccessibility of drugs and nutrients, and accumulation of metabolites, forming a “vicious circle”. The microcirculation of the body directly participates in the exchange of material, energy, and information in organs, tissues and cells, and is the most important place for tissue cell material exchange and metabolism. If there are different forms of microcirculation disorder, it will show different disease characteristics. Therefore, whether the microcirculation of the drug and nutrient supply channels of patients with ankylosing spondylitis is unblocked, and how unblocked? Will be directly reflected in the microcirculation test. Detecting by the microcirculation supply channel detector will directly find out which type of microcirculation the patient belongs to. It is of great significance to open up the drug and nutrition supply channel and distinguish the development stage and degree of the disease.

  A comprehensive examination is so important. Patients with rigidity should not be careless. Don’t blindly listen to other people’s suggestions. Having your own opinions is especially important for the treatment of ankylosing spondylitis. After patients are diagnosed with rigidity, they will have a healthy mindset. Yes, patient, confident and active to go to a regular hospital for treatment can restore health early.

Ankylosing spondylitis treatment

Mainly include non-steroidal anti-inflammatory drugs (NSAID), slow-acting drugs, and glucocorticoids.

   1. Non-steroidal anti-inflammatory drugs:

This class of drugs can quickly improve patients with low back pain and stiffness, reduce joint swelling and pain, and increase joint range of motion. It is the first choice for symptomatic treatment of patients with early or late ankylosing spondylitis. There are many types of non-steroidal anti-inflammatory drugs, and their effects on ankylosing spondylitis are roughly equivalent. The principle of individualized treatment should be emphasized. Doctors can choose one of them based on individual differences in patients. For example, if one drug is treated for 2 weeks, the effect is not obvious, and other varieties can be used. Using two or more non-steroidal anti-inflammatory drugs at the same time will not only not increase the therapeutic effect, but will increase the adverse reactions of the drugs and even cause serious adverse consequences. Indomethacin is particularly effective for AS, but there are many adverse reactions. If the patient is young and has no gastrointestinal, liver, kidney, and other organ diseases or other contraindications, indomethacin can be the first choice.

The specific usage is indomethacin 25mg, 3 times a day, taken immediately after meals. For those with obvious night pain or morning stiffness, add indomethacin suppository 50mg or 100mg before going to bed at night, plugging into the anus, can significantly improve the symptoms. Other optional drugs such as Aximethacin 90mg, once a day; Diclofenac sodium (Voltaren) 25mg, 3 times a day; Nimesulide 0.1g, 2 times a day; Runanfibrate 250mg, 3 times a day Times; sulindac 0.2g, twice a day; nabumetone 1000mg, once a day; meloxicam (Mobic) 15mg, once a day; etodolac 400mg, once a day; Celecoxib 200 mg, twice a day, etc. If the patient has a good effect on one of the anti-inflammatory drugs used, but there is no adverse drug reaction, the treatment should be continued until the pain, stiffness, or joint swelling is completely controlled. The treatment course is usually about 3 months, and the drug dose can be reduced later.

Consolidate the treatment with the minimum effective amount, and discontinue it as appropriate after maintaining a period of asymptomatic period. Symptoms improve after short-term medication. If the medication is stopped too quickly, it is not conducive to achieving the anti-inflammatory effect and can easily cause recurrence of symptoms. The main side effects are gastrointestinal reactions, such as nausea, abdominal distension, abdominal pain, etc. In severe cases, gastrointestinal bleeding and perforation may occur. Therefore, patients with a history of ulcers and long-term use of corticosteroids should be used with caution.

   2. Slow-acting drugs (medicine to improve the condition)

   (1) Sulfasalazine (SSZ):

Sulfasalazine can improve joint pain and stiffness in patients with ankylosing spondylitis, and can reduce serum IgA levels. It is generally believed that it is effective for ankylosing spondylitis with peripheral arthritis, but there is still controversy about the efficacy of ankylosing spondylitis with axial arthritis. Sulfasalazine has a slower onset, usually 4 to 6 weeks after taking the drug. In order to increase the patient’s tolerance, generally start with a small dose of 0.25g, orally, 3 times a day, and then increase it by 0.25g every week to 1.0g, 2 times a day, without increasing. The daily total amount is 2.0g, and the treatment is maintained for 6 months to 1 year. The treatment time can be extended if the condition requires it. The main side effects are gastrointestinal reactions, skin rash, fever, and leukopenia, which can gradually disappear after stopping the drug. Pay attention to check blood picture, liver and kidney function during medication and use with caution for hepatitis B virus carriers.

   (2) Methotrexate (MTX):

This product can only improve peripheral arthritis, low back pain, stiffness, and iritis, as well as the level of ESR and CRP, and it has an effect on the radiation pathology of the axial joint No evidence of improvement. Method of administration: once a week, 2.5-5 mg in the first week, and 2.5 mg a week thereafter to maintain it at 10-15 mg a week. Daily and intravenous medications have similar effects. The main side effect is gastrointestinal reactions. Other neurological symptoms such as bone marrow suppression, stomatitis, hair loss, and headache are rare. All side effects can be recovered after stopping the drug. The elderly, obese, diabetic, active peptic ulcer, liver disease, kidney disease patients should not use it; hepatitis B virus carriers should be used with caution; pregnant women should not use it. It is not advisable to drink alcohol during medication, and blood and liver function should be checked regularly.

   3. Glucocorticoids:

Hormones cannot affect the course of ankylosing spondylitis. Long-term use does more harm than good, so it should not be used routinely, especially large and medium-dose long-term use. The indications for its use are:

①Those who are allergic to non-steroidal anti-inflammatory drugs, or non-steroidal anti-inflammatory drugs cannot control their symptoms, can be treated with low-dose hormones (equivalent to prednisone 10mg/d); Anti-inflammatory drugs can be used to treat severe peripheral arthritis resistant to intra-articular injection of hormones or systemic medication. For example, prednisone 20-30 mg daily, after the symptoms are controlled and slow-acting drugs take effect, gradually reduce the dose or even stop;

③ those with extra-articular damage such as acute iritis and lung involvement need hormone therapy;

④ conventional treatment is to Take it every morning. If the pain is severe at night and non-steroidal anti-inflammatory drugs are ineffective, you can take 5 mg orally before going to bed, which is effective in reducing night pain and morning stiffness.

   Glucocorticoids should not be used as the first choice for AS, and once taken, they should be used regularly, and the dose should be gradually reduced to stop after the symptoms improve. The main side effects of glucocorticoids are Cushing’s syndrome, elevated blood sugar, elevated potassium, high blood pressure, peptic ulcers, osteoporosis, secondary infections, and so on. If the dose is less than 7.5 mg per day, the side effects are generally not significant. However, even small doses of sensitive individuals can cause Cushing’s syndrome. In addition, certain side effects of hormones, such as osteoporosis, are related to the total amount of medication. Therefore, long-term use should be closely followed up to find problems and deal with them in time.

   On the basis of systemic treatment, for single or a few non-infectious joint cavity effusions that are difficult to resolve, articular cavity puncture can be used, and the fluid is first drawn out and then hormones are injected. At present, such preparations as injections into the joint cavity, such as Trimetasone (dexamethasone palmitate liposome) and Depot (betamethasone sodium phosphate), is anti-inflammatory, analgesic, and reduce joint synovial fluid exudation The effect, and the curative effect can be maintained for 2 to 4 weeks.

Misunderstandings in the treatment of ankylosing spondylitis?

Ankylosing spondylitis is a chronic disease involving the spine and joints, and is called “undead cancer” by many people. Is this disease terrible? How to recognize it correctly and how to treat it?

  Misunderstanding 1: When there are symptoms of bone pain, should I go to the orthopedics clinic?

  It is easy to misdiagnose and delay the condition. First of all, we need to know the symptoms of ankylosing spondylitis. For some teenagers, if there are peripheral joints, single joints, and few joints, they should consider whether it is ankylosing spondylitis. For people in their 30s, lower back pain or back pain may be more common.

  In addition, there is a difference between simple bone pain and tonic bone pain. Ankylosing spondylitis usually manifests as more pain in the morning and lighter at night, that is, “morning is heavy and day is light”. And the longer you sit and sleep, the more obvious the pain will be.

  If the patient goes to the orthopedics department when the above-mentioned symptoms of low back pain occurs, the treatment is based on the lumbar disc herniation and the diagnosis is not obtained for a long time, it is easy to delay the condition and miss the best treatment opportunity. The correct approach is to go to the rheumatology department for consultation. If you have been to the orthopedics department, and the symptoms are suspected to be lumbar disc herniation or unexplained joint inflammation, you should go to the rheumatology department to further identify whether the disease is caused by other causes.

  Misunderstanding 2: Taking medicine to relieve pain can treat both the symptoms and the root cause?

  Taking medicine is not a long-term solution. Ankylosing spondylitis requires long-term treatment. First, because ankylosing spondylitis is an inflammatory disease, pain is only one manifestation. Because it is inflammation of the synovial membrane and tendon at the sitting point, this inflammation must be completely eliminated before the condition can be effectively controlled. Therefore, simply taking analgesics will not remove inflammation, and the patient will still have seizures. Second, if inflammation occurs repeatedly at the attachment point, ossification will gradually occur, and the limbs will be restricted and even deformed.

  Misunderstanding 3: More rest and less exercise are better for the condition?

  From a professional point of view, the most feared is that patients with ankylosing spondylitis are sedentary. For sedentary people, get up and move their lower limbs every 1 to 2 hours, especially for patients with spondylitis, so that they can maintain a relatively healthy posture. It is recommended that patients with ankylosing spondylitis exercise as much as possible.

  Patients with ankylosing spondylitis can be relieved by physical therapy or appropriate exercise. The recommended exercise is swimming, but you can also do some yoga, stretching and other sports.

  Misunderstanding 4: One of the causes of ankylosing spondylitis is genetic. Can I not have children?

  It is not recommended that patients do not give birth to the next generation because of related risks. From an ethical point of view, we will feel that a family has children to be complete. Although ankylosing spondylitis has a genetic tendency to pass on the susceptible genes to the next generation, the incidence of this genetic proportion is probably only a few out of 10,000, so the risk is relatively small. Moreover, even if the child’s B27 test is positive, through close monitoring and diagnosis, repair is still too late.

  Myth 5: Can ankylosing spondylitis be completely cured?

  The so-called “private secret recipe” can be cured, but there is no scientific basis. Ankylosing spondylitis is a chronic inflammatory disease. From a medical point of view, it is basically impossible to “cut the root”. The “private secret recipe” may be more of a false advertisement. Everyone should treat these slogans scientifically. If you stop the scientifically effective drug treatment and use a variety of special recipes, it is very easy to cause irreversible damage to the joints. Thus missed the best time for treatment.

  Although ankylosing spondylitis cannot be cured, it is a controllable disease. Rheumatology departments in most hospitals can treat patients well to ensure their basic living and working abilities.

  In fact, with the development of medicine, ankylosing spondylitis is not so terrible. It can be well controlled and will not cause too much impact on the patient’s normal life and work. Therefore, don’t panic too much. If you find that your body is abnormal, You should seek medical treatment in a timely and scientific manner to avoid delaying the best treatment opportunity.

Ankylosing spondylitis in women

Ankylosing spondylitis is a systemic disease with chronic inflammation of the sacroiliac joint and spine as the main symptoms. The pathological changes include attachment site inflammation and synovitis. This disease occurs more frequently in young people, especially young men. The proportion of men and women with rigidity has been reported to be very different (14.0:1-2.8:1).

In the past two years, some experts and scholars believe that the reason for the lower incidence of women than men is that the invisible period of female ankylosing spondylitis is more common than that of male patients. Therefore, it is more difficult for female patients with tonicity to detect the condition of tonic disease in the early stage of onset than male patients. Slightly larger, coupled with the lack of professional doctors specializing in tonicity in some remote areas, and lack of experience in the diagnosis of female tonicity, the diagnosis of female tonicity is generally slightly later than that of male patients, which affects the incidence of male and female patients. Some scholars believe that the proportion of men and women is equal according to the HLA-B27 genetic marker research.

According to relevant research statistics, the age of onset of male rigidity patients is 6 years earlier than females, and male patients have the characteristics of rapid onset, severe symptoms, rapid progress, and will be accompanied by fatigue, unexplained fever, sudden weight loss, and anorexia. And other symptoms. In addition to the difference in the incidence of female and male patients with rigid rigidity, there are the following differences.

Different affected parts

Peripheral joints are obviously involved:

In women with ankylosing spondylitis, peripheral joints are more common, such as shoulders, elbows, wrists, knees, ankles, toes, and temporomandibular joints, while the thoracic and lumbar spine are less affected than men. The incidence of knee joint involvement, neck involvement, and symphysis pubis involvement in female patients is higher than that in males. Under the same course of disease, female patients have milder clinical symptoms and less involvement of the entire spine, and imaging changes are also more common in early signs . The incidence of sacroiliac arthritis is higher in women than in men, and the formation of intervertebral bridges and bamboo joint changes in the spine are significantly higher in men. That is to say, men are more likely to cause undesirable results of spinal deformity than women.

Other performance is different

Performance other than joint involvement:

a. Female patients have a higher incidence of anemia than men;

b. Female patients’ heart involvement is more common than male patients, but there are also research reports showing that there are more cases of rigid male patients’ heart involvement than female patients;

c. The incidence of iridocyclitis is higher in female patients than in males, and the reason is not clear.

Check the data is different

Laboratory indicators:

The incidence and average of abnormal C-reactive protein and erythrocyte sedimentation rate in the acute phase of female rigidity patients are higher than that of males. However, in recent years, studies have also put forward different views, that there is no significant difference between male and female patients. In addition, there are reports that the positive rate of rheumatoid factor in female patients with rigidity is slightly higher than that in male patients, indicating that female patients may be more likely to have rheumatoid arthritis than male patients.

Different infection factors

The infectious factors that induce the onset of rigidity are different:

Infectious factors are one of the main reasons for the onset of ankylosing spondylitis. Infections can be divided into inflammatory gastroenteritis, urinary system inflammation, and prostate inflammation. Due to the different body structures of men and women, male and female patients with rigidity are similar. In comparison, there are subtle differences in the occurrence of rigidity induced by infection. In addition, female patients need to complete the tasks of pregnancy and childbirth, which is one more puerperium than male patients. Therefore, it also increases the factors of puerperal infection.

Treatment of female patients with rigidity

Caring for women’s health, the condition of female ankylosing spondylitis also needs to receive widespread attention from the society. At the same time, female patients with tonic spondylitis also need to face up to their own conditions, pay attention to their own conditions, and actively treat them on the basis of understanding their own conditions, and strive for harmony with normal people. Same life and work.

Compared with men, female patients with ankylosing spondylitis have a milder condition, do not have an urgent onset, and have a more gradual development trend. However, this does not mean that female patients can relax their vigilance and treat their condition well. On the contrary, female patients with ankylosing spondylitis should know that female ankylosing spondylitis is easier to control than males, but there are problems that are difficult to find in time in the early stage. Early detection and early treatment of patients with ankylosing spondylitis is a better way to deal with ankylosing disease. Therefore, female patients with ankylosing spondylitis should also try to detect the disease as early as possible and give positive and reasonable intervention measures.

For some female patients with mild sacroiliitis changes, ordinary X-ray examinations are difficult to accurately display the true lesion results, and CT examinations can be used. CT examination can accurately measure and evaluate the sacroiliac joint space, improve the detection rate of articular surface erosion, cystic degeneration, and cortical interruption, which is conducive to early diagnosis. If the female patients with conditions are still unclear after CT examination, MRI examination can be considered. MRI examination can show bone marrow fat deposits and bone (medullary) edema near the joints that cannot be shown by CT. Large areas of fat deposition may be related to the self-repair of sacroiliac arthritis, while bone (medullary) edema near the sacroiliac joints is an indirect reflection. The presence and activity of inflammation. For patients with suspected ankylosing spondylitis but an undiagnosed ankylosing condition, CT or MRI can be used. For specific conditions, you need to go to the hospital doctor and follow the doctor’s suggestion.

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