Symptoms:
The onset is slow, and the general symptoms are mild. In the early stage, there may be fatigue, reduced signs, or nausea and fever. Lower back pain, muscle spasm and stiffness gradually appear, and the symptoms are often aggravated after rest and relieved after exercise. Later, typical sacroiliac joint pain gradually appeared, and it involved the spine in an ascending way. The affected parts were painful, tender, stiff, and limited in movement, and flexion deformity gradually appeared. Symptoms increased on cloudy days or after fatigue, and were relieved after warmth or rest. Recurrent iriditis often coexists, and some patients may have sciatica. If the lesion spreads to the costal joint, there may be chest expansion limitation or loss during breathing and intercostal neuralgia.
In the late stage, the patient's spinal rigidity is in a deformed position, and the neck and waist can't rotate, so the whole body must be rotated when looking sideways, and severe hunchback deformity may occur, so he can't look forward. Lesions can sometimes spread to the hip and knee joints, and when the hip joint is involved, it shows a swinging gait. With the bony rigidity and pain in the affected parts gradually disappearing, leaving a lifelong deformity.
what is ankylosing spondylitis?
Ankylosing spondylitis is a very old disease. Evidence of ankylosing spondylitis was found in the bones of ancient Egyptians thousands of years ago. Ankylosing spondylitis used to be considered as the central type of rheumatoid arthritis, but with the development of medicine and the improvement of detection methods, it was found that the disease was very different from rheumatoid arthritis, so it was defined as an independent disease.
Modern medicine recognizes that ankylosing spondylitis is a chronic, progressive and inflammatory disease, and the lesion sites are mainly in sacroiliac joints, spine, soft tissues adjacent to spine and joints of limbs. This disease often starts from sacroiliac joint, gradually spreads to spine and paraspinal tissues, and finally causes bone ankylosis. At present, it is considered that this disease is a seronegative arthropathy of connective tissue and one of the more common diseases of low back pain.
what is the cause of ankylosing spondylitis?
The etiology of ankylosing spondylitis is not completely clear. At present, it is considered to be related to the following factors:
(1) Genetic factors: The onset of this disease is closely related to genetic factors. What is the HLA of ankylosing spondylitis? The positive rate of B27 was as high as 9% ~ 96%, and the positive rate of family inheritance was 23.7%. The incidence rate of rheumatoid family is 2 ~ 1 times that of normal people, while the incidence rate of ankylosing spondylitis family is 3 times that of normal people.
(2) Infection factors: Genitourinary infection is one of the important factors causing this disease. Pelvic infection spreads to sacroiliac joints and then to the spine through lymphatic route, and can also spread to the great circulation, resulting in systemic symptoms and pathological changes of peripheral joints, tendons and ocular pigment membranes.
(3) Endocrine disorder or metabolic disorder: Because rheumatoid disease is more common in women and ankylosing spondylitis is more common in men, it is considered that endocrine disorder is related to this disease. However, the use of hormones in the treatment of rheumatoid arthritis has not achieved obvious results, and the relationship between hormone imbalance and this disease is not certain. There is no significant increase or decrease in the rate of rheumatoid or ankylosing spondylitis in patients with hyperthyroidism.
(4) Other factors: age, physique, malnutrition, climate, soil and water, humidity and cold. Others, including trauma, parathyroid disease, upper respiratory tract infection, local suppurative infection, etc., may have a certain relationship with this disease, but the evidence is insufficient.
what is HLA-B27?
HLA is the initials of three English words, H stands for Human, L stands for Leuc ocyte, and A stands for Antigen, that is, human leukocyte antigen (hereinafter abbreviated as HLA). HLA is an individual-specific antigen controlled by heredity in tissues and cells. It was first found in white blood cells and platelets. Now it is found that HLA is widely distributed in the cell membranes of nucleated cells in tissues and organs such as skin, kidney, spleen, lung, intestine and heart. The 8th international conference on histocompatibility confirmed that there are 92 HLA loci, belonging to five sites, namely, A, B, C, D and DR, which are called HLA-A, HLA-B, HLA-C, HLA-D and HLA-DR respectively. There are 42 HLA-B loci, and B27 is one of them. It has been proved that those who are positive for HLA-B27 are much more likely to have ankylosing spondylitis than those who are negative for HLA-B27.
Is HLA-B27 positive ankylosing spondylitis?
HLA-B27 means human leukocyte antigen B27, also known as W-27. The positive rate of HLA-B27 in patients with ankylosing spondylitis can be as high as over 9%, and about 5% of the first-degree relatives of patients with ankylosing spondylitis are positive, while only 3% of ordinary people are positive. At the same time, there are other diseases such as psoriasis, ulcerative colitis, Crohn's disease, Whipple's disease and so on, and HLA-B27 antigen is also positive. Therefore, positive HLA-B27 is not necessarily ankylosing spondylitis, but it is more likely. At present, HLA-B27 is still one of the methods to detect early ankylosing spondylitis.
can people with negative p>HLA-B27 also get ankylosing spondylitis?
The positive rate of HLA-B27 in patients with ankylosing spondylitis varies greatly from country to country, with a few low reports of 22%, most of them 9% and some as high as 1%. On the other hand, these data show that 1% ~ 78% of patients with ankylosing spondylitis do not have HLA-B27, that is, they also have ankylosing spondylitis, which shows that HLA-B27 is not absolutely related to ankylosing spondylitis.
what are the diagnostic criteria for ankylosing spondylitis?
The diagnosis of ankylosing spondylitis mainly includes the following six indicators:
(1) Sacroiliitis is one of the main basis for the diagnosis of this disease, and normal sacroiliac joints can almost rule out this disease. The X-ray changes of sacroiliac joint are earlier than those of spine, which is beneficial to early diagnosis. X-ray manifestations of sacroiliitis can be divided into three stages. At the early stage, the joint margin is blurred and slightly dense, and the joint space is widened. In the middle stage, it can be seen that the joint space is narrow, the proliferation and corrosion of the joint edge are staggered, and the dense zone of the iliac bone is widened, and the maximum width can reach 3cm. In the late stage, it can be seen that the joint space disappears, the bone dense zone disappears, and the trabecular bone passes through, which has become bony rigidity.
(2) thoracic pain and rigidity.
(3) Low back pain and rigidity have been more than 3 months, but they can't be relieved even after rest.
(4) The lumbar motion is limited.
(5) Chest expansion is limited.
(6) iritis or other secondary diseases.
the diagnosis can be made by adding one more item to the first of the above six indicators. Four of the last five items can also be diagnosed.
where is the best position for patients with ankylosing spondylitis to take X-rays of sacroiliac joints?
sacroiliitis confirmed by X-ray film is a necessary condition for the diagnosis of ankylosing spondylitis. Therefore, it is of great significance to choose a suitable position to shoot sacroiliac joint films to best display the location and degree of lesions. Foreign experience shows that the right radiograph of sacroiliac joint is enough to clearly show the bilateral sacroiliac joint lesions, and the oblique radiograph or other radiographs are not helpful to improve the positive rate, so it is unnecessary to use it. In the Affiliated Hospital of Shantou Medical College, Guangdong, China, through the comparative study of the orthographic film and oblique film of sacroiliac joint in patients with ankylosing spondylitis, it is found that the result of orthographic film is better than that of oblique film, which is consistent with the observation conclusion abroad.
what are the main symptoms of ankylosing spondylitis?
This disease mostly occurs in young and middle-aged men, with slow onset and alternating onset and remission. At first, the symptoms are mild and easy to be ignored. The main part of the disease is the spine, that is, the symptoms of lumbar vertebrae, thoracic vertebrae and cervical vertebrae appear from the sacroiliac joint from bottom to top. At the beginning of the disease, patients occasionally have pain and stiffness in the back, sacrum and buttocks. About 1% of the patients' pain can radiate downward along the buttocks to the flexion side of thighs and calves (along the distribution range of sciatic nerve), but the neurological examination generally has no positive findings. After several months or years, the patient's symptoms gradually get worse, and there is persistent pain in the waist, chest or neck. He often wakes up in the middle of the night and has difficulty turning over, so he needs to get up and exercise to relieve it. With the development of the disease, dyspnea or banded chest pain may occur after the joint of thoracic vertebra and costal vertebra is involved, and the neck movement is limited when the lesion spreads to cervical vertebra. Finally, the whole spine may be stiff, and some of them are complicated with severe hunchback deformity, so that when the patient stands or walks, his eyes can't look straight, and he can only see a small piece of ground in front of his feet. The volume of chest and abdomen is reduced, and the cardiopulmonary function and digestive function are obviously impaired.
Can patients with ankylosing spondylitis develop ophthalmia?
iridocyclitis is an inflammatory disease of the eye, which usually manifests as eyeball pain, congestion and photophobia. About 25% patients with ankylosing spondylitis can develop iridocyclitis during the course of the disease. Most patients' iridocyclitis occurs several days or years before the symptoms of ankylosing spondylitis appear, so it is difficult to conclude that iridocyclitis is related to ankylosing spondylitis. There are also patients who develop iridocyclitis several days to 2 years after the symptoms of ankylosing spondylitis appear. Irisocyclitis can be seen on one side or both sides, and it can also occur alternately on both sides. The duration of inflammation is generally about half a month, and it may be very stubborn, persistent or recurrent, but it rarely leads to blindness. The occurrence of iridocyclitis has no obvious correlation with the peripheral arthritis of ankylosing spondylitis or the severity of symptoms of spondylitis.
how do patients with ankylosing spondylitis choose drugs for treatment?
At present, there is no special treatment for ankylosing spondylitis to prevent the development of the disease. The main purpose of treatment is to relieve pain, reduce inflammation, strengthen exercise and maintain good posture and function. Indomethacin (also known as indomethacin) has strong anti-inflammatory, analgesic and antipyretic effects, 25mg, taken three times a day after meals. Futalin has stronger anti-inflammatory and analgesic effects than indomethacin, and has less side effects. It has a sustained-release dosage form, and the number of times of taking medicine can be reduced to two times a day. The dosage of Futalin casing tablets is 25 ~ 5 mg, three times a day, which is worthy of clinical application. Other good anti-inflammatory drugs for ankylosing spondylitis include naproxen and ibuprofen. The above drugs should be treated continuously for several months, and then gradually reduced after the symptoms are completely controlled or disappeared. It is best to maintain an asymptomatic period with the minimum amount that can control the symptoms, such as about half a year. Attention should be paid to the adverse reactions of the above drugs, such as gastrointestinal discomfort, liver and kidney injury, headache and edema. Before and after treatment, blood and urine routine, liver and renal function should be checked regularly.
Can patients with ankylosing spondylitis be treated with corticosteroids?
Peripheral arthritis, sacroiliitis or spondylitis in patients with ankylosing spondylitis are not indications for corticosteroids. Because of the above performance, non-hormonal anti-inflammatory drugs and sulfasalazine can get obvious results. Therefore, considering the joint disease, it is not suitable for hormone therapy, but about 25% patients with ankylosing spondylitis can develop iridocyclitis during the course of the disease. Once it is diagnosed as iridocyclitis by an ophthalmologist, hormone therapy should be started. For patients with mild illness, .5% cortisone eye drops can be used four times a day. Some cases need to take prednisone for systemic treatment. These treatments should be carried out under the guidance of a doctor.
how does Chinese medicine treat ankylosing spondylitis?
TCM treatment of ankylosing spondylitis is based on the principle of tonifying kidney and strengthening waist, and clearing phlegm fire. Yougui Pill combined with Erchen Decoction is used for patients with kidney-yang deficiency, while Zhibai Dihuang Pill combined with Erchen Decoction is used for patients with kidney-yin deficiency. In case of extreme heat, Cortex Phellodendri, Rhizoma Anemarrhenae, Radix Rehmanniae, Radix Scrophulariae and Gypsum Fibrosum can be added to clear away heat and nourish yin; In severe pain, Herba Asari, Ramulus Cinnamomi, and Rhizoma Corydalis are added to dredge collaterals and relieve pain. Single Tripterygium wilfordii decoction has certain curative effect. Topical application of Shujin Huoluo ointment, such as Baozhen ointment and Dingtong ointment, or rubbing with musk rheumatism oil can have a certain analgesic effect.
what non-drug treatments can be given to ankylosing spondylitis?
Physical therapy and massage have auxiliary effects on the treatment of this disease. Commonly used are infrared radiation, ultrasound, microwave, wax therapy, hot water bath, iontophoresis and so on. Patients can also massage themselves, massage the skin of joints with their palms and press the muscles. Physical therapy and massage can promote blood circulation, remove blood stasis, relax muscles, dilate blood vessels, improve blood supply and promote the absorption of inflammatory products. When the deformity obstinately progresses, it can be corrected with stents or instruments. Skin traction or bone traction is suitable for those whose deformity is not serious and has not existed for a long time, with 4 ~ 6 kg for hip joint and 2 ~ 4～6kg for knee joint. Synoviectomy, joint debridement, release, fusion, plasty and joint replacement are feasible if conservative treatment fails.
should patients with ankylosing spondylitis adhere to exercise therapy?
Patients with ankylosing spondylitis and their families often make the diseased joints completely or basically inactive for a long time in order to avoid or alleviate the joint pain of patients, which leads to muscle atrophy and joint contracture, so that the joints and limbs that are not serious and may fully recover are actually in a state of disability or disability with loss of mobility. The correct way is to actively accept anti-inflammatory drugs to control joint pain and carry out joint activities in a timely and cautious manner. In the acute stage of the disease, gently help the joint activity once or twice a day to make it just reach the level of pain, which is helpful to alleviate the joint contracture. When not exercising, the acute inflamed joints should be placed in proper positions and/or braked with splints, so as to keep some functions when inevitable contracture and deformity cannot be corrected in the future. In the subacute and chronic stage of the disease, we should adhere to the stretching exercise of limbs and spine, and gradually increase the number, time and frequency of activities according to the degree of pain tolerance. Patients should know that it is very important to keep exercising in all parts. After the pain symptoms disappear completely and drug treatment is stopped, they should keep exercising for a long time and keep all joints in normal function as much as possible.
how to treat ankylosing spondylitis by manipulation?
Manual therapy is effective for early ankylosing spondylitis, which can relieve pain, help the spine and double hip joints to recover motor function, reduce stiffness, prevent hunchback deformity or slow down the development of deformity. The specific treatment methods are as follows:
(1) The patient is prone position: 2 ~ 3 pillows are respectively placed in front of the upper chest and thighs, so that the chest and abdomen are suspended, and the arms are bent in front of the head. The doctor stands by, treating the patient's back and back along the spine and both sides with the method of lifting up and down, and pressing the other palm along the spine on the back at the same time, which should cooperate with the patient's breathing when pressing, pressing down when exhaling, and relaxing when inhaling.
(2) Ascending the momentum: press the bladder meridian and the rank edge of the buttocks on both sides of the spine, jump around, and live? FDDD? Equal points.
(3) supine position of the patient: the anterior part of the hip joint was treated with the method of squatting, and the abduction and external rotation of the hip joint were coordinated. Then take the inner thigh muscles and rub the thighs.
(4) Sitting posture of the patient: the doctor stands in the back, applies it to both sides of the neck and the scapula with the massage method, and at the same time cooperates with the left-right rotation and pitching of the neck, then pushes both sides of the cervical vertebra up and down by massage or one finger meditation for several times, and then takes the wind pool and both sides of the cervical vertebra to the shoulder well.
(5) Connect the posture: instruct the patient to bend his elbows, hold them on the occipital part of the back of the head, and hold them with two fingers crossed.