Ankylosing spondylitis

Summary:Ankylosing spondylitis (ankylosingspondylitis, AS) has been called rheumatoid spondylitis (spondylitisdeformans). The deformation of

Content

Summary:

Ankylosing spondylitis (ankylosingspondylitis, AS) has been called rheumatoid spondylitis (spondylitisdeformans). The deformation of Spondylitis ankylosing spondylitis (spondylarthritisankylopoetica!)! (spondylarthriteankylosante) spinal ankylosis spondylitis (adolesentspondylitis) youth!! Marie_Stumpel disease and VoBetherew disease. Before 60s, AS was classified as a special type of rheumatoid arthritis. In 1963, the American College of Rheumatology classification in rheumatoid spondylitis ankylosing spondylitis was renamed the "1982 China's first rheumatism Symposium confirmed ankylosing spondylitis of the international unified nomenclature. Rheumatoid arthritis and rheumatoid arthritis and other diagnostic names have stopped using.

AS is a starting from the onset of the sacroiliac joint, mainly involving the sacroiliac joints, spine and hip joint chronic inflammation, and self limiting disease, spinal involvement of spinal ankylosis and flexion deformity, the exact cause is unknown, but associated with infection, heredity, damp and cold, autoimmune disorders and other factors etc.. AS is a chronic inflammatory lesion to the central axis of the joint based systemic disease, which belongs to the snsa. The prevalence was about 0.3%.

The mean age at onset of AS was 32.7 years. The incidence of occult, initially for sacroiliac joint or hip, thigh pain, difficult to locate. Low back pain and discomfort is the most common symptoms of the disease. Morning from the increase, after the active relief. The involvement of the spinal column is limited by the activity of the spine, and the involvement of the costal joint. During the active period, pain and tenderness were found in the sacroiliac joint, pubic symphysis, spinous process of spine, iliac crest, greater trochanter, tuberosity of tibia, tibial tubercle and calcaneal tuberosity. More than half of the patients suffered from peripheral joint pain and dysfunction. A walk of pain. During the active period, the lower back and hip pain were positively correlated with the erosion of sacroiliac joint CT.

Pathology:

The AS features of the pathological changes is the ligament insertion disease (enthesopathy) lesions, primary site is attached to Ministry of ligament and joint capsule, the inflammation of tendon, causing syndesmophyte formation (syndesmophyte), vertebrae squaring, vertebral endplate damage, tendonitis and other changes. Because at the end of the tendon is at least in the growth period is an active part of metabolism, is an area of occurrence of AS in young children, as to why the good hair at the tendon end, is still unknown.

Originally from the sacroiliac joint lesions gradually developed into the process of bone arthritis and rib vertebral spinal arthritis, other joint involvement in succession from the bottom to the top. Synovial changes in the surrounding joints of AS were characterized by granulomatous inflammation of the synovium. There was infiltration of macrophages, lymphocytes and plasma cells, synovial thickening around the small synovial membrane. After several months or years, there was granulation tissue formation. Soft tissue around the joint has obvious calcification and ossification of ligament attachment can be formed syndesmophyte, continue to extend longitudinally into two direct adjacent vertebral bone bridge, paravertebral ligament and anterior vertebral ligament calcification, the spine is bamboo".

With the progress of the disease, there is a significant tendency of ossification around the joints and joints. Early ligament, fibrous ring, intervertebral disc, periosteum and bone trabecula for vascular and fibrous tissue invasion, replaced by granulation tissue, leading to the destruction of the joint and nearby bone sclerosis; after repair, the final fibrous ankylosis and bony ankylosis, vertebral osteoporosis, muscle atrophy and thoracic kyphosis. Inflammation of vertebral cartilage endplate and intervertebral disc edge, resulting in local ossification.

The lesions of the heart are the invasion of the aortic valve, thickening of the anterior aortic membrane, shortening of the fibrosis, but not fusion, the enlargement of the active valve ring, and sometimes fibrosis of the aorta. I see the pericardium, myocardial fibrosis, histological visible epicardial vessel with chronic inflammatory cell infiltration and endarteritis; aortic medial elastic tissue destruction, fibrous tissue generation, fibrosis such as invasion of atrioventricular bundle, causing atrioventricular block.

Lung lesions are characterized by patchy inflammation of the lung tissue with round cell and fibroblast infiltration, which develops to fibrosis with hyaline degeneration.

diagnostic criteria

(1) the earliest diagnostic criteria for ankylosing spondylitis were presented at the 1961 meeting in Rome, called the Rome standard. The New York meeting in 1966 revised the Rome standard, called the New York standard:

X-ray classification of sacroiliac joint:

O level: normal. Level 1: suspicious changes. Grade 2: mild abnormality, visible localized erosion and sclerosis, but no change in joint space. Grade 3, obviously abnormal, in the case of moderate or progressive sacroiliac arthritis, with one or more of the following changes: erosion, hardening, narrowing of the joint space, or partial ankylosis. Grade 4: severe abnormality; complete ankylosis.

(1): the diagnosis of lumbar flexion, extension and lateral bending in three directions of activity limitation;

Low back pain history or current symptoms;

The activity of the fourth intercostal space was less than 2.5 cm.

(2) classification:

Ankylosing spondylitis

1 bilateral 3 ~ 4 grade of sacroiliac joint inflammation plus more than one clinical standard;

2 clinical standard of unilateral of grade 3 to grade 2 or grade II of the knee joint with L or 2+3.

Possible ankylosing spondylitis: bilateral 3 to 4 degree of sacroiliac arthritis without clinical criteria.

(2) New York diagnostic criteria revised in 1984 (Modified New York, criteria, 1984)

(1) diagnosis

Clinical standard

1 lower back pain, stiff for more than 3 months, activity improvement, rest no improvement.

2 lumbar frontal and sagittal plane limited activity.

3 the degree of thoracic activity was lower than that of the corresponding age and sex.

Radiological criteria:

Bilateral sacroiliac arthritis reached or exceeded grade 2 or unilateral sacroiliac joint inflammation from grade 3 to grade 4.

(2) classification

1 ankylosing spondylitis: consistent with radiological criteria and more than 1 clinical criteria.

2 possible ankylosing spondylitis: in line with the 3 clinical criteria. Consistent with radiographic criteria without any clinical criteria (should be removed from other causes of sacroiliac arthritis).

The standard improves the sensitivity of the diagnosis of ankylosing spondylitis, but the clinical level of 3 cases of sacroiliac arthritis is not easy to determine, and ignore the early symptoms of the disease, it is not satisfactory.

All of the above diagnostic criteria emphasize low back pain, lumbar movement limitation, thoracic activity limitation, and sacroiliac joint inflammation. Male adolescents, who have acute or chronic waist and lower back pain, stiffness, and should be suspected of this disease, must be as early as the sacroiliac joint X-ray radiography to clear the diagnosis.

(3) the new diagnostic criteria (Linden criteria 1987) 1 inflammatory pain, onset before the age of 45 2.HLA-B27 positive or family history of AS, and any one of the following: A. recurrent unexplained chest pain or stiffness B. unilateral uveitis and tendon, ligament and bone junction. Other C. seronegative spinal joint lesions in 3 lumbar motion limited range 4 chest limited range

(4) diagnostic criteria of 2001 Shantou national AS Symposium recommended: clinical manifestations of A. {1}, or the waist and spine, groin, buttock or leg pain (or asymmetric peripheral oligoarthritis, especially the lower extremity oligoarthritis, duration of symptoms 6 weeks; > {2} or night pain the time of morning > 30 min {3} {4} with ease after tendon pain or other attachment points of pain {5} iridocyclitis symptoms or history or family history of {6} {7} B27 positive non steroidal anti-inflammatory drugs can quickly slow

B. combined with X-ray CT imaging diagnosis can be clearly diagnosed

(5) European spondyloarthropathy Study Group criteria: inflammation of spinal pain or symmetry and the lower extremity joints mainly synovitis, and any one of the following projects, namely urethritis, cervicitis or acute diarrhea in 1 positive family history of psoriasis and inflammatory bowel disease, 2 3 4 arthritis within 1 months before the 5 bilateral; hip pain in 6 alternate enthesis 7 sacroilitis.

Ankylosing spondylitis auxiliary examination

White blood cell count was normal or slightly increased, the proportion of lymphocytes, a minority of patients with mild anemia (positive cell hypochromic), erythrocyte sedimentation rate can be increased, but little correlation with disease activity, and C reactive protein is significant. Serum albumin decreased, alpha 1 and gamma globulin increased, serum immunoglobulin IgG, IgA and IgM increased, serum complement C3 and C4 increased. About 50% of patients with elevated alkaline phosphatase, serum creatine phosphokinase also increased. Serum rheumatoid factor negative. Although more than 90% ~ AS patients with LHA-B27 positive, but generally do not rely on LHA-B27 to diagnose AS, LHA-B27 is not a routine examination, can not be screened in patients in turn. The diagnosis mainly depends on clinical manifestation and radiological evidence.

X-ray examination is very important for the diagnosis of AS, about 98% ~ 100% cases of early sacroiliac joint X-ray changes, is an important basis for the diagnosis of this disease.

The primary AS and secondary to inflammatory bowel disease, Reiter syndrome, psoriatic arthritis associated with spondylitis, X-ray manifestations are similar, but the latter is the asymmetric tonic. In the ligament, tendon, bursa attachment can occur and bone periostitis is seen most frequently in calcaneus, ischial tuberosity, iliac crest. Similar X-ray changes may occur in other peripheral joints.

In the early X-ray examination, radionuclide scanning, computed tomography and magnetic resonance imaging were performed to detect the early symmetrical sacroiliac joint lesions [27]. However, it is necessary to point out that a simple and convenient X-ray film of the anterior posterior position can diagnose the disease.

In a word:

Diagnosis should be based on symptoms, signs of joint, extra articular manifestations, family history.

First, the symptoms of low back pain in patients with mechanical pain, non inflammatory pain. The patients with inflammatory pain. Inflammatory pain: 1 back discomfort before the age of 40, 2. 3 March 4 more than the slow onset of symptoms of back pain and stiffness 5 back discomfort activity reduced or disappeared after the above 5 items 4 items which support the inflammatory pain.

Two, physical examination to sacroiliac joint and paraspinal muscle tenderness, tenderness and range extended; lumbar curvature decreases, the direction of the activities of the first spine or disappeared, thoracic activity reduced, cervical curvature decreased or disappeared. Methods: double foot wall test, the requirements of the foot and the pillow can touch the wall for the normal, or strong spinal cord; chest expansion test; pelvic separation test, 4 word test positive.

Three, X-ray manifestations:

The early X-ray manifestations of sacroiliac joint inflammation, lesions generally in the sacroiliac joint in the lower part of the beginning, for both sides. To infringe the iliac side, and lateral sacral invasion. Visible or massive bone side visible. And then the whole joint can be invaded, the edge is serrated, subchondral bone sclerosis, bone hyperplasia, joint space narrowing. At last, the joint space disappeared and bony ankylosis occurred. From the sacroiliac joint development, there are a few from the neck down. The early manifestations of sacroiliac joint pain, and X online performance is not obvious. After the sacroiliac joint edge blurred and slightly dense, joint space widening, further development of articular cartilage and articular surface was destroyed. Joint space irregular, late stiffness, joint gap disappears completely. Sacroiliac joint X-ray diagnosis standard and easy to use the button about classification of 5 grades: 0 grade for normal sacroiliac joint, grade one was suspicious of sacroiliac joint inflammation on both sides; the second is the sacroiliac joint edge blur, slightly hardening and micro erosion of articular cavity lesions, mild narrow; the third is on both sides of the sacroiliac joint hardening joint, edge blur, erosion lesions with articular cavity disappeared; IV for complete fusion or joint ankylosis with or without residual hardening.

The most characteristic of spine X-ray, mainly for the early vertebrae squaring and decalcification, appeared after spinal kyphosis and slub change. Square: because the upper and lower margin of vertebral anterior ligament attachment osteophyte caused by new bone hyperplasia caused by vertebral square change. Bamboo like: in the late change of this disease, because the new osteophyte formation in the adjacent vertebral bone bridge on both sides, is a piece of interbody bone bridge like bamboo. 3 with top-down longitudinal spinal ossification. Ossification of the spinous process and ossification of the spinous process and the ossification of the spinous process. Kyphosis: advanced lesions of intervertebral disc, intervertebral space narrowing, disappearance of normal physiological curvature.

There is also literature that: the X-ray manifestations of spinal lesions, early common osteoporosis, vertebral facet joint and vertebral bone Liang Mohu (DBM), the annulus fibrosus incidental vertebra angle and the angle of the destructive erosion, vertebral body was "square, before the normal lumbar vertebra" radian disappear and straight that can cause one or more vertebral compression fractures. The development of thoracic and cervical lesions to the facet joint, disc gap calcification, annulus and calcification, ossification of ligament, anterior longitudinal ligament osteophyte formation, the adjacent vertebral interbody bone union, the formation of the bridge, a bamboo spine is the most characteristic of the "".

Four, laboratory examination, blood sedimentation rate, white blood cell count was normal or slightly increased, the proportion of lymphocytes, a minority of patients with mild anemia (positive cell hypochromic), erythrocyte sedimentation rate can be increased, but little correlation with disease activity, and C reactive protein is significant. Serum albumin decreased, alpha 1 and gamma globulin increased, serum immunoglobulin IgG, IgA and IgM increased, serum complement C3 and C4 increased. About 50% of patients with elevated alkaline phosphatase, serum creatine phosphokinase also increased. Serum rheumatoid factor negative. Although more than 90% ~ AS patients with LHA-B27 positive, but generally do not rely on LHA-B27 to diagnose AS, LHA-B27 is not a routine examination, can not be screened in patients in turn. The diagnosis mainly depends on clinical manifestation and radiological evidence.

Five, diagnostic criteria: according to the 1984 New York standard or in 2001 the AS conference in Shantou to develop standards.

Juvenile ankylosing spondylitis (juvenileankylosingspondylitis, JAS) originally refers to 16 years of age as a result of spinal cord disease caused by ankylosing spondylitis. In 1973, the American Association of Rheumatology identified the disease as an independent disease from rheumatoid arthritis. In the published data, the proportion of JAS men and women have a greater difference, about 2.8:1~9:1. Calin et al. Reported that gender differences in JAS were related to age. Below 12 years of age, the male to female ratio was 1.4:1. 12~16 years old patients with 3:1, similar to the adult AS. in unrelated JAS patients, more than 90% of HLA_B27 positive. JAS has an amazing family. The onset of the peripheral joint is the first symptom before the back, and is characteristic of juvenile ankylosing spondylitis. Lower extremity joints, especially the hip joint. The non symmetry of the lower extremity arthritis or joint pain! And heel tendon inflammation is one of the important features of this disease, especially the incidence of oligoarthritis were more common. However, the incidence of AS in adult patients was only 30%. JAS invasion of the spine is less, more susceptible to hip joint, 5%~10% high fever, weight loss, weakness, muscle atrophy and systemic failure, a small number of lymph nodes may be swelling and serious poverty. JAS diagnosis: onset before the age of 16, X-ray confirmed bilateral or unilateral sacroiliac joint lesions at the same time, with the following conditions in at least 2 or 3: (1) low back pain or low back pain history (2) peripheral arthritis, especially in the lower extremity (3) heel pain or enthesitis (4) human leukocyte antigen (HLA_B27) positive (5) family history of joint disease and spinal except seronegative spondyloarthropathy, can diagnose"

14%~27% of AS patients with iris. Adult ankylosing spondylitis 50% may have cardiovascular disease, juvenile rare. Some patients with AS intervertebral disc and lumbosacral vertebrae, sternum handle multiple damage, surrounded by soft tissue mass, similar to metastatic tumor or infectious disease

The clinical manifestations were mainly low back pain, lumbar stiffness, and lumbar dysfunction. The respiratory and circulatory dysfunction of digestive kyphosis caused by.

There is also literature that the main symptoms are pain, swelling, deformity with morning stiffness, numbness, fever, sweating, spine, spine and joint joint movement disorder.

Ankylosing spondylitis of the initial position in the lumbosacral region, 100% patients with sacroiliac joint pain. The main lesion in the spine. Initial feeling of low back pain, stiffness, not sedentary. The condition such as the continued development can produce cold limbs, bending difficult, even rigidity condition is not controlled, will lead to continued development of ankylosis of the spine bent, not pitching, upright front, even involving the heart, lung and kidney. Can also produce iris inflammation.

The obvious clinical type type

Acute attack stage:

Generally more young men than women. The health of the body, suddenly appear lumbosacral pain, sometimes pain is more serious, sometimes up to chest and neck, sometimes even more thigh heel, activity limitation, life can not take care of themselves. For a long time and were upset irritability, anxious, then dry red, mouth parched and tongue scorched, or have a fever or fever, chills, tongue pale white or light yellow, pulse string number.

Remission period:

At the end of the acute episode, the symptoms are alleviated, which does not mean that the disease is cured. This period should not be left symptoms, leaving the root cause.

The occult:

Early may not want to eat, fatigue, weight loss and anemia, a few may have fever and joint pain, like early suffering from rheumatic fever or tuberculosis, usually not serious so often fail to arouse people's attention, the disease in trauma, overwork or infection after the occurrence of this disease, as for.

Review of clinical symptoms:

AS is common in 16 ~ 30 years old young men, more common, after the age of onset for the first time is rare, accounting for about 3.3% of the total number of people in the world, the number of patients with the disease is less than. The onset of the disease is insidious, the progress is slow, systemic symptoms are lighter. In the early stage, there was a low back pain and stiffness in the morning. After the operation, the symptoms were reduced, and the symptoms of low fever, fatigue, anorexia and weight loss were observed. Intermittent pain at the beginning, a few months after several years of development of persistent inflammatory pain disappeared after spinal, bottom-up all or part of ankylosing kyphosis appeared. It is more common for female patients to be invaded around the joints.

1 joint lesions showed AS patients with joint lesions, and most of the first invasion of sacroiliac joint, the future development of the cervical spine. A minority of patients by cervical spinal segment at the same time or several violations, can also invade surrounding joints, early lesions joint inflammatory pain associated with knee muscle spasm, feel stiff, morning is obvious; can also be characterized by pain, activity or take painkillers to ease. With the development of the disease, joint pain is reduced, and the spinal segments and joints are limited and deformed, and the entire spine and the lower limb are turned into a stiff bow.

The sacroiliac joint: about 90%AS patients as the first manifestation of sacroiliac arthritis. After the upward development to cervical vertebra, presenting with recurrent low back pain, lumbosacral stiff feeling, with intermittent or alternate sides appear on both sides of back pain and hip pain radiating to the thigh, there are no positive signs, straight leg raising test negative. But direct pressure or stretch the sacroiliac joint can cause pain, so don't like sciatica. Some patients had no symptoms of sacroiliac joint inflammation, only X-ray examination showed abnormal changes. About 3%AS of the cervical spine was involved in the first place, and then went down to the lumbosacral region. 7%AS was involved in several spinal segments.

The lumbar spine: spine involvement, the majority showed lower anterior dorsal and lumbar activity limited. Lumbar flexion, lateral bending and rotation, buckle y can be restricted. Physical examination can be found in the lumbar spine tenderness, lumbar muscle spasm; lumbar atrophy in the latter period.

The thoracic lesions: thoracic involvement, manifested as back pain, chest pain and chest side, the weapon of kyphosis. For example, the joint of the cervical vertebrae, the body of the sternum, the joint of the acromioclavicular joint, the [19, 20], and the costal cartilage were involved in the chest pain, limited expansion of the chest, and severe chest pain when breathing or coughing. In severe cases, the chest remained in the state of the call, and the thoracic expansion was reduced by more than 50% compared with that of the healthy people. Due to the reduction of the thoracic and abdominal cavity, the heart and lung function and digestive dysfunction.

The cervical lesions: a minority of patients as the first manifestation of cervical spondylosis, first cervical pain, along the neck towards the head arm radiation. The muscles of the neck begin to spasm and atrophy, and the progression of the disease can develop to the cervical kyphosis. The head activity was limited, often fixed in flexion and lateral bending, not upward or turn. Serious person can only see his toes in front of the small ground, cannot rise head.

The periarticular lesions: about half of AS patients with acute peripheral arthritis in short, about 25% permanent joint damage around. Generally occur in large joints, lower limbs than the upper limbs. Some statistics, the incidence of peripheral joints, hip and shoulder was 40%, knee, 15, ankle, foot, ankle and foot of the 5%, rarely involved in the hands of the hands of 10%. The people's Liberation Army General Hospital reported 80 cases of AS, hip involvement rate of symptoms (100%); limitation of activity (64%), flexion contracture (38%), muscle atrophy (25%), (37%), ankylosis is the main cause of disability in AS patients; hip symptoms occur after the onset within 5 years accounted for 94%. The first 5 years, suggesting that the incidence of AS without involving the hip joint, then it is unlikely.

Shoulder joint involvement, joint mobility pain is more obvious, hair, hands and other activities are limited. The knee joint is a violation of compensatory bending, walking, sitting and make daily life more difficult. Very few violations of the elbow, wrist, and foot joints, which are rare in some sections.

In addition, the pubic symphysis pelvis can be affected, on the edge, the ischial tuberosity, the greater trochanter and femoral heel may have symptoms of an early manifestation of osteitis, local soft tissue swelling, pain, late bone thick. General arthritis can occur before or after the spondylitis, local symptoms and rheumatoid arthritis is not easy to distinguish, but less than those who left the deformity.

AS extra articular lesions 2 joints, mostly in spondylitis, occasional musculoskeletal symptoms before a few months or years of extra articular symptoms occur. AS can invade multiple systems of the body and is associated with various diseases.

The heart disease: aortic valve disease is common, according to the autopsy of aortic root lesions with about 25%AS cases of cardiac involvement in clinical symptoms, may also be evident. Clinical have different degrees of aortic regurgitation were about 1%; about 8% of heart block occurred, can not exist alone and the closure of the aortic valve, serious occurrence of Adams Stokes syndrome with complete atrioventricular block. Angina pectoris can occur when the lesion involves the coronary artery. Few cases of aortic aneurysm, pericarditis and myocarditis. AS patients with heart disease, the general age, a longer history, more lesions of the spine and peripheral joints, systemic symptoms are more obvious. Gould et al. Examined the cardiac function of 21 patients with AS, and found that the cardiac function of AS patients was significantly lower than that of the control group.

The eye disease: long-term follow-up, 25%AS patients have conjunctivitis, iritis, uveitis or uveitis, which even can be complicated with spontaneous hyphema. Inflammation of the iris disease recurrence, the longer the higher incidence, but the severity and spondylitis independent of the common peripheral joint disease, a few may precede spondylitis occurrence. Eye disease is often self limiting, and sometimes need to be treated with corticosteroids, some without proper treatment can cause glaucoma or blindness.

The ear lesions: Gamilleri reported 42 cases of AS patients in 1/2 cases (29%) had chronic otitis media, is 4 times the normal control and, in the event of chronic otitis media in patients with AS, the extra articular than AS patients with chronic otitis media.

The pulmonary lesions: a minority of AS patients in later stage lung spots on irregular punctate lesions associated with fibrosis, asthma, even for expectoration, hemoptysis, and may be associated with recurrent episodes of pneumonia or pleurisy. X-ray examination showed diffuse pulmonary fibrosis on both sides of the upper lobe, which could cause cyst formation and parenchymal destruction.

The lesions of the nervous system due to ankylosis of the spine and osteoporosis, the dislocation of cervical vertebra and the occurrence of spinal fractures caused by spinal cord compression; such as the occurrence of discitis is caused by severe pain; late AS may invade the cauda equina, cauda equina syndrome occurs, resulting in lower limbs or hips radicular pain; sacral nerve distribution area of infection loss, Achilles tendon reflex weakened and motor dysfunction of bladder and rectum.

It is associated with AS amyloidosis: a rare flat. It is reported that 35 cases of AS, the conventional rectal mucosal biopsy found in the presence of amyloid deposits in most of the 3 cases, there is no special clinical manifestations.

, kidney and prostate lesions: compared with RA, AS rare occurrence of renal damage, but the occurrence of IgAD nephropathy report. AS complicated with chronic prostatitis was higher than that of the control group.

According to the New York revised standard of ankylosing spondylitis (1984), the image classification was performed according to the X-ray findings. Level 0: normal. Level I: suspicious changes. Grade II: mild abnormality, visible localized erosion and sclerosis, but no change in joint space. Grade III: significantly abnormal, moderate or progressive sacroiliac joint, with 1 or more of the following: erosion, hardening, widening or narrowing of the joint space, or partial ankylosis. Class IV: severe abnormalities, complete ankylosis.

(two) there is no uniform classification standard of CT classification of sacroilitis CT at present, according to the X-ray manifestations of the classification can be divided into 0 levels: normal, sacroiliac joint, joint surface finishing, joint clearance, no deformation; I, blurred articular surface, cortical continuity is poor, no joint capsule change, no bone destruction, no hardening hyperplasia, no change of joint space; II, limitation of cortical bone sclerosis, blurred articular surface and plaque decalcification, cartilage erosion, coarse and tiny subchondral cysts, joint space was normal, the bone surface in abnormal bone erosion, cystic and common in sacroiliac the joints in the lower part, rarely involving ligament department; grade III, subchondral bone erosion and obvious diffuse sclerosis, joint surface brush or zigzag, osteoporosis and cystic degeneration also increased significantly, the joint space was irregular narrow or wide narrow uneven, some rigidity; IV Grade II, sacroiliac joint ankylosis, generalized osteoporosis, ligament erosion and cystic changes were common and more pronounced.

Imaging findings (two) imaging findings of sacroiliac joint in ankylosing spondylitis

The X-ray and CT findings of sacroiliac joint: bilateral symmetry is the main basis for the diagnosis of AS disease "mainly sacroilitis for osteoporosis, subchondral bone erosion, cystic degeneration, hyperosteogeny, narrowing of joint space or uneven width, finally completely bony fusion. The first change was the soft tissue density erosion of the facet joint, and gradually increased. 1/3 joint erosions in the most obvious, is often hardening wide band, more than 1cm. The development of lateral sacral erosion lesions can lead to articular surface, joint surface erosion, often show irregular joint gap widened, for aggressive pannus hyperplasia, often called / pseudo widened joint space. After the joint space and gradually narrowed, and finally the trabecular bone through the joint surface and the formation of bony ankylosis, pain subsided. After the onset of sacroiliac joint, about 74.8% of cases were gradually invaded and spine. In some cases, the spine has changed, but there is no obvious abnormal change of sacroiliac joint. Along with the progress of the disease, the joint capsule, the ligamentum flavum, the interspinous ligament and the Supraspinal Ligament can be ossified. After the minor trauma can cause attachment fracture, fracture nonunion can be formed with a high density of calcium sclerosis edge of the soft tissue density of light transmission line, that is, false joint. Vacuum phenomenon in fracture.

Another characteristic of the AS attachment points for disease, manifested as tendon, ligament and joint capsule and bone attachment and visible bone surface vertical ossification, a beard, also can have bony erosion, low density cystic cortex, ischial tuberosity, trochanter and iliac crest, spinal spine and as the common incidence of calcaneal tubercle. In the involvement of peripheral joints of hip in the most common, accounting for 37.9% AS, multi bilateral involvement, manifested as a joint effusion, homogeneous joint space narrowing, blurred articular surface disruption, the articular surface of the adjacent bone in the small circular soft tissue density cystic, cystic areas surrounding mild reactive bone sclerosis, acetabulum and the articular surface of the femoral head edge osteophytes and joint ankylosis. JAS may also involve the hip joint (approximately 76% of the final involvement) or the knee joint, and subsequently the sacroiliac joint and spine.

The value of X-ray and CT in diagnosis of sacroiliac joint lesions in AS: AS is a kind of unexplained chronic diseases, almost all patients of the earliest radiographic changes were bilateral sacroiliac arthritis involving the spine and peripheral joints, then. Characteristic feature of sacroiliitis imaging for erosion of articular surface! Cysts, joint space narrowing or widening joint ankylosis; other manifestations of articular surface hardening and loose joint surrounding bone, soft tissue swelling etc.. The lower part of the early changes of sacroiliac joint (synovial SAC) erosion, hip side, may be related to the articular cartilage is weak, while the cystic degeneration and subchondral sclerosis "in patients with early symptoms, X-ray is difficult to find the sacroiliac joint changes, CT can clearly distinguish the faults of synovial Department of imaging and ligament, clear.

It is pointed out that:

The X-ray of sacroiliac joint was not sensitive to the first and second grade lesions. X-ray examination of 0~ II patients with waist and sacroiliac pain, morning stiffness and other symptoms, and underwent CT scanning, X-ray was found in subchondral cysts, bone sclerosis, decalcification and other phenomena, and CT examination revealed fine cysts, subchondral osteoporosis, edge mild hardening. Plaque decalcification, mainly for fat deposition caused by wide range, can be used as one of the diagnostic reference standard of AS, which may lead to inflammation or inflammation and late bone marrow fatty degeneration caused by [. X-ray bone cartilage tissue due to overlap more, not development, for small cortical bone became unclear, while the CT check for cross section scan, no interference level, CT high resolution, can display the bony joint space clear, small cortical bone changes, osteoporosis, bone sclerosis and other signs. For measuring the width of sacroiliac joint gap, whether ankylosis judgment meaningful. CT is more sensitive to the diagnosis of 0~ grade II sacroiliac arthritis than conventional X-ray examination, which is of clinical significance in the diagnosis of non inflammatory sacroiliac arthritis.

Sacroiliitis imaging examination: routine X-ray examination is used and the left and right oblique examination of sacroiliac joint, the diagnosis can be made for most sacroiliitis, so X-ray was the preferred method is the most simple and economical. But because of the sacroiliac joint is relatively fixed, only to do the whole pelvic motion, X-ray projection can avoid bone structure, feces and intestinal gas shadow and effect observation of lesions; axial CT scan can clearly display the anatomic integrity of the distribution range and bone cortex location and bone in the sacroiliac joint! Violation the adjacent tissue when necessary, coronal, sagittal and 3D surface reconstruction shows complex anatomy and imaging in detecting early lesions, significantly better than X-ray plain film, in addition to CT joint anatomy showed clear effects on more favorable.

CT advantage: CT high resolution, anatomical structure without overlap, can clearly show the change of joint space, easy to measure. CT was more clear than the X-ray findings in the case of subchondral cystic degeneration, cortical disruption, and slight subchondral erosion. In general, in the evaluation of III, IV levels of sacroiliac arthritis, X-ray and CT film reading error is small for suspicious I grade and II grade of sacroiliac joint inflammation, must be CT. However, CT can not show the joint cartilage and the adjacent soft tissue inflammation, so the evaluation of CT on the level 0 and I grade of sacroiliac joint inflammation, in order to determine the presence of inflammation, the need for MRI examination.

Differential diagnosis:

Differentiation of sacroiliac joint lesions:

(1) rheumatoid arthritis of sacroiliac joint, often bilateral disease often lesions of different degrees, the upper half of the invasion of sacroiliac joint, articular surface of cortical bone density, bone defect in joint capsule and surrounding with different hardening zone.

(2) the pyogenic sacroiliac joint inflammation was unilateral sacroiliac joint disease, early joint cyst swelling, joint space widening, followed by osteoporosis, bone destruction, proliferation coexist, soft tissue calcification around the bone.

(3) tuberculous sacroiliitis often unilateral joint diseases, early blurred articular surface, widened joint space, and 13 sacral anterior inferior iliac bone destruction, destruction of the cavity edge is not clear, soft tissue residual ossicles, patchy high density calcification and dead bone. A fine granular or "sand like" dead bone, may be cool dry matter calcification, may also be the real "sand like" dead bone [5]. Joint space narrowing, periarticular cold abscess or sinus formation.

(4) the tightness of the iliac bone inflammation, occurred in women, often associated with pregnancy, the surface of the iliac bone joint was a triangular bone dense shadow, the width is narrow, the edge of the lateral edge is not clear, the sacroiliac joint surface without destruction of bone, joint space does not change.

Two, and can occur or cause ankylosing spondylitis and sacroiliac joint lesions:

1 lumbosacral joint strain chronic lumbosacral joint strain for persistent, diffuse back pain, with lumbosacral spine most important activities are not limited, no special X-ray changes. Acute injury of lumbosacral joint pain, because of the activity after, relieved by rest.

2 osteoarthritis often occurs in the elderly, characterized by degeneration of bone and cartilage, hypertrophy, synovial thickening, joint damage to the spine and knee joints are more common. Involving the spine often in chronic low back pain as the main symptom, AS and confused; but the incidence of ankylosis and muscle atrophy, no systemic symptoms, X-ray showed osteophyte formation and intervertebral space narrowing.

3.Forestier disease (ankylosing hyperostosis, senile vertebral joint thickness) also occurred in continuous osteophyte, AS like bamboo spine, but normal sacroiliac joints, facet joint infringement.

4 tuberculous spondylitis clinical symptoms such as spinal pain, tenderness, stiffness, muscle atrophy, kyphosis, fever, blood sedimentation rate and AS similar, but X-ray can be distinguished. Tuberculous spondylitis, spine edge blur, intervertebral space narrowing, anterior wedge deformation, no ligament calcification, sometimes exist near the spine tuberculosis abscesses shadow, sacroiliac joint unilateral involvement.

5 rheumatoid arthritis has now confirmed that AS is not a specific type of RA, there are many differences between the two can be identified. RA is more common in women, usually with a small joint infringement of foot, bilateral symmetry, the sacroiliac joint is generally not involved, such as violations of the spine, cervical invasion and no more, paraspinal ligament calcification, with rheumatoid subcutaneous nodules, serum RF HLA-B27 antigen positive constant, often negative.

6 enteropathic arthropathy of ulcerative colitis, Crohn disease or intestinal lipodystrophy (Whipple) can occur and spondylitis, enteropathic arthropathy joint and X-ray changes similar to AS but not easy to distinguish, therefore it is necessary to find the intestinal symptoms and signs for the differential. The colonic mucosa ulcer, ulcerative colitis, edema and bloody diarrhea; abdominal pain, nutritional disorders and fistula regional enteritis formation; Whipple disease steatorrhea, rapid weight loss, all contribute to the diagnosis of primary disease. Enteropathic arthropathy HLA-B27 positive rate is low, Crohn patients in the intestinal perfusate increased IgG, AS and IgG in patients with normal intestinal perfusate.

7.Reiter syndrome spondylitis and sacroiliitis syndrome and psoriatic arthritis disease can be two, but as generally occurs late, lighter, less paraspinal tissue calcification, syndesmophyte in non edge type (fiber ring outer fibrous tissue calcification), in two adjacent vertebral body is formed between the bamboo spine portion of bone bridge different from AS; sacroiliitis is typically unilateral or asymmetric double Jie damage, psoriatic arthritis, psoriasis skin damage can be identified.

8 tumor can also cause progressive pain, the need for a comprehensive examination, a clear diagnosis, misdiagnosis.

Three, and common spinal stiffness disease want to identify:

1 skeletal fluorosis in endemic areas, with fluorosis etc.. The X-ray showed dense vertebral Sakura, interspinous ligament ossification and less, does not infringe the joint.

2 young hunchback: X-ray vertebral wedging. No ligament calcification, no invasion of sacroiliac joint.

3: degenerative spinal disease occurred in elderly, X-ray showed bone hyperplasia and osteophyte formation of bone bridge, but no ligament calcification.

4 lumbar disc herniation: body and CT.

5 diffuse idiopathic skeletal hyperostosis syndrome: clinical manifestations, X-ray features similar to AS, but the sacroiliac joint lesions of ESR in normal B27 normal.

Treatment:

Principles of treatment: focus on early detection, early prevention of deformity, relieve pain, improve function, delay the progress of the disease, if necessary, for the correction of severe deformity of late surgery. Song teacher: both disease prevention, both disease prevention, both disease prevention.

Treatment of ankylosing spondylitis

The treatment of AS is still unknown because of its unknown etiology, and there is no effective therapy to prevent the progression of the disease. Fortunately, many patients with sacroiliac arthritis developed to grade II or III and no longer continue to develop [15], only a few people can progress to complete ankylosis.

The purpose of AS treatment is to control inflammation, reduce light industry to relieve symptoms, maintain normal posture and the best functional position, to prevent deformity. To achieve the above purpose, the key is early diagnosis and early treatment, take comprehensive measures for treatment, including the patient and family education, physical therapy, physical therapy, drug and surgical treatment.

1 educate patients

The treatment of this disease begins from the patient and family education, to understand the nature of the disease, disease duration, the roughly measures and future outcomes, to improve the resistance to the confidence and patience, to obtain their understanding and close cooperation.

Pay attention to the daily life in order to maintain normal posture and activity, such as walking, sitting and standing should be somewhat sleep without chest abdomen with a thin pillow or pillow, sleep hard board bed, supine or prone, prone sooner or later each day for half an hour; kidney do labor and physical activity; work notice posture, prevent campylorrhachia etc..

The optimistic mood, tension and anxiety, depression and fear; quit alcohol; time and rest, kidney medical physical exercise.

The understanding of drug effects and side effects, learn to adjust drug dose and treatment side effects of drugs, in order to cooperate with the treatment, to achieve better results.

2 physical therapy

Physical therapy is good for all kinds of chronic diseases, more important to AS. Can maintain the physiological curvature of the spine, and prevent deformity; keep my profile activity, maintain normal respiratory function; maintain bone density and strength, prevent osteoporosis and limb disuse muscle atrophy, can make the following specific movement.

A deep breath: every morning, work and rest time and at bedtime should be routinely for deep breathing exercise. Deep breathing can maintain the maximum activity of the chest, maintain good respiratory function.

The cervical vertebrae: head and neck movement can move forward and backward, Xiang Zuo, turning right, and the head of the rotary motion, in order to maintain the normal activity of cervical vertebra.

The lumbar motion: waist movement, daily flexion, lateral bending and rotation around the back, body, make the waist spine to maintain normal activity.

The body movement: for push ups, bracing, lower limb flexion and extension, chest movement and swimming. Swimming is not only conducive to the movement of limbs, and help to increase lung function and maintain spinal physiological curvature, is the most suitable body movement AS.

Patients can take appropriate exercise and exercise according to their individual circumstances, the beginning of the exercise may occur when the muscle joint pain or discomfort, but after a short period of exercise can be restored. If the new pain lasts more than 2H can not be restored, indicating excessive exercise, should be appropriate to reduce the amount of exercise or adjust the exercise.

3 physical therapy

Physical therapy generally available therapy, such as hot water bath, water bath or shower, mineral spring bath, in order to increase local blood circulation, relax muscles, relieve pain, conducive to joint activities, maintain normal function, prevent deformity.

4 drug therapy

The first-line drugs: non steroidal anti-inflammatory drugs; second-line drugs: sulfasalazine, methotrexate, azathioprine, tripterygium glycosides; three line drugs:

According to Gram Husby reported in 1992 and the drug treatment of AS can be divided into three types: the control of disease activity, influence the progression of drugs such as sulfasalazine, methotrexate, and now the most significant effect of the new "biologics" (such as the November 2007 listing of Issei spectrum). AS for disease activity, AS and newly discovered AS with peripheral arthritis. Nonsteroidal anti-inflammatory drugs are suitable for patients with severe pain and stiffness during the night. Analgesics and muscle relaxants, such as new analgesic, strong and smooth muscle, commonly used in the long-term use of non steroidal anti-inflammatory drugs ineffective.

Commonly used drugs are as follows:

The non steroidal anti-inflammatory drugs (NSAIDs) have digestive pain, relieve muscle spasm and stiff action. The phenylbutazone 0.1g orally 3 times a day, used the drug after the drug was found edema and hematuria and other side effects, therefore generally do not advocate the use of. The indomethacin (Xiao Yantong) 25 ~ 50mg 3 ~ 4 times daily oral administration, as the preferred drug currently used. The other is naproxen 0.25g, 2 times a day oral ibuprofen; 0.1g, orally 3 times a day; feldene 20mg oral once a day can be selected. The adult Oxaprozin[29] 600 ~ 1200mg, once daily oral, children's day per kg of body weight 10 ~ 20mg oral. Side effects were gastrointestinal reaction, kidney damage and bleeding time. Pregnant women and lactating women, generally preferred ibuprofen [22].

The sulfasalazine (sulfasalzine, SSZ) SSZ is 5- aminosalicylic acid (5-ASA) and sulfasalazine (SP) azo compound, starting in 80s for the treatment of AS by 0.25g, dose 3 times daily, weekly increase of 0.25g to 1.0g, 3 times daily maintenance. Efficacy increased with the director of medication time, the effective rate of medication was 71% for half a year, for a period of 1 years, with an average of 2 years of 90%. Improvement of the patient's symptoms, laboratory indexes and radiographic signs. The main side effects were gastrointestinal symptoms, skin rash, blood and liver function changes, but they are rare. During the course of medication should regularly check blood.

The methotrexate (methotrexate, MTX) reported efficacy was similar to SSZ, a small dose of shock therapy and 1 times a week, the first week of 0.5 ~ 5mg, a week after the increase of 2.5mg, to maintain the weekly 10 ~ 15mg. Oral and intravenous drugs similar efficacy. Side effects are gastrointestinal reactions, bone marrow suppression, stomatitis, alopecia, medication during regular check liver function and blood, avoid drinking.

The adrenal cortex hormone (CS) usually without adrenal hormone therapy for AS, but in acute iritis or peripheral arthritis treated with NSAIDs is invalid, available CS local injection or oral. Peters[30] were applied methylprednisolone a day 1000mg/ times and 375mg/ times of intravenous infusion in the treatment of other drugs in the treatment of acute phase of invalid activity of AS 17 and 59 cases, for 3 days, for a long time remission, curative effect of high dose group was slightly better, has obvious effect on improving spine pain control, but between the two groups no statistically significant.

The Tripterygium wilfordii (Trirptrygium wilfordii Hook, named T2) its first triptolide tincture in the treatment of AS, which has anti-inflammatory and analgesic effects, daily 12% ~ 30ml 15 tincture of Tripterygium wilfordii, 3 times after meal. Disease control (3 to June), to maintain the volume of daily or every other day 5 ~ 10ml. After using semi purified multi glycosides of Tripterygium wilfordii tablets (T2) 20mg, orally 3 times a day, the curative effect is good easy to take tincture. Side effects were gastrointestinal reaction, reduction of white blood cells, menstrual disorder and decreased sperm motility.

Such treatment of traditional Chinese medicine: Chinese medicine, kidney deficiency caused by appropriate treatment of warming kidney puzzle, oral medicine and external application of Chinese herbal medicine. Guilin rheumatism research center Fengshikang capsule Navy Fengshikang treatment of AS120 patients with indomethacin as control, has a good curative effect. Fengshikang by Yangjinhua, Strychnos, ginseng, epimedium and other Chinese herbs, each capsule containing 0.25g, the general 8 capsule daily, take 3 ~ June. The recent control condition 10.8%, markedly effective, improved by 44.2%, ineffective, the total effective rate was 95%, and the total effective rate was 5%. The most obvious effect of reducing pain, improve the efficiency of 96.7%; secondly, flexion, extension, lateral bending, by referring to test, chest test and 20m walking time determination, function improvement rate was 84.2%; in the improvement of clinical symptoms at the same time, ESR, C reactive protein and anemia have better weight also increased. In different degree, but after spinal deformity and X-ray treatment did not change significantly. Side effects include vertigo, dizziness, dry mouth. Side effects can be gradually disappeared with the prolongation of medication time and the adaptation to drugs.

It is not clear that the mechanism of the treatment of AS in the treatment of rheumatoid capsule, from the treatment of patients with serum IgA decreased significantly, it is speculated that the drug has an inhibitory effect on humoral immunity.

5 surgical treatment

Severe spinal kyphosis correction can be made to be in stable condition after surgery, lumbar vertebral osteotomy for correction of kyphosis deformity is feasible; play 7 neck chest 1 osteotomy can correct cervical severe deformity. Rowed[31] reported 21 cases of AS patients with cervical injury due to fall, half after conservative treatment with good prognosis; the other half for recurrent cervical vertebral compression displacement or worsen symptoms and nerve decompression and internal fixation, also received good results. Severe hip flexion deformity, total hip replacement or feasible hip arthroplasty, but the effect is not ideal, postoperative easy re ankylosis.

6 other treatments

After 80s, the use of pure natural blue shark, the blue shark cartilage powder to human cartilage regeneration, restoration of joint from the inside, thorough treatment of ankylosing spondylitis, has become a new attempt in the advanced countries. In Europe, shark cartilage extracts have been identified as drug, OAM (American alternative medical affairs bureau) the shark cartilage powder as the research and popularization of medical instead of a ring, while Japan is the blue shark cartilage powder as a substitute for the medical part used in clinical mandatory spondylitis, and sum up the best dose for the statistical data of 7.5g/ days, brings new hope to solve human ankylosing spondylitis.

In addition, the depth of X-ray and radium 224 radiotherapy for early AS patients to relieve symptoms, improve function have certain effect, remission rate was 80% ~ 96%, but can not stop the progress of the disease, and the risk of aplastic anemia, leukemia and transverse myelitis, has not used. Antimalarial drugs, preparation, penicillamine and azathioprine for AS is invalid, has not.

The lung disease is mainly symptomatic treatment, prevention and treatment of secondary infection, heart disease and severe aortic regurgitation, aortic valve surgery is feasible, the serious block can be artificial cardiac pacemaker.

Dietary conditioning of ankylosing spondylitis:

Due to ankylosing spondylitis is renal vein vessel two empty, because of the cold, available diet.

(1) hot food: antirheumatic Quhan evil, such as pepper, onion, pepper, aniseed, fennel, garlic sterilization, such as anti-virus, can prevent intestinal infection and virus infection. The winter clothes appropriate to wet ginger stomach for dispelling cold. Depending on the condition.

(2): soybeans, black beans, soy beans, rich in plant protein and trace elements, promotes muscle, bone, joint, tendon metabolism, help repair lesion effect. Can be treated with wet weight based Fengshigutong, not heavy on the body, adverse joints, tendons spasm or petrified, joint pain and the heavy rheumatism, good effect. The pain of rheumatism with black beans, black beans to join semi coke Yellow Wine, effective treatment of joint pain, gastritis with caution.

(3) fruit food: chestnuts have kidney gluten bone, the bones and tendons, meridians, rheumatism, weakness in loin is extremely useful. Ankylosing spondylitis is due to the bones, muscles and joints caused by the deficiency of the kidney lesions. Can produce food, cooked food, long service will be strong gluten, bone, kidney. The chestnut smashed deposited surface of the skin to cure gall bones; fresh chestnut leaves Daolan topical, but also can reduce the inflammation of the muscles and joints, skin.

Plum has Shengjinzhike, astringent antidiarrheal effect, beneficial to all patients with diarrhea, rheumatism, lumbago, joint pain can be plum rubbing the affected area can relieve pain and promoting blood circulation.

Ebony is plum dry or immature fruit, have good effect on rheumatism, Wumei acid dry sword Yin meridian, acid, to nourish the liver, alleviate the effect of joints, muscles pain, spasm.

Mulberry cherry is nourishing yin and blood, can cure rheumatism.

There is not enough clinical validation information for reference only.

Health care of ankylosing spondylitis

Ankylosing spondylitis patients how to self care?

Spinal deformity and ankylosis leading to the dysfunction of the patient bent, chest and neck flexion movement, will cause great pain and difficulty. In order to reduce or prevent the adverse consequences of these patients, in addition to a variety of examination and treatment by a doctor, should learn how to self care, such as careful long-term postural training (initial treatment should be the guidance of a physician), to obtain and maintain the best position of the spine, enhance the paraspinal muscle strength and increase lung capacity. In the rest of the first is to maintain proper posture, should sleep hard Banchuang, supine position, to avoid promoting the flexion deformity of the position. Once the lesions to the upper thoracic spine and cervical spine, should stop using a pillow. Physical activity that can cause persistent pain should be avoided: regular measurement of height; keeping height records is a good measure to prevent early spinal curvature that is difficult to detect. Chest wall lesions are common, stop smoking.

Nursing care of patients with ankylosing spondylitis

Ankylosing spondylitis treatment nursing aims to slow down the progression of the disease, reduce deformities.

Psychological care: this disease is insidious chronic progressive arthropathy. Education of patients with the disease, to understand the prevention and treatment methods, according to the requirements of treatment and exercise, master the method of self-care. This is especially important for reducing joint dysfunction, delaying the course of disease, and taking part in normal work and study.

The basic principles of activity: early appropriate activities can reduce the degree of spinal and joint deformities. The flexion and extension of the spine and hip joints were performed 2 times daily, and the amount of each activity was not limited to the joint symptoms of the second days. Before the activity should first massage the paravertebral muscles, can relieve pain, prevent muscle damage. At the same time, the treatment method of spa and ultrashort wave physics, can play a relieve muscle spasm, improve blood circulation and anti-inflammatory and analgesic effect. Nursing care of delaying mental deformity: maintaining upright posture and normal height. Sleep low pillow to reduce anterior cervical curvature. Hard bed. Usually pay attention to reduce the weight of the spine, avoid long-term bending activities. Obese patients should lose weight, thereby reducing the burden on the joint.

Prevention of infection: due to the involvement of the chest, prone to pulmonary infection, patients should be encouraged to expand chest movement and deep breathing every day. Life can not take care of the patient, for turning back, encourage cough. At the same time, pay attention to nutrition, enhance body resistance.

When the eyes are complicated with uveitis, the eyes should be cleaned regularly to keep the conjunctival sac clean.

Medication: during the application of sulfasalazine, should regularly check the blood, to reduce granulocyte, should take protective measures. At the same time regularly check the liver and kidney function, strengthen the protection of liver and kidney function.

Specific guidance

Life guidance

A healthy and active lifestyle is conducive to the rehabilitation of the disease. Do not give up easily, in order to reflect the value of their own, enhance self-confidence in life. In daily life we should beware of wind cold damp, often indoor ventilation, keep dry, work should also pay attention to avoid long cold wave and wind environment, the winter to keep warm. Avoid handling heavy loads and overwork. Pay attention to the law of life and health diet, quit smoking wine, eat high protein, high nutrition, easy to digest food, eat less spicy food, cold and hard, improve the patient's immune ability. Prevention of upper respiratory tract, gastrointestinal tract, urinary tract infection, so as not to aggravate the disease. Sit, stand, walk should develop good habits, work to often change positions, to maintain the same posture for a long time, such as the use of computer time should not last too long, every 1 ~ 2H to get up for a while, long-distance drivers from time to time to rest, get off the waist, do stretching exercises, especially at the desk workers should be more active. The rest should be used strictly to avoid the use of soft hard chair, recliner or inclined back chair, sleep posture should be straight, prevent scoliosis, and take appropriate hard mattress, low pillow supine, not adapt to the low pillow can decrease the height of the pillow. Should participate in some collective activities.

Exercise therapy

AS patients in order to avoid or reduce joint pain, often make the lesion completely or almost completely inactive for a long period of time, which leads to muscle atrophy and joint contracture, was not serious and it can completely recover the joint or limb disability or disability status in activity loss. In the subacute and chronic stage of the disease, it is necessary to adhere to the stretching movement of the limbs and spine, which can maintain or increase the range of joint motion, and relieve the pain caused by muscle spasm or tension. Therefore, in the treatment of anti-inflammatory drugs, joint disease can be controlled at the same time, should be cautious and progressive functional exercise, exercise therapy can help prevent deformity and reduce dysfunction. To overcome the fear of disease, often exercise on the spine, hip, shoulder, knee, exercise should be gradual, to exercise fatigue and pain in 2H recovery, with the improvement of the condition, gradually increase the amount of exercise, according to the degree of pain tolerance, gradually increase every day the number of activities, activity time and activity frequency. After exercise can maintain the physiological curvature of the spine, maintain thoracic activity and prevent limb disuse atrophy, bone density and bone strength, prevent osteoporosis, prevention of malformations, reduce disability. Exercise therapy plays an important role in the rehabilitation of ankylosing spondylitis.

Functional exercise of spine

Do cervical lumbar flexion, extension, lateral flexion and rotation around the direction of the exercise, to maintain spinal flexibility. After the exercise of spinal extension movement, such as lifting arm waist, legs, waist, chest and head prone extension, push ups, "the ship body movement and push up chest movement, also can guide the patient to stomach, 3 times / day, 30min / time, or appropriate to do push ups, bracing the use of their own weight, correction of deformity. Keep the chest and abdomen the habit of sitting or standing, exercise the back wall standing for 2 to 3 times per day, in order to maintain good posture, prevent spinal deformity.

Joint mobility training

Hip, shoulder and knee joints. The activity of the hip in flexion, shoulder to shoulder with shoulder and knee adduction, squat exercise and activities through hip joint completion. Insist for a long time do crawling exercise, 2 times / D, 15min / time, exercise limbs and joints function, also can be in bed or other fixtures do help the supine flexion of the hip, knee exercise, 3 / D, 10 ~ 30min / times, practice and external rotation of hip extensor muscle, to keep the hip function. The severe dysfunction of the hip, to wear socks, pants and stand up, squat, straddle, walking and other life skills training, not strenuous exercise, running is not suitable for patients with hip involvement, should do moderate exercise, such as walking, joint exercises etc.. The condition permitting patients to better encourage swimming, the heart, lungs and limbs, waist function training combined, at the same time because of the action of buoyancy, to maximize the limb movement, but also caused by the movement of the spine stretch, so swimming is a particularly worth promoting exercise, but should pay attention to the water temperature, so as to avoid joint cold and aggravate the inflammation caused by the recurrence of disease.

Chest movement and breathing exercises

Time to do chest exercise and breathing exercises, mainly to the regularity of respiratory training and on the back stretch gymnastics combined with deep breathing exercises 5 to 6 times per day, 20 / times, with the respiratory rhythm chest movement, such as arms out chest or arms raised chest when breathing, reduction exhale, to keep the thoracic activity and increase lung capacity, prevent thoracic stiffness, affect respiratory function. Take the seat or before the cervical, slightly buckling, in order to make cough more comfortable and effective, in this position, double cough inspiratory slightly after abdominal contraction to do high-profile, deep, to the exclusion of respiratory obstruction and maintain lung smooth.

Functional exercise

Ankylosing spondylitis patients often associated with spinal movement disorder in different degree or deformity, in addition to drug treatment, functional exercise to improve disease resistance, strengthen respiratory function, maintain and develop the physical activity of each joint function, prevention and correction of joint deformity and dysfunction, and has a good effect of "functional exercise should pay attention to self training. Persevere.

Flying swallow type

Prone on the plank bed, his hands placed on top of the hip, chest and back and lower limbs straight leg extension

Four point formula

Supine double lower limbs is buckling arranged on the bed, and then use the hands, chest, head lift up from the bed, the body arched should exercise daily, at the beginning should not be too many times, and then gradually increase, not less than 3 times a day, every time 30~50

Friction Shenshu

Hands on the waist massage, the key stimulation of the second lumbar spinous process open by 1.5 inches Shenshu, duration 3min; hands on the waist massage, 3min key to stimulate the second lumbar spinous process of Mingmen and fourth lumbar spinous process Yaoyangguan, depression; it has good effect on kidney health care.

Exercise waist strengthening method

Sitting in bed, or cross legged or hanging legs, rub your hands and pressed in, repeatedly rub the 3min feet apart with attention posture,, shoulder width, bend down, let the fingertips of both hands palm or try to, with a bow, even 21 times stood at attention, hands akimbo twisting the hips, waist, slowly rotating, first clockwise 21 times, then counter clockwise 21 times; the temperature Shenqiang waist effect, can loosen the waist muscles, help the treatment of ankylosing spondylitis with stiff waist.

More than four, can take in exercise, gradually increase, skilled after four even do, keep practicing, can receive Zhuangyao fitness effect, of great help for the rehabilitation of patients with ankylosing spondylitis.

 

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