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Beijing 2010-03-10 (MARKET WIRE) - Ankylosing spondylitis is the sacroiliac joints and spine chronic progressive inflammation, violations of limbs and other organs, mostly gradual onset of the hidden, only 5% of the acute attack . Often accompanied by acute onset of high fever or fever, waist, hip and other affected joints, severe pain, often due to pain in bed, can not turn over activities, and some patients in 2-3 months iliac ankylosis occurs, resulting in permanent disability, lumbar , hip pain, mostly associated with lower back stiffness flu. Spinal ligaments on both sides of late have been due to ossification, or severe spinal deformity surgery bypass hyperplasia, humpback and disability, loss of self-care ability, worse, there will be life-threatening kidney disease caused lga.
Longevity Health and Bone Disease Hospital in Beijing more than 30 MD, professor of the joint efforts of experts, according to the pathogenesis of ankylosing spondylitis successfully developed for ankylosing spondylitis can completely cure
Basic Introduction to ankylosing spondylitis disease, also known as Marie-strÃ¼mpell, Von Bechterew disease, rheumatoid spondylitis, deformity spondylitis, rheumatoid central type, etc., are all known as AS. AS the characteristics of the waist, neck, spine and sacroiliac joints and ligaments joint inflammation and ossification, hip joint is often involved in other inflammatio
1. Joint disease patients in the relevant section of the performance of AS lesions, and most of the first violation of the sacroiliac joint, after the upstream development to the cervical spine. Small number of patients first by cervical spinal segments at the same time or a few violations, but also may invade the peripheral joints, early lesions are inflammatory joint pain, accompanied by muscle spasms around the joint, a rigid sense, was early morning; pain at night can also be expressed as by the activities or services analgesic relief. With the progression of the disease, joint pain relief, and the spinal segment and joint activity limitation and deformity, late into the spine and lower limbs strong bow, forward flexion. â‘´ sacroiliitis: the first about 90% AS patients showed sacroiliitis. After ascending to the development of cervical spine, showing recurrent low back pain, lumbosacral rigid sense, intermittent or alternating low back pain on both sides and both sides of the hip pain, may radiate to the thigh, no positive signs, straight leg test was negative. However, direct compression or stretching sacroiliac joint can cause pain, so I do not like sciatica. Some patients had no symptoms of sacroiliitis, only X-ray examination found abnormal. About 3% AS the first cervical involvement, later down the development to the lumbosacral region, 7% AS with a spine for a few paragraphs at the same time involved. â‘µ lumbar spine: lumbar spine involvement, the majority of the performance before the lower back and waist activity limitation. Lumbar flexion, buckle Yan, lateral bending and rotation can be limited. Physical examination can be found in lumbar spinous process tenderness, lumbar muscle spasm side; late may have psoas muscle atrophy. â‘¶ thoracic lesions: thoracic involvement, manifested as back pain, chest pain, chest and side, the most common for the humpback deformity. Vertebral joints, such as ribs, sternum handle body joint, sternoclavicular joint and the cartilage between the joints 19,20 involved, then the ribbon beam was chest pain, chest expansion is limited, chest pain when coughing or sneezing, breathing heavier. In severe cases, call the state maintain thoracic, thoracic distension by 50% or more than normal, so can only rely on abdominal breathing aids. Reduced capacity of the abdominal cavity, causing heart and lung function and digestive dysfunction. â‘· cervical lesions: a small number of patients first manifested as cervical spondylosis, cervical pain first, along the arm to the head and neck radiation. When the neck muscles begin to spasm, after shrinking, the lesion can progress to cervical thoracic kyphosis developed. Activities significantly limited the head, often fixed in flexion, not on belief, scoliosis, or rotation. In severe cases, can only see their toes in front of a small piece of ground, not the rise of head-up. â‘¸ peripheral joint disease: about half of AS patients have short-term acute peripheral arthritis, around 25% of permanent joint damage. More commonly occurs in large joints, lower limbs than upper limbs. Some statistics, around the joint involvement rate of 40% of hip and shoulder, knee, 15,5, 10% ankle, foot and wrist of the 5%, rarely involving the hands. Reported 80 cases of AS, hip joint involvement was symptomatic (100%); activity limitation (64%), flexion contracture (38%), muscle atrophy (25%), the occurrence of ankylosis (37%), the AS patients the main causes of disability; hip after the onset of symptoms accounted for 94% within 5 years, suggesting that AS the first 5 years without disease involving the hip joint, the subsequent involvement is unlikely. Shoulder joint involvement, joint pain, activity limitation is more obvious, hair, raising his hand and other activities are limited. Violations of the knee joint was compensated when the bend is to make walking, sitting and other daily life more difficult. Very few violations of the elbow, wrist and foot joints, violations of those sections in the part of the more rare. In addition, the pubic symphysis can be involved, on the edge of the pelvis, ischial tuberosity, greater trochanter of femur and heel bone inflammation may have symptoms of early manifestation of the local soft tissue swelling, pain, late of the thick bone. Arthritis can occur in the general surrounding spondylitis before or after the local symptoms of rheumatoid arthritis not easy to distinguish, but the remaining deformity less.
2. Articular manifestations AS, articular lesions, mostly in spondylitis, the occasional musculoskeletal symptoms for several months or years before the occurrence of extra-articular symptoms. AS may invade the body multiple systems, and associated with many diseases. â‘´ Heart Disease: The aortic valve disease is more common, according to an autopsy made about 25% AS patients with aortic root disease, cardiac involvement may be clinically asymptomatic, may have significant performance. Different degrees of clinical aortic insufficiency by approximately 1%; about 8% of cardiac conduction block, aortic valve insufficiency with simultaneously occur in isolation, because of serious and complete atrioventricular block occurred Ah Si syndrome. When lesions involving the coronary angina can occur when the mouth before. A small number of fibroids occur aorta, pericarditis and myocarditis. The AS patients with heart disease, generally older, longer history, spondylitis and peripheral joint disease more obvious symptoms. Gould24 and other tests, cardiac function in 21 patients with AS patients and found that cardiac function in AS patients was significantly lower than the control group. â‘µ eye disease: long-term with the housing, 25% AS patients have conjunctivitis, iritis, uveitis or uveitis, which even can be spontaneous hyphema. Iritis easy to relapse, the higher the incidence of the disease longer, but independent of the severity of spondylitis, a peripheral joint disease were common, a few may occur before spondylitis. Eye diseases often self-limiting, and sometimes need to use corticosteroids, some without proper treatment can cause glaucoma or blindness. â‘¶ ear disease: Gamilleri other patients reported 42 cases of AS 1 / 2 (29%), chronic otitis media, 4 times the normal controls, and, in the event of AS patients with chronic otitis media, significantly more than its non-articular AS patients with chronic otitis media. â‘· lung lesions: a few of the late AS patients can be complicated by the irregular-shaped spots on the lung fibrosis, manifested as cough, asthma, or hemoptysis, and may be associated with recurrent episodes of pneumonia or pleurisy. X-ray examination showed diffuse bilateral upper lobe fibrosis, cyst formation and may have physical damage, similar to tuberculosis, need to be identified. â‘¸ nervous system lesions: the spine, and osteoporosis, stiffness, easy to make and the occurrence of cervical spine fracture dislocation, caused by spinal cord compression; If the occurrence of discitis caused severe pain; AS latter may invade the tail, the occurrence of cauda equina syndrome, which led to radicular leg or hip pain; infection loss of sacral nerve distribution area, reduced Achilles tendon reflex and the bladder and rectum and other movement disorders. â‘¹ amyloidosis: a rare complication for the AS. AS has been reported in 35 cases, routine rectal biopsy in 3 patients amyloid deposition, are not specific clinical manifestations. â‘º kidney and prostate lesions: comparison with RA, AS rare renal dysfunction, though there were reports IgAD nephropathy. AS complicated with chronic prostatitis higher than the control group, and its significance is unknown. Initial symptoms of ankylosing spondylitis ankylosing spondylitis is the more common diseases, lingering disease, and could easily lead to disability, therefore, should strive for early diagnosis and treatment. Of 16-25 year-old youth, especially young men, where there is the following symptoms, you should be especially vigilant against possible without ankylosing spondylitis. (1) low back pain, stiff back more than 3 months, can not be relieved by rest. (2) unilateral or bilateral sciatica, no history of trauma, sprain history. (3) recurrent knee or ankle swelling, joint effusion, no significant history of trauma, infection history. (4) calcaneal tubercle recurrent swelling and pain or heel pain. (5) recurrent iritis. (6) without cough and other respiratory symptoms, no history of trauma belted chest pain and a sense of thoracic activity limitation. (7), spinal pain, stiffness, flu, or even activities dysfunction, no history of trauma, sprain history. (8), bilateral hip, and hip pain, no history of trauma and strain history. (9) sudden large joints of the spine and limb pain, swelling, mobility impaired. Comparison of the general onset occult ankylosing arthritis, without any clinical symptoms of early stage, some patients may show mild early symptoms, such as fatigue, weight loss, chronic or intermittent low fever, loss of appetite, mild anemia. As less severe, most patients can not be early detection, resulting in delays in disease, lose the best treatment opportunity. Cause of the pathological cause of AS is not yet fully elucidated, most of the view that genetic, infectious, immune and other relevant environmental factors. 1, genetic genetic factors in the pathogenesis of AS plays an important role. According to epidemiological investigation, AS HLA-B27 positive patients was 90% ~ 96%
The general population with ankylosing spondylitis HLA-B27 positive rate was only 4% ~ 9%; HLA-B27 positive AS incidence rate of about 10% to 20%, while the general population incidence is 1 â€° ~ 2 â€°, a difference of about 100 times. It has been reported, AS AS a group of relatives with the risk of higher than the average person 20 to 40 times the prevalence of domestic investigations AS degree relatives was 24.2%, 120 times higher than the normal population. HLA-B27 negative healthy, than the relatives of the probability of occurrence of AS HLA-B27 positive relatives of AS patients is low. All of these shows HLA-B27 in the pathogenesis of AS is an important factor. It should be noted, however, on the one hand is not HLA-B27 positive spondyloarthropathy all happened the other hand, about 5% to 20% of patients spondyloarthropathy HLA-B27 testing was negative, suggesting that in addition to genetic factors, there Other factors affect the incidence of AS, so the expression of HLA-B27 in AS is an important genetic factor, but not the only factor affecting the disease. There are several hypothesis can explain the HLA-B27 and spondyloarthropathy joints: â‘ , HLA-B27 as an infectious agent receptor site; â‘¡, HLA-B27 immune response genes is land reform, the environment stimulating factors in the decision susceptibility; â‘¢, HLA-B27 cross-reaction with foreign antigens to induce tolerance to foreign antigens; â‘£, HLA-B27 increased neutrophil activity 15. Membership Assistant monoclonal antibodies, cytotoxic lymphocytes, immune electrophoresis and restriction fragment length polymorphic method (restriction fragment length polymorphism), has already identified about seven kinds of HLA-B27 subtypes 1 or 8. HLA-B27 positive healthy subjects and patients with spine disease may be genetic differences such as HLA-B27 individuals all have a constant HLA-B27M1 epitopes, epitopes for this antibody cross-reactivity with HLA-B27. There are many molecular HLA-B27 M2 epitope. HLA-B27M2 negative elements seem to HLA-B27 than other subtypes have stronger links with the AS, in particular, Asians, and HLA-B27M2 positive subtypes may increase susceptibility to Reiter syndrome. Has been demonstrated, HLA-B27M1 two epitopes with the M2 and joints caused by factors Shao Kelei white fungus, and that Shigella bacteria can cross reaction Mickelson. Reactions seem more performance for the low AS, are the development of response enhancement of reactive arthritis or Reiter syndrome. 2, infection incidence in recent years, research suggests that AS may be associated with infection. Ebrimger AS patients found in the stool such as Klebsiella pneumoniae detection rate was 79%, while the control group "30%; AS activity period in the intestinal Klebsiella pneumoniae carrying rate and serum IgA antibodies against the bacteria titer than the control group and correlated with disease activity. Klebsiella spp was improved with the HLA-B27 antigen may be cross-reactions during or residual common structure, such as HLA-B27 (host antigen residues 72-77) and lung as Klebsiella (residues 188-193) The oxygen acid sequence homology with other gram-negative bacteria have antibodies pregnant with this combination of synthetic peptide, HLA-B27 positive AS patients, 29%, while the control group, only 5%. Mason and other statistics, 83% male AS patients complicated with prostatitis, and some of ulcerative colitis found that about 6% of combined AS; other reports confirmed, AS in patients with Ulcerative Colitis and limitations than the general population the incidence of enteritis much higher, suggesting that AS may be associated with infection. Romonus think that pelvic infection may spread through lymphatic channels to the sacroiliac joint, and then the spinal venous plexus spread to the spine, but the lesion could not be found in the original infection (bacterial or viral). 3, autoimmunity was found in 60% AS patients with elevated serum complement, most of the patients had IgA-type related wet factor, C4 and IgA serum levels were significantly increased in the serum circulating immune complex (CIC), but the nature of unidentified antigen. Immune mechanisms involved in these phenomena suggest the incidence of this disease. 4, the incidence of chronic enteritis is one of the reasons. Beijing Hospital, the experts remind us of Rheumatology, attention to chronic, recurrent disease. "It's like chronic enteritis, recurrent urinary tract infections, psoriasis, etc., in the eyes of some patients who are not easily hurt the lives of disease, but that would cause these diseases are occurring human inflammatory changes in the sacroiliac joint, resulting in the occurrence of ankylosing spondylitis. When the body joint pain, do not rush to treatment, such as anti-inflammatory drugs or analgesics can temporarily ease the pain though, but the treatment of certain diseases would not achieve a fundamental role, and sometimes to conceal the nature of the illness and to follow-up treatment difficult. 5, other trauma, endocrine, metabolic disorders and allergic reactions and other risk factors were also suspected. In short, the cause of this disease is currently unknown, yet a theory can satisfactorily explain the AS All performance is likely on the basis of genetic factors to environmental factors (including infection) and other aspects of the disease. ankylosing spondylitis causes of genetic disease is not conclusive, but 90% of ankylosing spondylitis The patient was a genetic factor. So ankylosing spondylitis is a closely related genetic diseases. research shows that ankylosing spondylitis and HLA-B27 and for the close relationship, and the incidence of ankylosing spondylitis with HLA-B27 directly related to the ankylosing spondylitis and HLA-related
The strongest, HLA-B27 positive does not occur in 80% of ankylosing spondylitis, and ankylosing spondylitis in 10% of patients with HLA-B27 negative. It does not happen HLA-B27 positive ankylosing spondylitis, HLA-B27 does not occur is not necessarily negative ankylosing spondylitis, can not believe that is the HLA-B27 positive ankylosing spondylitis. Can confirm that the family of ankylosing spondylitis, only the individual who will be among patients with ankylosing spondylitis, and most people life is not sick. Ankylosing spondylitis in hereditary long been the medical world, Kell-gren 1964, ankylosing spondylitis in the family census found that families of patients, the average disease prevalence rate of 4%, while the average population prevalence rate was only 0.1% difference between the two actually 40 times the incidence, indicating that family history does with the pathogenesis of ankylosing spondylitis. Brewerton, etc. in 1973 patients with ankylosing spondylitis histological type to achieve significant evidence of genetic factors, they are typical of patients in 75 cases and found 72 cases of HLA-B27 positive, 96%, in their first-degree relatives of 60 31 (51%) in the HLA-B27 positive, and in 75 control group, HLA-B27, only 3 were positive, 4%, indicating that HLA-B27 positive patients with ankylosing spondylitis disease are closely related. The HLA system and the blood group antigens, is genetically determined, so the genetic pathogenesis of ankylosing spondylitis is one important reason. In the HLA-B27-positive population, incidence of the disease about 20%, the remaining 80% is not this disease, indicating that in addition to genetic factors still exist in other pathogenic factors. Clinical study found that the incidence of ankylosing spondylitis and is closely related to the body's own immune disorders, ankylosing spondylitis, the patient was found in immunology, immunoglobulin, Cf-reactive protein, C, C have different levels of change, which that ankylosing spondylitis and their immune function, and also ankylosing spondylitis, systemic inflammation, ankylosing spondylitis and various body organs is closely related to ankylosing spondylitis and medicine are related. Finally, ankylosing spondylitis involving the whole body bone joints, ankylosing spondylitis, a relationship with the orthopedics. Therefore, ankylosing spondylitis, a multi-disciplinary disease, is a kind of immune genetic medical disease of bone in the treatment of autoimmune regulator from the start, combined with anti-inflammatory analgesic, absorption of sequestrum, early control of the disease and reduce the tonic spondylitis disability. Pathological changes characteristic pathological changes in AS is the ligament attached to the terminal disease (enthesopathy), the primary site of disease ligament and joint capsule is attached to the Ministry, namely, inflammation of the tendon end, resulting in syndesmophytes (syndesmophyte) formation, vertebral square change, vertebrae end plate destruction, Achilles tendinitis, and other changes. Because the tendon end of growing season is metabolically active, at least in part, is a young manager to place AS region, as to why occur in the tendon end, is still not clear. Lesions initially evolved from the sacroiliac joint to the bone rib vertebral arthritis and sudden arthritis in other joints of the spine from top to bottom have been involved. AS change around synovial joints characterized by synovial granuloma fire. Small blood vessels surrounded by synovial macrophages, lymphocytes and plasma cell infiltration, synovial thickening, after several months or years after the formation of granulation tissue in synovial involvement. Articular soft tissue calcification and ossification obvious, ligament attachment syndesmophytes can be formed, to keep the vertical extension, direct straight into two adjacent vertebral bone bridge, paravertebral ligament calcification with anterior ligament, so that the spine was "bamboo-like." With the progress of disease, joint and joints more significant near the ossification tendency. Early ligament, annulus fibrosus, intervertebral disc, periosteum and trabecular bone to blood vessels and fibrous tissue invasion, was replaced by granulation tissue, leading to the vicinity of the joint destruction and bone sclerosis; After repair, the eventual joint fibrous and bony ankylosis ankylosis, vertebral osteoporosis, muscle atrophy, and thoracic kyphosis. Vertebral end plate and intervertebral disc cartilage inflammation of the edge, and ultimately lead to partial ossification. Heart Disease is characterized by violations of the aortic valve, the aorta before the film thickness, due to fibrosis and shortening, but not fusion, active valve ring to expand, sometimes up to aortic fibrosis beneath the base. Occasionally pericardial and myocardial fibrosis, histology shows epicardial blood vessels and chronic inflammatory cell infiltration endarteritis; aortic wall elastic tissue destruction of the middle, on behalf of the fibrous tissue, fibrotic tissue, such as violations of atrioventricular bundle, then induced atrioventricular block. Lung disease is characterized by patchy inflammation of lung tissue with something round cell and fibroblast infiltration, and to develop to the alveoli with hyaline fibrosis between. Check the related normal or elevated white blood cell count, lymphocyte percentage a little, a small number of patients have mild anemia (low-pigmented cells is), erythrocyte sedimentation rate may be faster, but the correlation with disease activity is not, and C-reactive protein were more meaningful. Reduction of serum albumin, Î±1 and Î³-globulin increases, serum immunoglobulin IgG, IgA and IgM increased, serum complement C3 and C4 often increased. Alkaline phosphatase increased about 50% of patients, serum creatine kinase often increased. Serum rheumatoid factor negative. Although more than 90% to 95% of the LHA-B27-positive AS patients, but generally do not rely on LHA-B27 to diagnose AS, LHA-B27 is not for routine examination. The diagnosis relies on clinical manifestations and radiological evidence. X-ray examination in the diagnosis of AS is very important, about 98% to 100% of the cases the early stage of the sacroiliac joint X-ray changes, is an important basis for the diagnosis of this disease. X ray findings of early sacroiliitis, usually in the sacroiliac joint disease in the lower part onwards, bilateral. Start multi-lateral iliac violations, violations of the sacrum and then the side. Visible spots or block-shaped bone side of the obvious. Then may invade the joint, serrated edges, subchondral bone sclerosis, bone hyperplasia, joint space narrowing. Finally, disappearance of joint space, bony ankylosis occurred. Sacroiliitis X line-to-use button for about diagnostic criteria for Category 5: 0 for normal sacroiliac joints, â… level as doubtful on both sides of the sacroiliac joint inflammation; â…¡ level as sacroiliac joint edge blur, a slight hardening and small erosion lesions, slightly narrowed articular; â…¢ grade hardened on both sides of the sacroiliac joints, joint edge of the blurred, there is erosion of articular lesions with disappearance; â…£ level is fully integrated or joint ankylosis with or without residual sclerosis. X-ray findings of spinal diseases, as the universality of early osteoporosis, vertebral facet joints and vertebral trabecular bone fuzzy (DBM), Department of vertebrae with the intervertebral disc under the top corner and the destructive erosion of the vertebral body was " square vertebrae, "the normal lumbar curvature of the disappearance of the former straight, can cause one or more vertebral compression fractures. Lesion to the thoracic and cervical facet joint, the gap between the occurrence of disc calcification, fibrous ring and the former longitudinal ligament calcification, ossification, ligaments osteophyte formation, so that together with the adjacent vertebral body, interbody bone bridge formation, was the most characteristic "bamboo-like spine." Primary and secondary to inflammatory bowel disease AS, Reiter syndrome, psoriatic arthritis, and concomitant spondylitis, X-ray findings are similar, but the latter a non-symmetric stiffness. In the ligaments, tendons, synovial bone for the attachment and periostitis may occur, most found in the calcaneus, ischial tuberosity, iliac crest and so on. Can also occur around the joints similar to other X-ray changes. Early X ray examination negative, possible radiation radionuclide scanning, computed tomography and magnetic resonance imaging to detect early sacroiliac joint symmetry. But it must be pointed out that the former position after the general simple sufficient X-ray diagnosis of the disease. AS diagnostic criteria are still used in New York, 1966, standards, or New York in 1984, revised criteria, conditions are as follows: New York standards (1966) criteria: X film confirmed the bilateral or unilateral sacroiliitis (according to the above 0 - â…£ grade classification), and add the following clinical manifestations were 1 or 2, that is, â‘ lumbar flexion, lateral flexion and extension of the three directions are limited; â‘¡ history or current symptoms of low back pain ; â‘¢ thoracic extension range is less than 2.5cm. According to the above points, diagnosis requires a positive AS: X-ray films confirmed grade â…¢ - â…£ bilateral sacroiliitis, and additional clinical manifestations of the above at least one in; or X ray confirmed grade â…¢ - â…£ unilateral sacroiliitis or bilateral sacroiliitis grade â…¡, respectively, the clinical presentation of additional 1 or 2. (1984) criteria: â‘ the course of low back pain for at least 3 months, pain with activities to improve, but the rest does not relieve; â‘¡ before and after lumbar and lateral bending in the direction of limited mobility; â‘¢ thoracic extension range is less than the same age and sex the normal value; â‘£ bilateral sacroiliitis â…¡ - â…£ level, or unilateral sacroiliitis grade â…¢ - â…£. If the patient and are attached with â‘£ â‘ - â‘¢ any one article can be diagnosed as AS. Can be seen from the above two kinds of standards, they all lack sensitivity for early diagnosis of patients. For this reason, some temporarily does not meet the diagnostic criteria for AS patients, as its performance in line with European spondyloarthropathy study group preliminary spondyloarthropathies developed diagnostic criteria, can also be included in such diagnosis and treatment, so as not to delay treatment. The diagnostic criteria were: inflammatory spinal pain or non-symmetry of the lower limb joints based synovitis, and add any of the following items, namely: â‘ positive family history; â‘¡ psoriasis; â‘¢ inflammatory bowel disease ; â‘£ arthritis within 1 month before urethritis, cervicitis or acute diarrhea; â‘¤ alternating bilateral hip pain; â‘¥ tendon terminal disease; â‘¦ sacroiliitis. Preventive care is particularly ankylosing spondylitis added: HL-B27 after 2009 has been included in seronegative spondyloarthropathies (including ankylosing spondylitis) diagnostic criteria. National Seminar on ankylosing spondylitis AS diagnostic criteria established by the Chinese organizers of Internal Medicine, Shantou University Medical College of Rheumatology Research Center hosted the "National Seminar on ankylosing spondylitis" in September 2001 21 ~ 22 was held in Shantou. AS diagnostic criteria established at the meeting: 1. Clinical Performance (1) lumbar and (or) the spine, groin, buttocks or lower extremity pain discomfort; or widowed asymmetric peripheral arthritis, particularly in the lower extremities few arthritis. Symptoms persist for â‰¥ 6 weeks. (2) night pain or morning stiffness â‰¥ 015 h. (3) post-remission. (4) heel pain or other tendon attachment points for disease. (5) iridocyclitis disease or past history now. (6) AS positive family history or HLA2B27. (7) non-steroidal anti-inflammatory drugs (NSAIDs) can rapidly relieve symptoms. 2. Imaging or pathology (1) bilateral X-class â‰¥ â…¢ SIJ inflammation. (2) bilateral CT SIJ â‰¥ â…¡ level. (3) CT SIJ inflammation less than grade â…¡, possible MRI. If the performance of cartilage destruction, joint swelling and the side (or) extensive fat deposition, especially in dynamic enhanced MRI joint or joints next to the enhanced strength of> 20%, and increase the slope of> 10% / min were. (4), pathological examination showed that the sacroiliac joint inflammation. 3. Diagnostic and clinical criteria in item 1 of 3 in the other, as well as imaging, pathology any standard, could diagnose AS. Complications 1. Cardiomyopathy: the aortic valve disease is more common, according to an autopsy made about 25% AS patients with aortic root disease, cardiac involvement may be clinically asymptomatic, may have significant performance. 2. Eye disease: long-term with the housing, 25% AS patients have conjunctivitis, iritis, uveitis or uveitis, which even can be spontaneous hyphema. Iritis easy to relapse, the higher the incidence of the disease longer, but independent of the severity of spondylitis, a peripheral joint disease were common, a few may occur before spondylitis. Eye diseases often self-limiting, and sometimes need to use corticosteroids, some without proper treatment can cause glaucoma or blindness. 3. Ear disease: Gamilleri other patients reported 42 cases of AS 1 / 2 (29%), chronic otitis media, 4 times the normal controls, and, in the event of AS patients with chronic otitis media, significantly more than their extra-articular AS patients without chronic otitis media. 4. Lung lesions: a few of the late AS patients can be complicated by the irregular-shaped spots on the lung fibrosis, manifested as cough, asthma, or hemoptysis, and may be associated with recurrent episodes of pneumonia or pleurisy. X-ray examination showed diffuse bilateral upper lobe fibrosis, cyst formation and may have physical damage, similar to tuberculosis, need to be identified. 5. Nervous system lesions: the spine, and osteoporosis, stiffness, easy to make and the occurrence of cervical spine fracture dislocation, caused by spinal cord compression; If the occurrence of discitis caused severe pain; AS latter may invade the tail, the occurrence of cauda equina syndrome, and lead to lower limb or buttock pain, nerve root; infection loss of sacral nerve distribution area, reduced Achilles tendon reflex and the bladder and rectum and other movement disorders. 6. Amyloidosis: a rare for the concurrent AS level. AS has been reported in 35 cases, routine rectal biopsy in 3 patients amyloid deposition, are not specific clinical manifestations. 7. Kidney and prostate lesions: comparison with RA, AS rare renal dysfunction, though there were reports IgAD nephropathy. AS complicated with chronic prostatitis higher than the control group, and its significance is unknown. Treatment 1. Control the treatment of AS because of unknown etiology, and lack of means to rule, nor stop the progress of the disease and effective therapy. Fortunately, the development of many patients to sacroiliitis grade â…¡ or â…¢ and no longer continue to develop after only a few people can progress to complete ankylosis. AS the purpose of treatment is to control inflammation, reduce or relieve symptoms, maintain normal function of position and the best position to prevent deformities. To achieve the above purpose, the key is early diagnosis and early treatment, to take comprehensive measures for treatment, including patient and family education, physical therapy, physical therapy, medication and surgical treatment. â‘´ disease treatment from the patient and family education to proceed, to understand the nature of the disease, general course and possible outcome measures and the future to enhance the resistance of the confidence and patience to obtain their understanding and close coordination. â‘µ attention to daily life to maintain normal posture and movement such as walking, sitting and standing should Yan chest or abdomen with a pillow while sleeping without a thin pillow, sleep hardwood Banchuang, supine or prone position, face down every morning and evening half an hour; participation can and the labor and sports activities; work, attention to posture, to prevent spinal curvature deformity. â‘¶ optimistic mood, relieve stress, anxiety, depression and fears; quit alcohol; time and rest to participate in medical exercise. â‘· understanding drug action and side effects, learn to adjust drug dose and treatment side effects, with the benefit of treatment, to achieve better results. 2. Physical therapy physical therapy are beneficial for various chronic diseases, on the AS is more important. Spine curvature can be maintained to prevent deformity; to maintain thoracic activity, maintain normal respiratory function; maintain bone density and strength, prevent osteoporosis and limb disuse muscle atrophy, specifically to make the following campaign. â‘´ deep breath: every morning, work and rest time for deep breathing exercise before bedtime should be routine. Take a deep breath to maintain the largest activity of thoracic and maintain good respiratory function. â‘µ cervical spine motion: head and neck can be used for forward, backward, left, right turn, and head rotation in order to maintain the normal activity of the cervical spine. â‘¶ lumbar motion: Every day for the waist motion, flexion, back, left and right lateral bending and rotating body, the lumbar spine to maintain normal activity. â‘· limb movements: can be used for push-ups, bracing, leg flexion, extension, chest movement and swimming. Swimming is conducive to limb movement, but also help to increase lung function and to maintain the physiological curvature of the spine is the most appropriate body movement AS. The personal circumstances of the patient can take appropriate mode of motion and exercise, begin to exercise muscle and joint pain may occur or not, but after a short rest after exercise can be restored. 2h as pain lasting more than a new can not be restored, this indicates that excessive exercise, adjustments should be appropriate to reduce the amount of exercise or movement. 3. Hyperthermia physical therapy treatments are generally available, such as hot water bath, water bath or shower, hot spa bath, so as to increase local blood circulation, relax muscles, relieve pain, is conducive to joint activities to maintain normal function and prevent deformities. 4. Drug treatment, according to Gram and Husby 1992 28 reports of drug treatment of AS can be divided into three categories: â‘ control of disease activity, disease progression influence of drugs such as sulfasalazine, methotrexate, and the current was also a significant effect "biological agent" (such as the November 2007 listing of the benefits of competition spectrum - tumor necrosis factor-antibody fusion protein). For disease activity in AS, AS with peripheral arthritis and the newly discovered AS. â‘¡ non-steroidal anti-inflammatory drugs for severe pain and stiffness in patients at night, can be taken at bedtime. â‘¢ analgesics, such as analgesics and muscle relaxants new, strong muscle pain smoothed pyridine, commonly used in long-term use of nonsteroidal anti-inflammatory drugs ineffective. Commonly used clinical drugs were as follows: (1) non-steroidal anti-inflammatory drugs (NSAIDs) have digestive pain, reduce stiffness and muscle spasms effects. â‘ Phenylbutazone 0.1g orally 3 times a day, it used the drug, the drug was found edema, hematuria, and other side effects, it generally does not advocate the use of the present. â‘¡ indomethacin (indomethacin) 25 ~ 50mg 3 to 4 times a day orally, for the commonly used drug of choice. â‘¢ Others are still naproxen 0.25g, 2 times a day orally; ibuprofen 0.1g, 3 times a day orally; inflammatory pain Xikang 20mg once daily oral administration, etc. can be selected. â‘£ Oxaprozin29 Adult 600 ~ 1200mg, once daily, oral, pediatric day 10 ~ 20mg per kg body weight orally. Side effects were gastrointestinal reactions, kidney damage, the Director of bleeding time. Pregnant and lactating women are generally preferred ibuprofen 22. (2), sulfasalazine (sulfasalzine, SSZ) SSZ is 5 - amino salicylic acid (5-ASA) and SASP (SP) of the azo compounds, 80, began for the treatment of AS, the dose of 0.25g per 3 times a day starting a week to increase 0.25g, 1.0g 3 times a day to maintain. Director of efficacy with time, increased medication, medication effective six months was 71%, 85% 1 year and 2 years was 90%. Patient symptoms, laboratory parameters and radiographic signs of improvement or stability. The main side effects were gastrointestinal symptoms, rash, and changes in blood picture and liver function, but are rare. Medication should be regularly checked during the blood. (3) MTX (methotrexate, MTX) and SSZ reported similar efficacy of low-dose pulse therapy with weekly 1 the first week of 0.5 ~ 5mg, a week after the increase in 2.5mg, to 10 ~ 15mg per week to maintain. Similar efficacy of oral and intravenous administration. Side effects are gastrointestinal reactions, bone marrow suppression, stomatitis, alopecia, medication during the investigation of liver function and blood regularly, avoid alcohol. (4), adrenocorticotropic hormone (CS) generally do not have adrenal hormone therapy skin AS, but in acute iritis or peripheral arthritis with NSAIDs treatment fails, the available local injection or oral CS. Peters30 applications, respectively, day methylprednisolone 1000mg / times and 375mg / sub-infusion treatment of other acute medical treatment fails in AS activity and mobility of the 17 and 59, use 3 days to obtain longer relief slightly better efficacy of high dose group, the control of spinal pain and significantly improve the effect, but no statistical significance between the two groups. (5) TWP (Trirptrygium wilfordii hook, code-named T2) domestic initial treatment with Tripterygium tincture AS, has anti-inflammatory analgesic, 12% of Tripterygium tincture daily with 15 ~ 30ml, 3 times after meals. After disease control (about 3 to 6 months), use maintenance dose, daily or every other day service 5 ~ 10ml. After the semi-purified products with Tripterygium wilfordii tablets (T2) 20mg, 3 times a day orally, compared with tinctures good efficacy, easy to take. Side effects are gastrointestinal reactions, leukopenia, menstrual disorders and reduced sperm motility and so on, stopping after the resumption. 5. Surgical treatment of severe spinal kyphosis can be used to be in stable condition after corrective surgery, Lumbar spinal osteotomy for deformity correction of kyphosis feasible; on the chest 1 C7 cervical osteotomy to correct severe deformities. Rowed31 AS patients reported 21 cases of cervical spine injury due to fall to half of a good prognosis with conservative treatment; the other half due to recurrent cervical spinal nerve displacement or deterioration of the symptoms of decompression surgery and internal fixation, it also received good results. Severe hip flexion deformity, possible conversion total hip surgery or hip arthroplasty, but the effect is not ideal, easy to re-ankylosis after. In addition, the depth of X ray and radium 224 AS patients of early radiation therapy to reduce symptoms and improve function of a certain effect, the recent remission rate of 80% to 96%, but can not prevent disease progression, and there induced aplastic anemia, leukemia and the risk of transverse myelitis, has not. Antimalarial drugs, gold preparations, penicillamine and azathioprine and so on AS is invalid, has not. Lung disease is mainly symptomatic treatment and actively prevent and treat secondary infections, heart attack plus severe aortic insufficiency, aortic valve surgery feasible, serious conduction block may install artificial cardiac pacemaker. 6. Instead of 80 after the medical use of natural peak saw tooth shark, blue shark cartilage powder to the regeneration of human cartilage, restore joint from the inside, a thorough treatment of compulsory spondylitis, advanced countries have become a new attempt. In Europe, the extract of shark cartilage powder has been identified as pharmaceuticals, the United States OAM (Alternative Medical Services Authority) have replaced the shark cartilage powder as a part of medical research and popular, while Japan saw the peak use of shark cartilage powder, tooth As used in place of a part of the mandatory medical spondylitis clinical, and summarized the best dose is 7.5g / day statistics in order to solve the mandatory human spondylitis brings new hope. Conditioning conditioning of healthy eating is the internal cause of ankylosing spondylitis renal vein Du deficiency, because the cold outside, can diet. (1) Xin Hot food: to anti-rheumatic Quhan evil, such as pepper, onion, pepper, aniseed, fennel, garlic has antiseptic, antiviral and other effects, can prevent intestinal infections and viral infections. Due to the wet winter clothes ginger stomach and cold. Subject to the condition may be. (2) beans: beans, black beans, soybeans, etc. are rich in vegetable protein and trace elements, for muscles, bones, joints, tendon metabolism, the role of help repair lesions. Can be treated by wet weight-based rheumatic pain, the body of heavy, bad joints, tendons and Spasm or insensitive, joint pain, heavy with the discomfort of rheumatism, is better. Treat rheumatic pain, black beans with black bean stir-fry until semi-coke add rice wine, and effective treatment of joint pain, have gastritis with caution. (3) Fruit Food: gluten chestnuts have kidney bone health effect on the bones, meridians, Fengshibitong, waist and knee weakness extremely useful. Ankylosing spondylitis is due to kidney deficiency caused by bones, muscles and joints of the lesions. Can be eaten raw, cooked, Jiufu will be gluten, bone, kidney. Chestnut mash and apply to affected area to cure sore muscles; fresh chestnut leaves smashed external application, can also relieve muscle, joint and skin inflammation. (4) of fresh shrimp 500 grams, 500 grams of rice wine. Method: Wash shrimp immersed in wine for 15 minutes, picked up, ranch wear, split food, wine and shrimp can be the same food. Effectiveness: wet kidney yang, Shujin pain. Ome have thirst, Shibuya intestinal Zhili effect on patients with diarrhea, useful, where rheumatism, back pain, joint pain can rub the affected area with the green plum, blood can be pain. Hume is dry or immature plum fruit, and rheumatism are Zhuo Xiao, Jian Yin ebony acid can dry the acid by the liver, the liver may nourish the joints, muscles pain, Spasm with mitigation. Yin and blood mulberry, cherry also can cure rheumatism. There was no adequate clinical validation above information is for reference only. Rehabilitation exercise is a cause of ankylosing spondylitis is unknown, chronic inflammation of the joints to the main axis of the systemic disease, primarily involving the sacroiliac joint, hip joint, inter-column joints, ribs, vertebral joints, the sacroiliac disease section of the most magnetic Frequently, there are about 1 / 3 of patients can be seen around the joint symptoms. The main treatment is drug therapy, physical therapy, surgical therapy, etc., the condition improved after the rehabilitation period should be noted that the exercise: 1. Everyday posture training 1) stand: head stays in place, the next stool micro-income, under the towering blind not down and relaxed; abdomen slightly adduction, feet and blind width, ankle, knee, hip and other joints to maintain the natural position, not to shift the focus of the middle; 2) seat: day to sit at right angles hard wooden chair, back straight, tired depend upon when the hips, lower back tight towel resting in a chair; 3) supine: Hard to sleep Banchuang day, should sit, alternating between side to avoid the one position for a long time, pillows should not be too high or do not show pillow, another month or early morning before going to bed can be prone for 5 minutes. 2. Gong Exercise 1) Gong 1: Sit and scrambling feet, toes up, hands naturally at your sides, holding the breath tune about 3 minutes, and then asked to inhale, with the idea of the gas into the pubic region, while the waist, hips arched upwards, will impulsive concentrated in the waist and upper body, breath, waist, hips down, so the number of repeated interest rate 10 times; 2) Gong 2: legs and step standing (inside of the heel and toe Qi), hands on her hips to the waist for the movement point to the left, backward, right, forward rotation of 50 times, then reverse rotation 50; 3) Gong 3: hands on her hips, back exercises receded more than 10 minutes , action relatively mild, the activity is not. Increase the activity of the exercises easy to drive by choice, five animals, or tai chi, etc., Hok Pile. Posture in patients with ankylosing spondylitis nursing care directly determines the posture of the joint function of whether the patient can get a good recovery. In addition to the acute phase of sharp and severe pain, patients with ankylosing spondylitis should be insisted on correct posture and joint function of the exercise. Patients in walking and standing, should try to maintain normal posture, the patient should be sitting to now, standing should be straight, must not be in order to avoid back pain or fatigue with the bend to bend, how comfortable do, so long down can speed up the spinal deformity. In order to maintain the activities of spine and joint function, the patient should always be the neck, thoracic, lumbar flexion in all directions, backwards, turning left and right and other activities, in order to maintain the activity of the thorax, the patient should always take a deep breath and chest movement, In order to maintain hip, knee activity, to prevent the hip, knee contracture deformity, should be frequent squatting and other activities. On the posture of ankylosing spondylitis care can be effective in preventing spinal stiffness, tendon contracture, muscle atrophy, joint dysfunction and other symptoms. Note that to do other related orthopedic physical therapy gym in the permit conditions, targeted preventive and corrective orthopedic gymnastics is the main measure spinal deformity. Is a simple deep breathing exercises and chest movement. Both expanded the thorax, rib vertebral ankylosis prevention, increasing the role of vital capacity, due to the expansion of the thorax, but also indirectly play a role in prevention of kyphosis. (1) Take a deep breath: every morning, work and rest time for deep breathing exercise before bedtime should be routine. Take a deep breath to maintain the largest activity of thoracic and maintain good respiratory function. (2) cervical spine motion: head and neck can be used for forward, backward, left, right turn, and head rotation in order to maintain the normal activity of the cervical spine. (3) lumbar motion: Every day for the waist motion, flexion, back, left and right lateral bending and rotating body, the lumbar spine to maintain normal activity. (4) physical exercise: can be used for push-ups, bracing, leg flexion, extension, chest movement and swimming. Swimming is conducive to limb movement, but also help to increase lung function and to maintain the physiological curvature of the spine is the most appropriate body movement. Diving is prohibited but the patients in order to avoid cervical spine and cervical spinal cord injury. (5) hip and knee: Sports as with rheumatoid arthritis. (6) feet and shoulder width apart, hands on his hips, upright, straight ahead, do Xiongshihuxi. (7) position with the former, changing hands breathe boxing. On the move by the side of the body and shoulder level, while the chest, shoulder to the spine Shoulong, head thrown back, toe Hing Wah Street West, exhale restored. (8) position forward, inhale on the two upper limbs held straight by the side of the body; breath, legs straight, upper body flexion, touch the ground. (9) one meter from the wall, his hands were on both sides of the support wall, flush with the shoulder, leaning forward when inhaling the waist before the pretty, the heel should not lift, exhale restored. (10) stones throw away from the wall, standing, arms straight, hold the wall, slightly more than shoulder width, inspiratory elbow, forearm and touch the wall, the chest before the Ting; exhale restored. (11) holding hands grasp the horizontal bar suspended by its own weight for traction, you can also pull up the line, inhale, and exhale restored. (12) other training methods can refer to the motion method for osteoporosis III. In addition, a large cloud hands tai chi help to increase the rotation of the spine; back extensor exercise to help prevent kyphosis. The above training methods, the patient can choose from several sections, usually exercise 1-2 times a day, each action repeated 8-10 times. (13) biofeedback applications in ankylosing spondylitis: Ankylosing spondylitis likely to cause cervical spine, lumbar spine and hip joint stiffness, so to strengthen these parts of the exercise. The following three parts can be measured once a month, the patient can personally see that your body function is gradually improving after combined treatment, thereby increasing confidence in their struggle with the disease. 1) Measurement of cervical spine movement, including flexion, extension, lateral bending, rotation. 2) The lumbar spine is more convenient means to measure the distance, the more accurate is the modified Schober test. â‘ refers to distance, referring to the standing position, place both knees straight, feet close together, as do the body flexion (bending) action, measuring the distance from fingertip to the ground; â‘¡ modified Schober test, after the bilateral iliac the midpoint on the spine at one point connected with the 10cm to make a vertical line (ie, the intersection of the spine in the belt and make a point, from this point along the spine up 10cm, make a point), measured from flexion extension of the time points, the normal people up to 16-22cm, while the heavy increase in ankylosing spondylitis, only 1-2cm. 3) Although the hip hip a variety of sport, but for patients, the most important function of flexion. Maintaining the function of hip flexion for patients with ankylosing spondylitis is maintained for daily living. The simplest method is to measure from the hip, referring to patients as a squat movement, the vertical distance from the anus to the ground. 4) The appropriate work and rest over exertion to promote bone and joint damage, easy to form disabled; too much emphasis on rest, easy to make the loss of bone and joint activity, will also result in disability. According to clinical experience, in the case of pain to endure, note the function of joint activities, both for disease recovery, and it helps to maintain joint function and prevent or reduce the incidence of disability. Patients generally do not complete rest, should insist on doing some general work. At the same time, to avoid the invasion of wind cold dampness evil, to avoid colds and injuries, to avoid long been engaged in the work of bending, proper physical therapy, rest. Traditional Chinese medicine interpretation of ankylosing spondylitis is a "kidney Bi", "paralysis" "Gubi", "Du disease." Cause of the "kidney Governor empty" "feel evils" "congestion - Du meridian block" oriented. Gubi before seen in a "Yellow Emperor", a "five-body paralysis" one. "Q - On cavitation" said: "plot to stay cold homes, Rong Wei is not home, the volume reduced muscle meat, ribs may extend the elbow, the bone weakness, outside the heartless, Ming Yue less -" . It simply due to the passage of alpine outside, hot and humid steeped, bruises, blood stasis, blood runs sluggish, or Congenital deficiency, kidney essence deficiency, caused by bone pulse dystrophy. Leading causes summarized as follows: (1) rheumatoid pathogenic cold outside attack: the land of the living in the cold and wet, or rain, wading, labor sweat when the wind, wet clothing, or climatic upheaval, hot and cold cross Erzhi invasion of the body of the evil cold rheumatism, Note on the meridians, to stay in the joints, blood Blockage Erzhi the disease. (2) immersed heat: hot and humid year-old gas line order, or a long summer on the occasion, make steam or hot and humid alpine simmers course of time, Yu and heat, damp heat evil steeped in turn, Blockage of blood, bones dystrophy Erzhi the disease. (3) blood stasis: servant or contusion, loss and back, bleeding within the stop, blocking the meridians, blood runs sluggish, bones dystrophy Erzhi. (4) Kidney essence deficiency: Congenital deficiency, combined with too tired or ill for a long physically weak, or old and feeble, or the AV section of that loss of kidney essence is not, bones and hair dystrophy of the disease. Incidence of the disease all year round, occur in the central joints are more male youth, made in the peripheral joints are more female youth. According to ancient books and records of the Gubi modern clinical comprehensive analysis of the lesion location Gubi foot Shao, full sun, Du and other meridian. Points to the items on the back, hip and knee issued. Incidence of disease is characterized by secrecy, longer duration, when the acute attack. Waist, rump, hip, hip stiffness, supine inconvenience, pain, dull pain, tingling. Acute attack of severe pain. Can be described as "back pain, such as folding"; back on the rump with neck pain, shoulder, hip cited under, stocks, knee, Achilles tendon and so on. , Acute fever, heat the cold outside, the tongue dry throat, pain in knee hot red amidships. Or effusion. Shoulder, waist Tajiri, fear of cold feet fear the wind, heat or after exercise, relieve pain and other symptoms. Marital Notes disease caused by a variety of causes, only one genetic cause, is not the only factor affecting the disease. This means that if you are a patient with ankylosing spondylitis, your likelihood of children suffering from the disease only 20% to 30%. Some patients with ankylosing spondylitis, even if HLA-B2, antigen positive, their children are not always positive, even if their child is sick is not necessarily positive, because the normal in about 5% HLA-B2, antigen positive. Have reported that treatment of ankylosing spondylitis in the sulfasalazine drugs, methotrexate, Tripterygium have a certain influence on the gonadal, but are reversible. There were also reports, methotrexate side effects are caused by fetal malformation, but after more than a larger amount, and in the treatment of ankylosing spondylitis, the whole course of the maximum amount of not more than 1000 mg. However, prenatal and postnatal care starting early in preparation for childbirth should be discontinued for six months or longer, generally does not affect the reproductive quality. Non-steroidal anti-inflammatory analgesic drugs, such as taking too large, too long, because inhibit prostaglandin synthesis, so the adverse effects on sexual function is sometimes, but reversible, adjustment or return to normal after treatment. Not every day just thinking after illness will not develop disease, will not cause deformity, after how to do, the mood is not conducive to the rehabilitation of the disease, should be properly arranged life, learning, therapy, exercise time, and good mood to treat disease. Furthermore, the depressed mood can lead to circulation slow down, drop resistance, easily lead to other diseases. By resolve psychological barriers, the correct evaluation of their disease, the patient's attitude from negative to positive, the patient's mood changed by the pessimistic optimism, with treatment from passive to active, so that patients with ankylosing spondylitis have a healthy attitude , with the external treatment of the pathological body have become more health. Differential diagnosis of a lumbosacral strain with chronic lumbosacral joint articular disorders are persistent, diffuse low back pain, the most important to the lumbosacral spinal activity is not restricted, X ray no special change. Acute lumbosacral joint disorders, pain management due to additional activities, rest after mitigation.
2 ankylosing spondylitis, osteoarthritis often occurs in the elderly, is characterized by bone and cartilage degeneration, hypertrophy, synovial thickening, damage to weight-bearing joints of the spine and knee and other more common. Involving the spine are often the main symptoms of chronic back pain, easily confused with AS; but ankylosis does not occur in this disease and muscular atrophy, no systemic symptoms, X-ray findings as osteophyte formation and disc space narrowing. 3, Forestier's disease (senile ankylosing bone joint hypertrophy) the continuity of spinal osteophytes also occur, similar to bamboo-like change AS of the spine, but normal sacroiliac joints, facet joints are not violated. 4, tuberculous spondylitis clinical symptoms such as spinal pain, tenderness, stiffness, muscle atrophy, kyphosis, fever, ESR and quick and AS similar, but the identification of X-ray examination can be funded. Tuberculous spondylitis, the spine edge of the blurred, disc space narrowing, wedging before, no ligament calcification, sometimes with spinal tuberculous abscess adjacent to the shadow of the existence of unilateral sacroiliac joint involvement. 5, rheumatoid arthritis has been confirmed that AS is not a special type of RA, there are many differences between the two can be funded identification. RA women more common, usually small joints of the first violation of hand, foot, and there was bilateral symmetry, sacroiliac joint is generally not affected, such as violations of the spine, more than just violations of the cervical, and no paravertebral ligament calcification, subcutaneous rheumatoid nodules, serum RF always positive, HLA-B27 antigen often negative. 6, Enteropathy joint disease ulcerative colitis, enteritis or intestinal immunogenicity limitations of lipodystrophy (Whipple) can occur spondylitis and bowel disease arthropathy affected joints and X-ray changes and AS similar and not easy to distinguish, Therefore, intestinal symptoms and signs need to find a token of identification. Ulcerative colitis colon mucosa ulcers, edema, and bloody diarrhea; limitations of abdominal pain, colitis, nutritional disorders, and fistula formation; Whipple's disease fatty diarrhea, rapid weight loss, etc., all contribute to the diagnosis of primary disease. Enteropathy joint disease of HLA-B27-positive rate, Crohn disease patients with higher IgG intestinal perfusion fluid 17, and AS patients with bowel irrigation fluid IgG were normal. 7, Reiter syndrome and psoriatic arthritis, two diseases may occur spondylitis and sacroiliitis, spondylitis, but generally occurs later, lighter, less paraspinal tissue calcification, osteophytes, ligament-based non-edge type (fiber outer ring of fibrous tissue calcification), in the part of two adjacent vertebral bone bridge formed between the bamboo-like spine with different AS; unilateral sacroiliitis usually asymmetric or double-Jie damage, psoriatic arthritis, there are skin damage to be on behalf of the identification of psoriasis. 8, the tumor can also cause sexual bitterly tumor, need for a comprehensive examination, diagnosis, misdiagnosis of the rabbit. 9, some patients with acute rheumatic fever resembling the early clinical manifestations of acute rheumatic fever, or any major joint pain, or with long-term fever, weight loss, high fever and acute inflammation of peripheral joints as the first symptom is not uncommon, such patients more common in young people, it tends to be long-term misdiagnosis. 10, TB. Similar to the initial individual patient of tuberculosis, manifested as fever, night sweats, weakness, fatigue, weight loss, anemia, sometimes associated with unilateral hip arthritis, easily misdiagnosed as tuberculosis. Ankylosing spondylitis, psychological care nursing: The disease is insidious chronic progressive joint disease. Educate patients understand the disease, understand the prevention and treatment methods, treatment and training required to master self-care approach. This is to reduce joint dysfunction and delay the normal course up to participate in work and learning is particularly important. Activities of the basic principles: early appropriate activities can reduce the degree of deformity of the spine and joints. Daily spine and hip joint flexion and extension exercises 2 times per day do not cause activity to increase the extent of joint symptoms. Paraspinal muscle activity should be preceded by massage release, relieve pain, prevent muscle injury. At the same time, spa, FM and other physical therapy, can play a relieve muscle spasm, improve blood circulation and anti-inflammatory analgesic effect. Sense of abnormal delay nursing ideology: to maintain upright posture and normal height. Sleep low pillow to reduce cervical bending. Hard Banchuang sleep. Usually pay attention to the spine to reduce weight, avoid prolonged bending activities. Obese patients should lose weight, so as to reduce the burden on joints. Prevention of infection: involvement of the thorax, prone to lung infections, patients should be encouraged to exercise and deep breathing daily chest. Of life of patients can not take care of themselves, to give stand up shot back, encourage coughing. Also, pay attention to nutrition, enhance the body resistance. Concurrent eye uveitis, the time remaining eye wash secretions, conjunctival sac to keep clean, the eye should not be covered to avoid infection. Rome criteria of ankylosing spondylitis (a) clinical indicators 1, lower back pain and stiffness, rest can not be reduced more than 3 months. 2, chest pain and stiffness. 3, the waist activity limitation. 4, thoracic movement is limited. 5, there is a history of iridocyclitis or sequelae. (B) X ray index changes typical of bilateral sacroiliac joints (osteoarthritis should be excluded from both sides) (iii) a clear 1 ankylosing spondylitis and bilateral sacroiliitis grade 3 to 4, plus at least one clinical indicators . 2, at least four clinical indicators. New York, ankylosing spondylitis improved standard (A) clinical 1, low back pain, stiffness in the more than 3 months, symptoms improved after the event, rest no improvement. 2, lumbar flexion, lateral bending activity limitation. 3, thoracic mobility is lower than the corresponding age and gender normal population. (B) the standard bilateral radiological sacroiliitis is greater than or equal to two or unilateral sacroiliitis grade 3 to 4. (C) must comply with ankylosing spondylitis radiology standards and a more clinical diagnostic criteria. (D) may ankylosing spondylitis 1, in line with three clinical criteria. 2, in line with radiological criteria rather than clinical criteria (except for other reasons should be due to sacroiliitis.) Family history of ankylosing spondylitis causes of ankylosing spondylitis has long been a family physician hereditary attention in 1964, ankylosing spondylitis Kellgren family survey found that families of patients, the average disease prevalence rate of 4% , while the national population average prevalence rate was only 0.1% difference between the two actually 40 times the incidence, indicating that family history does with the pathogenesis of ankylosing spondylitis. Brewerton, etc. In 1973, patients with ankylosing spondylitis histological type to achieve significant evidence of genetic factors, they are typical of patients in 75 cases and found 72 cases of HLA-B27 antigen positive, accounting for 96% of its 60 first-degree relatives in 31 (representing 51%) HLA-B27 antigen was positive, and in 75 control group, HLA-B27, only 3 were positive, 4%, indicating that HLA-B27 positive patients with ankylosing spondylitis disease are closely related. The HLA system and the blood group antigens, is genetically determined, so the genetic pathogenesis of ankylosing spondylitis is one important reason. In the HLA-B27-positive population, the incidence of this disease is only about 20%, 80% of the remaining reasons for not contracting this disease? In addition to genetic factors that still exist in other pathogenic factors. Early symptoms of ankylosing spondylitis in early ankylosing spondylitis mainly lumbar and sacral parts of the pain and stiffness associated with lower back of a sense of the majority, such a rigid sense of the morning was clear after the event can still reduce the by. Also to the knee, ankle, heel, sciatica onset. Therefore, if 12 to 30 years old young men, the occurrence of lumbar and hip joints of continuous or intermittent pain, while being accompanied by lower back stiffness and bending, squatting is limited, or occur with unknown causes bone, chest rope, rib vertebral, temporomandibular, handle body, and other small metatarsophalangeal joint pain, should be thought of suffering from ankylosing spondylitis disease. Ankylosing spondylitis and seronegative spondyloarthropathy differentiated 1. Reiter syndrome and psoriatic arthritis, two diseases may occur spondylitis and sacroiliitis, spondylitis, but generally occurs later, lighter, less paraspinal tissue calcification, osteophytes, ligament-based non-edge-type (outer annulus fibrous tissue calcification), in between two adjacent vertebral bone bridge formed part of the bamboo with ankylosing spondylitis different kind of spine; sacroiliitis - as for the unilateral or bilateral non-symmetry, facet joint disease of bone rare, non-universality of osteoporosis. In addition, Reiter syndrome conjunctivitis, urethritis, skin and mucous membrane damage, psoriatic arthritis, psoriasis is a skin for identification of such damage. 2. Bowel disease ulcerative colitis arthritis, limitations enteritis, intestinal immunogenicity lipodystrophy (Whippe) spondylitis can occur, and Enteropathy arthritis affected joints and X-ray changes similar to ankylosing spondylitis is not easy to distinguish Therefore, intestinal symptoms and signs need to find a token of identification. Ulcerative colitis colon mucosa ulcers, edema, and bloody diarrhea; limitations of abdominal pain, colitis, nutritional disorders, and fistula formation; Whipple's disease fatty diarrhea, rapid weight loss, etc., all contribute to the diagnosis of primary disease. Enteropathy arthritis HLA-B27 positive rate is low, Crohn disease patients with higher IgG intestinal perfusion fluid, and ankylosing spondylitis in patients with bowel irrigation fluid IgG were normal. 3. Reactive arthritis often secondary to other parts of the body after infection, usually can be found foci, antibiotics effective. Myotonic myopathy myotonic myopathy are the majority of a genetic disease. Myotonic dystrophy is an autosomal dominant inheritance. Congenital myotonia also autosomal dominant. Vice myotonia congenital autosomal disorder caused by mutations. Muscle pathological changes typical nuclear transfer, was arranged in chains, large and small muscle cells, showing mosaic distribution of myofibril formation are often back to the sarcoplasmic side of the block, muscle cell necrosis and regeneration is not obvious. Means the involvement of myotonic myopathy in skeletal muscle contraction is not easy to relax, reduce or disappear after continuous contraction, characterized by the cold can aggravate the symptoms of a group of muscle diseases. Including myotonic dystrophy, congenital myotonia myotonia and vice psychosis. Disease myotonic dystrophy is a multi-system involvement of autosomal dominant genetic disease, the global prevalence of 3-5/10 million, the incidence rate is about 1 / 8000 live births, is the most common adult muscular dystrophy disease, no obvious geographical or ethnic differences. The pathogenesis of myotonic unclear, but in some cases, abnormal muscle fiber membrane of m