英文-強(qiáng)直性脊柱炎

ANKYLOSINGSPONDYLITISAnkylosingSpondylitisIntroductionEtiologyClinicalfeature&DiagnosisTreatmentIntroductionAnkylosingSpondylitis(AS)isachronicseronegativein-flammatorydiseasethataffectstheaxialskeleton,especia-llythesacroiliacjoints,hipjoints,andspine.Extraskeletalinvolvementisfoundintheaorta,lung,anduvea.Thecharacteristicsofthisdiseaseisthesacroilitis,whichspreadupwardslowlytothespine,finallycausecompleterigidityor(and)deformityofthespine.

Thediseaseusuallyhasitsonsetduringearlyadulthoodandmalesareaffectedmorefrequentlythanfemaleswiththemale/femaleratioof2-7:1.EtiologyHeredityfactorApproximately90%ofpeoplewithASexpressthe

HLA-B27

genotypeand1-2%ofindividualswiththeHLA-B27genotypecontractthedisease,meaningthereisastronggeneticassociation.Infection

Thediseaseiscommonlyconmitantwithprostatitis,ulcerativecolitisandpelvicinfection,soinvestigatorshavepostulatedthatinfectionis

one

ofthe

etiological

agentforthedisease.3.Autoimmunity

Auto-antibodiesspecificforAShavenotbeenidentified.Anti-neutrophil

cytoplasmicantibodies

(ANCAs)areassociatedwithAS,butdonotcorrelatewithdiseaseseverity.Clinicalfeature&DiagnosisPeakonset:between20and30yearsofage.Theinitialsymptomsareinsidiousandadvancegradually,includingpaininthebuttocks,heels,andlowback,sometimescompaniedbysystemicfeatures,suchasfatigue,anorexia,mildfeverandweightloss.Attheoutset,thepainisintermittent,thenitgraduallybecomedurativewhenthediseaseprogess.Eventually,somepatientsdevoloplossofmotionandsubsequentlossofkyphosisinthecervicalandlumbarspine。Clinicalfeature&DiagnosisSpondylitis，startsinthesacroiliacjoint,graduallymigratescephaladtolumbar,thoracic,andcervicalspine.Painandlossofmotionofthelowbackarecausedbysacroilitisjointandlumbarspineinvolved.Themyalgiaofthebackisdiffuseatfirst,andthenisfocusedonthelumbosacral

vertebraes.Clinicalfeature&DiagnosisTerminalchangeofthespine:

Cervical:anteflexion

Thoracic:kyphosisandchesttightness.lumbar:kyphosis.HipandKnee:flexioncontractureClinicalfeature&DiagnosisPeripheraljointsinvolved:

shoulderandhip:40%respectively

knee:15%

ankle:10%

wristandfoot:5%respectively

hand:seldominvolvedExtraskeletalinvolvement:

uveitis:30%;chesttightness:30%;aorta:lessthan5%

Clinicalfeature&DiagnosisAccessoryexamination1.Physicalfindings:a.Schober’stest:decreasedspinalmobility;b.Mennell’stest:painofsacroiliacjoints;c.reducedchestexpansionduringinspiration;d.anteriorsagittalimbalance(plumblinefallinginfrontofthehipjoint.Clinicalfeature&Diagnosis2.Imagingstudies

Radiographicexamination：a.symmetricbilateralbonyerosionsfollowedbybonysclerosisofthesacroiliacjoints;b.ankylosisofthelumbarspine:theso-calledbamboospine.

ComputedTomography

Thespinecanbepreciselyvisualizedwith3DCTimaging,particularlythedorsal

elements(posteriorlongitudinalligament,spinousprocessandfacetjoints),

whicharemoredifficulttovisualizewithX-ray。Clinicalfeature&DiagnosisClinicalfeature&DiagnosisLaboratoryInvestigationsInfla