强直性脊柱炎中心

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The Universal Guide to Ankylosing Spondylitis: Everything you ever wanted to know, straight from the experts.

在本文中:什么是强直性脊柱炎?|Causes|Symptoms|诊断|Treatment|与As一起生活|来源

如果您被诊断出患有强直性脊柱炎(AS)或怀疑您可能患有它,那么您可能会痛苦。幸运的是,在过去的几十年中,对这种形式的脊柱关节炎的治疗已经走了很长一段路。较新的疗法通常意味着减少炎症,控制症状更好,甚至疾病进展较慢。

“That’s an important thing to know, because when people hear ‘ankylosing spondylitis,’ they will Google it and find pictures of patients with end-stage disease from the days when we did not have treatments. That can be frightening,” saysJoerg Ermann,医学博士,在波士顿的杨百翰和妇女医院的风湿病学,炎症和免疫学系的副医师。

So, what is AS exactly? What causes it, and how is the condition diagnosed? Perhaps most important, what treatments can help AS patients achieve less pain and improve their quality of life?

什么是强直性脊柱炎?

Ankylosing spondylitis is also known as Marie-Strumpell disease or Bechterew’s disease. It’s a form of inflammatory arthritis that primarily affects your spine. After several years, the bones in the spine, called vertebrae, may fuse together. When this happens, the spine becomes stiff and less flexible.

  • Ankylosis:关节融合在一起并变得不可动摇
  • Spondylitis:涉及脊柱椎骨和刻面关节的炎症

Healthy spine versus one with ankylosing spondylitisWhen vertebrae or other bones/joints fuse together, the spine becomes stiff and immobile. Photo Source: 123RF.com.

AS often develops in the sacroiliac joints (SI joints), which connect your lower spine to your pelvic bones. It can also develop in other parts of your spine and cause symptoms and conditions elsewhere in your body.

有时,会影响您的姿势。例如,您可能会弯腰。医生叫这个Kybhosis, an abnormal forward position of the upper spine.

What Are Possible Ankylosing Spondylitis Causes?

Causes of Ankylosing SpondylitisThe common causes of Ankylosing Spondylitis.

Inflammation is your immune system’s way of fighting illness and injury. During an inflammatory response, chemicals and cells in your bloodstream rush to protect healthy tissue and repair any damage done. This can cause pain and swelling, among other symptoms.

当您有AS时,炎症反应无法正常工作。取而代之的是,炎症是在身体的健康部位引起的,包括脊柱和SI关节。

我们不知道什么原因是什么,但是几个因素可能会增加您的风险。

Gender.Experts used to believe men were up to nine times more likely to have AS than women. But in recent years, research has shown the difference is much smaller than we thought—if there is one at all. One possible reason: Women may have been misdiagnosed or underdiagnosed in the past.

家史。如果您的父母或祖父母拥有,那么您更有可能自己开发它。

HLA-B27:Human leukocyte antigen B27 (HLA-B27) is a protein you may have in your blood. It’s found in the vast majority of Caucasian people with AS, and about half of Black people with AS.

Having the HLA-B27 protein doesn’t mean you have AS—and vice versa. You can have AS without this marker, and you can have this marker without developing AS.

What Are Typical Ankylosing Spondylitis Symptoms?

AS的症状可以从任何年龄开始,但是它们通常在45岁之前开始。尽管有些人非常普遍,但它们可能在一个人到另一个人之间有很大差异 - 包括在该强直性脊柱炎症状清单上的那些:

Chronic pain and stiffness.这些症状通常首先出现在下背部,并且经常出现臀部和臀部。必威 app不适通常在数周或几个月内缓慢地积累。它可以位于身体的一侧,两侧或两侧之间的来回移动。

Some people experience intermittent back pain, and others have serious pain and stiffness for long periods of time. Almost all cases of AS are characterized by acute pain followed by temporary remission when symptoms subside.

Discomfort at certain times of the day.“A lot of the time, patients report nocturnal back pain,” says Namrata Singh, MD, Assistant Professor in the Division of Rheumatology at the University of Washington Medical School in Seattle. Many people with AS feel sore and stiff first thing in the morning, as well.

随着运动的改善。“The other hallmark is the pain gets better as your day goes on or you move around, and the pain gets more severe or you get more stiff as you sit more,” Dr. Singh explains.

Inflammation in key areas.如果您在身体的不同部位遇到不适,那可能是责备。最常受到影响的地方包括:

  • Si关节
  • 必威 app下背部椎骨
  • Hip and shoulder joints
  • The entheses, or areas where tendons and ligaments attach to bones, mainly in your spine but sometimes at the back of your heels
  • Cartilage around your ribs and breastbone

Ankylosing spondylitis SI joint inflammationAS often causes SI joint inflammationAdditional body-wide symptoms.Early on, someone with AS may also experience fatigue, loss of appetite, low fevers and mild anemia.

其他条件可能会发展

当您拥有AS时,您可能会增加某些其他炎症状况的风险。患有葡萄膜炎的患者中,多达40%的患者是一种炎症性眼病,可能导致发红,疼痛和视力改变。

Sometimes, says Dr. Singh, patients will present with eye problems first, and the subsequent workup will reveal signs of AS. “We are referred to patients who are actually re-diagnosed with ankylosing spondylitis from ophthalmology,” she explains.

About 10% of AS patients have inflammatory bowel disease (IBD), an umbrella term describing two conditions:克罗恩病andulcerative colitis。Symptoms can include abdominal pain, diarrhea, and bloody stools.

Less often, you can develop more serious health problems with AS. Inflammation in your body can affect your heart, which may increase your risk of cardiovascular events such as heart attack and stroke. Pulmonary issues are also linked with AS, since stiff ribs can affect lung function and the ability to breathe.

How Can You Get an Ankylosing Spondylitis Diagnosis?

Since symptoms often come on slowly and can resemble those of other conditions, it frequently takes years for AS to be correctly diagnosed. But a diagnosis is critical to getting the right treatment early on. If you believe you might have AS, your best bet is to see a doctor called a rheumatologist, who specializes in musculoskeletal and some autoimmune diseases.

“The big question we are asked is, ‘Do you have a blood test you can do for me to diagnose this?’” says Dr. Singh. “And the answer usually is no.”

Instead, your rheumatologist will use a combination of methods to pinpoint AS and rule out other conditions, called a differential diagnosis. These methods may include the following.

体检。为了解决问题的根源,您的提供者会在身体周围的某些点(例如背部,Si关节,骨盆和高跟鞋)寻找疼痛,肿胀和压痛。他们还将检查您的脊柱和其他关节的移动性限制。这可能涉及一些简单的办公室测试要求您执行某些动作。

During a Schober test, for example, your provider would assess your lower back flexibility by asking you to bend forward. And for a Gaenslen test, you would be asked to lie down and flex one of your knees while your provider applies pressure to your other leg. This helps to evaluate pain in the SI joints.

Medical history.This will entail a rundown of your symptoms, as well as their severity, duration and location. Problems like uveitis and IBD will be considered as well.

血汗工作。您的医生将寻找HLA-B27蛋白以及其他炎症标记。炎症的证据可能暗示AS,但也可能是许多其他条件。

成像。最早的变化你的医生可以在X -现货ray are likely in the SI joints, though it may be years before there is enough damage to show up. Magnetic resonance imaging (MRI) and computed tomography (CT) are more sensitive tests for AS. These can detect earlier stages of the disease, such as inflammation of the joints before bone changes occur.

什么是强直性脊柱炎治疗选择?

There is no cure for AS, but several different therapies can ease pain, decrease inflammation, improve function, and slow the progression of the disease.

Pain relievers.通常建议使用非甾体类抗炎药(NSAID),例如布洛芬(Advil,Motrin)和萘普生(Aleve),以减轻作为症状的痛苦。也可以使用像对乙酰氨基酚这样的镇痛药。

修饰抗疾病药物(DMARDS)的疾病。This class of drug is prescribed to help reduce inflammation and slow the progression of several kinds inflammatory and/or autoimmune diseases, including AS. DMARDs prescribed to treat AS include methotrexate and sulfasalazine (Azulfidine).

生物制剂。These are special kinds of DMARDs created from living cells. Biologics for treating AS are administered via infusion at a medical facility or by self-injection at home. There are several your doctor may recommend, such as: adalimumab (Humira), certolizumab (Cimzia), secukinumab (Cosentyx), and ixekizumab (Taltz).

锻炼。Physical therapy and exercise are very important if you have AS. Not only can gentle stretching and exercise help relieve back and/or neck stiffness, they can help you stay as mobile as possible. Your physical therapist can prescribe a home stretching and exercise program and teach you good practices for proper posture. Bonus: Physical activity can boost your cardiovascular health and mood as well.

埃尔曼(Ermann)博士警告说,患有AS的人应避免某些类型的运动,因为这会增加脊柱骨折的风险。其中包括接触运动和活动,造成脊柱受伤的威胁,例如滑雪和滑雪板。

强直性脊柱炎运动Beware activities that carry an increased risk of spine injury, like skiing.

手术。尽管大多数患有AS的人可以在不手术的情况下成功治疗,但强直性脊柱炎的手术may be necessary in certain cases. A surgeon will help decide what kind of procedure you need depending on your symptoms, age, overall health and specific situation, among other factors.

  • 椎板切除术。Sometimes, AS can cause nerves or the spinal cord itself to become compressed. This may result in pain, weakness, numbness or tingling. To ease this pressure, your surgeon may perform alaminectomy,其中涉及去除椎骨的后弓,称为薄片。
  • 截骨术。When someone with AS develops a curved spine, it can seriously damage their day-to-day function and quality of life. During an osteotomy, bone is cut and reshaped for better posture and movement. Osteotomy for AS is considered to carry risks and is rare in the United States.
  • 脊柱仪器和融合。与没有AS的人相比,患有脊柱骨折风险的人明显更高。Ermann博士说:“在大多数情况下,这需要通过外科手术进行固定,因为这些骨折通常不稳定,并且对脊髓构成威胁。”

If bones in your spine have been damaged or you’ve had an osteotomy, your surgeon may use instrumentation—such as wires, screws, rods, bars, or cages—将周围的骨头融合在一起。这可以使您的脊柱保持稳定,并保护脊髓不受伤害。

  • 关节更换。Knee, shoulder or髋关节置换术可能需要“经过多年的治疗,尤其是在生物制剂可用之前发生疾病的患者中,” Ermann博士解释说。

AS的手术在医院进行。完成后,根据您的程序和整体健康状况,您可能会在几天甚至几个小时内就开始协助。一些手术要求您在医院度过多个晚上。

在家里,无论您进行了哪种手术,都必须遵循您的医疗团队给出的所有指示。您可能必须戴支架或项圈,限制活动,甚至以某种方式洗澡。可能建议使用药物来控制该手术导致的疼痛。紧密遵守指示会极大地影响您恢复的速度和成功。

What Are Some Tips for Living with Ankylosing Spondylitis?

与As一起生活can be challenging, especially if it’s left untreated. As time goes on and the disease progresses, you might need to pass on certain plans or activities. You may not be able to sleep well. You could have a harder time in the weight room, in the yoga studio, on the athletic field—or even just keeping up with your kids. Sometimes, people with AS develop depression or anxiety.

但是,您可以采取一些步骤来减少疾病对您的身心的影响。这些才一点点。

戒烟。Not only is smoking a risk factor for AS, it can worsen your disease, reduce the effectiveness of treatment, not to mention, duh, it can kill you. Come on, you know what you need to do here, but if you need us to spell it out: Q-U-I-T

Focus on healthy eating.Though there is no special diet designed for people with AS, a diet focused on whole, nutritious foods can help tame inflammation. It can also help you maintain a healthy weight, which is key to managing to the disease. You’ll want to include fruits, vegetables, whole grains, and lean proteins, and limit alcohol, sugar, sodium, and saturated fats. If you need more structure than these general guidelines, reach out to a dietitian who can customize an eating plan around healthy foods you will enjoy.

Consider assistive devices.如果行走会伤害您的背部,请愿意为鞋子使用拐杖,沃克和骨科插入物。请记住,温和的活动可以帮助缓解症状,而久坐的活动将为它们做出贡献。还有一些辅助设备可以使您更舒适地拿到家中的物品,坐上车等。

Ankylosing spondylitis assistive devicesAssistive devices such as canes and walkers can help keep you moving when you have AS.

尝试简单的家庭治疗。必威betway微博Cold therapies can help reduce inflammation, and heat can help relieve joint stiffness. Look for packs at your local drugstore.

优先考虑您的心理健康。心理和身体健康密切相关。找到可以公开谈论您的AS的人,从朋友和家人到支持小组。寻找适合您的压力缓解者。如果您的情况变得压倒性,请与您的医生或心理健康专家联系寻求帮助。

谨慎使用互补疗法。Though there isn’t much research to support their effectiveness, some people with AS find that complementary therapies, such as acupuncture and gentle massage, help relieve symptoms. Your doctor can help decide what’s safe for you and may even be able to refer you to a practitioner with relevant experience. Be aware that experts strongly recommend against chiropractic care for AS due to a high risk for injury.

Once you’ve been diagnosed with AS and begin to receive treatment, it’s important to stay in close communication with your rheumatologist and other members of your healthcare team. Keep an eye out for new symptoms and alert your providers to any significant changes between regular visits. Always follow your treatment plan closely, too, and take care not to skip appointments. Through diligence and dedication, you can improve your chances of a better AS outcome.

来源

What is AS:Mayo Clinic. (N.d.) “Ankylosing Spondylitis.”
https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808

原因:杨百翰和妇女医院。(2007)“护理标准:强直性脊柱炎。”https://www.brighamandwomens.org/assets/bwh/patients-and-families/hearabilitation-services/pdfs/l-spine-ankylosing-spondylis-spondylis-bwh.pdf

Symptoms:Mayo Clinic. (N.d.) “Ankylosing Spondylitis.”
https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808

诊断:杨百翰和妇女医院。(2007)“护理标准:强直性脊柱炎。”https://www.brighamandwomens.org/assets/bwh/patients-and-families/hearabilitation-services/pdfs/l-spine-ankylosing-spondylis-spondylis-bwh.pdf

Arthritis Foundation. (n.d.) “Axial Spondyloarthritis.”关节炎。org/diseases/ankylosing-spondylis

加拿大脊柱炎协会。(N.D.)“强直性脊柱炎。”脊柱炎

加拿大脊柱炎协会。(n.d。)“管理脊柱炎。”脊柱炎

Casper Webers,Ivette Essers等人,“强直性脊柱炎的性别差异差异:对强直性脊柱炎的结局的长期结果。”Rheumatology,第55卷,第3期,2016年3月,第419-428页。
Academic.up.com/rheumatology/article/55/3/3/419/1793176


约翰·霍普金斯医学。(n.d。)“椎板切除术”。hopkinsmedicine.org/health/treatment-tests-and-therapies/laminectomy

Medlineplus。(N.D.)“强直性脊柱炎。”medlineplus.gov/ankylosingspondylitis.html

National Health Service (UK). (2019) “Ankylosing Spondylitis: Causes.”nhs.uk/conditions/ankylosing-spondylitis/causes/

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2020) “Ankylosing Spondylitis.”niams.nih.gov/health-topics/ankylosing-spondylis

Physiopedia. (n.d.) “Gaenslen Test.”physio-pedia.com/Gaenslen_Test

Physiopedia. (n.d.) “Schober Test.”physio-pedia.com/schober_test

Saad B. Chaudhary, Heidi Hullinger, and Michael J. Vives. “Management of Acute Fractures in Ankylosing Spondylitis. ISRN Rheumatology. 2011; 2011: 150484.ncbi.nlm.nih.gov/pmc/articles/pmc3263739

The Spine Hospital at The Neurological Institute of New York. (n.d.) “Osteotomy.”columbiaspine.org/t必威betway微博reatments/osteotomy/

美国脊柱炎协会。(2019年。)“ 2019年轴向脊椎关节炎治疗建议:患者和家庭的简要概述。”spondylitis.org/wp-content/uploads/2020/01/SAA_Pocket_Guide_WEB.pdf

美国脊柱炎协会。(n.d。)“补充治疗”。必威betway微博脊柱炎必威betway微博

美国脊柱炎协会。(n.d.) “Diagnosis of Ankylosing Spondylitis.”脊柱炎diagnosis/

美国脊柱炎协会。(n.d.) “Diet's Effect on Spondylitis Symptoms.”脊柱炎

美国脊柱炎协会。(n.d.)“锻炼”。spondylitis.org/about-spondylitis/treatment-information/exercise/

美国脊柱炎协会。(n.d.) “Most Common Symptoms.”脊柱炎symptoms/

美国脊柱炎协会。(n.d.) “Overview of Ankylosing Spondylitis.”脊柱炎

美国脊柱炎协会。(n.d。)“可能的并发症:一个人如何影响?”脊柱炎

美国脊柱炎协会。(n.d.) “Spondyloarthritis: Autoimmune or Autoinflammatory?”脊柱炎。org/spondylitis-plus/spondylohrathis-automune-ormune-or-autoinflammatoration/

美国脊柱炎协会。(n.d。)“女性的脊椎关节炎。”脊柱炎

美国脊柱炎协会。(n.d。)“脊椎关节炎的治疗。”脊柱炎treatment-ankylosing-spondylitis/

UpToDate.com. (2020) “Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics).”uptodate.com/contents/axial-spondylohrohranitis-concluding-ankylosing-spondylis-beyond-the-basics

UW Medicine - 正交与运动医学。(N.D.)“强直性脊柱炎。”orthop.washington.edu/patient-care/articles/arthicletic/ankylosingspondylitis.html

威尔·康奈尔(Weill Cornell)的大脑和脊柱中心。(2020)“强直性脊柱炎”。weillcornellbrainandspine.org/condition/ankylosing-spondylitis/surgery-ankylosing-spondylitis

更新:03/30/21
Ali A. Baaj, MD
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