Young people with back pain may suffer from ankylosing spondylitis if rest does not relieve the pain but makes it worse.

Author: Wu Husheng, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Zhang Zhuoli, Chief Physician, Peking University First Hospital

Ankylosing spondylitis belongs to the category of rheumatism. It is a chronic inflammatory bone and joint disease that mainly affects the sacroiliac joints. It can cause spinal ankylosing, hunchback, and limited walking activities. It can also affect peripheral joints such as the hip, knee, and ankle.

The prevalence of ankylosing spondylitis in my country is about 0.3%. It can occur in any age group, with the peak age being 20-30 years old. The male to female ratio is basically 3:1.

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The pathogenesis of ankylosing spondylitis is still unclear, and it is believed to be closely related to heredity and the HLA-B27 gene. However, HLA-B27 positive people may not necessarily develop ankylosing spondylitis, and HLA-B27 negative people may not necessarily not develop ankylosing spondylitis, indicating that in addition to genetic factors, there are other external factors.

Clinical studies have found that the onset of ankylosing spondylitis is also closely related to the body's own immune disorders. In order to resist foreign infections, the immune system will trigger an immune response. If the immune tolerance is poor, it may also damage its own tissues when resisting external pathogens, such as releasing a lot of tumor necrosis factor, interleukin 23, interleukin 17, etc., causing damage to its own tissues. This is an immune inflammatory response, which is a very important factor in inducing ankylosing spondylitis.

Ankylosing spondylitis is mainly manifested as low back pain, which is an inflammatory low back pain. Inflammatory low back pain has certain characteristics. The onset is relatively hidden. The low back pain does not worsen during activities. It cannot be relieved by rest, but will worsen instead. The pain at night is accompanied by morning stiffness. Due to the influence of inflammation, staying still for a long time during sleep at night will cause the accumulation of inflammatory exudates in the joints, resulting in stiffness when getting up in the morning. However, with the increase in activity, blood circulation is accelerated, inflammatory substances gradually dissipate, and the corresponding symptoms will also be alleviated.

Inflammatory low back pain is an early clinical manifestation of ankylosing spondylitis. The pain is mainly in the buttocks or lower back, and may occur alternately on both sides of the buttocks. It may also be bilateral at the same time or radiate to the waist and back. As the disease progresses, limited movement will occur, such as bending forward and backward, and bending sideways. In more serious cases, the spine may become rigid, and even hunchbacks and scoliosis may occur, causing spinal deformities. It can also cause neck contracture and the head to stretch forward.

In addition to the spine, peripheral joints such as the hip, knee, ankle and upper limb joints may also swell and have limited function. Ankylosing spondylitis causes severe joint damage and ankylosing, which can affect normal life and work and cause certain disability. In the late stage, it is often accompanied by decreased bone density, severe osteoporosis, and easy fractures.

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Ankylosing spondylitis is a chronic inflammatory disease. In addition to joint involvement, other systems may also be affected, such as the eyes, kidneys, heart, lungs, nervous system, skin and mucous membranes, intestines, etc., and a series of related symptoms may appear.

If ankylosing spondylitis is suspected, the doctor will perform relevant physical examinations, imaging tests, and blood tests, and make a comprehensive diagnosis based on various indicators.

The goal of treating ankylosing spondylitis is to control inflammation, relieve symptoms, and prevent deformities. The key lies in early diagnosis and early treatment.

Treatment includes non-drug treatment, drug treatment, surgical treatment, etc. Non-drug treatment is implemented throughout, including educating patients and their families to understand the nature, course, treatment measures and prognosis of the disease, so that patients can actively cooperate with the treatment.

In daily life, such as when walking, sitting and standing, you should keep your chest up and abdomen in, and maintain an upright position; when sleeping, do not use a pillow or use a low pillow, sleep on a hard bed, maintain a supine or prone position, and do not sleep with your body bent; exercise actively, it is recommended to do aerobic exercise, the most important thing is to exercise the waist and back muscles, such as swimming, cycling, and flying swallows; it is recommended to do more deep breathing exercises to exercise the mobility of the chest; if necessary, physical therapy can be used, usually heat therapy, such as hot water baths, etc., to increase local blood circulation, relax muscles, relieve pain, facilitate joint movement, maintain normal function, and prevent deformities.

Drug treatment, commonly used drugs in clinical practice, such as non-steroidal anti-inflammatory drugs, have the effects of anti-inflammatory, analgesic, relieving stiffness and muscle spasms. It is recommended to take non-steroidal anti-inflammatory drugs regularly during the active stage of the disease, and take drugs as needed when the condition is relatively stable. There are also anti-rheumatic drugs that improve the condition, including sulfasalazine, methotrexate, leflunomide, thalidomide, etc. Another category is glucocorticoids, which are not recommended for oral, intravenous or intramuscular use. It can be used locally, such as when the joints are severely swollen, local injection of glucocorticoids after puncture and fluid extraction, but it is not suitable for long-term use.

In recent years, targeted drugs have become an increasingly important direction in the treatment of ankylosing spondylitis. These drugs target inflammatory factors in ankylosing spondylitis, such as tumor necrosis factor and interleukin 17. Tumor necrosis factor antagonists include etanercept, infliximab, adalimumab, and golimumab; interleukin 17 antagonists such as secukinumab and ixekizumab have significant therapeutic effects on ankylosing spondylitis.

In the late stage of the disease, serious deformities will appear, such as hunchback, neck stretched forward, inability to bend hips and knees, which seriously affect life. This situation requires surgical treatment, such as hip and knee replacements, spinal correction, etc. Surgery is the last option.