Do you know? Open the door┋Ankylosing spondylitis, how much do you know?

Starting from November 10, 2021, Xinjiang Science and Technology Association launched a new science interpretation column "Do You Know? Open the Door", inviting experts from Science Popularization China to participate in the selection, writing and review of science popularization content. The column was first released on the official WeChat public account of Xinjiang Science and Technology Association "Science Popularization Xinjiang" and was simultaneously broadcast on the official website of Xinjiang Science and Technology Association, Toutiao, Weibo and other platforms. Please stay tuned.

Contributors: Kaosail Mamtiaili, a master's student in rheumatology and immunology at the First Clinical Medical College of Xinjiang Medical University; Ji Peng, associate chief physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

Review expert: Luo Li, chairman of the Clinical Immunology Branch of the Xinjiang Immunology Society; vice president of the Xinjiang Uygur Autonomous Region Immunology Society; director, professor and chief physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

1. What is ankylosing spondylitis? What are the dangers of ankylosing spondylitis?

Ankylosing spondylitis is a chronic inflammatory disease of unknown cause that mainly affects the axial spine and may be accompanied by joint and extra-articular manifestations. In severe cases, spinal deformity and ankylosis may occur. The inflammation of the disease begins in the sacroiliac joints and spinal joints. Over time, it causes fusion of the vertebrae, leading to low back pain and limited mobility. In addition to causing spinal deformity and ankylosis, ankylosing spondylitis can invade multiple systems throughout the body, and in severe cases, it can significantly affect the quality of daily life.

The picture comes from the Internet

2. Why do people get ankylosing spondylitis?

The exact cause of ankylosing spondylitis is still unclear, but it is believed that the disease is the result of a combination of factors including genetics, the immune system, and environmental factors.

(1) Genetics: Highly correlated with HLA-B27. HLA-B27 positivity may greatly increase the risk of ankylosing spondylitis.

(2) Overactive immune system: It may attack the body’s own normal tissues, leading to inflammatory responses.

(3) Environmental factors: Infections such as bacteria and viruses may also play a role in the onset of the disease.

3. What is HLA-B27? Does a positive HLA-B27 necessarily mean ankylosing spondylitis?

HLA-B27 is a human leukocyte antigen, a gene site that is basically expressed on all nucleated cells in the body. The expression of this antigen is highly correlated with ankylosing spondylitis, and more than 90% of patients with ankylosing spondylitis are HLA-B27 positive. However, in the normal population, there are still about 10% of people who are positive for HLA-B27 serological tests but do not suffer from ankylosing spondylitis. Therefore, although HLA-B27 is an important positive indicator for determining ankylosing spondylitis, it cannot be 100% certain that HLA-B27 positivity is definitely ankylosing spondylitis. It is also necessary to combine other clinical symptoms, such as whether there is morning stiffness, whether there is sacroiliitis, and whether there are obvious changes in the spine, to comprehensively diagnose whether you have ankylosing spondylitis.

4. What are the symptoms of ankylosing arthritis?

The main symptoms of ankylosing spondylitis are pain and stiffness in the spine and pelvic area.

Typical signs and symptoms include:

1) Pain in the lower back and back that gradually worsens over time; the pain worsens after standing or sitting for a long time and is relieved after activity;

2) Back stiffness when getting up in the morning, and the stiffness is more severe;

3) pain in half of the buttocks, the entire buttocks, or the shoulder;

4) Limited flexibility of the spine, making it difficult to turn over at night;

5) Ligaments and tendons attached to the spine, such as heel pain, rib pain, etc.;

In addition to joint symptoms, other extra-articular symptoms may occur:

1) Eye inflammation: Patients may experience eye pain, redness, sensitivity to light, and blurred vision, and may develop uveitis;

2) Cardiovascular disease: It may lead to complications such as high blood pressure, arteriosclerosis and heart disease, so regular cardiovascular examinations are essential for patients with ankylosing spondylitis;

3) Pulmonary lesions: Patients may develop interstitial pneumonia, pulmonary fibrosis and other changes;

4) Kidney disease: If the kidneys are affected, IgA nephropathy, renal amyloidosis, etc. may occur;

5) Gastrointestinal lesions: Crohn's disease, ulcerative colitis, etc., accompanied by poor appetite, nausea, vomiting, diarrhea, bloody stools and abdominal pain, etc.;

6) Skin and mucous membrane lesions: erythema nodosum, purulent keratosis pilaris, conjunctivitis and oral ulcers, etc.;

7) Neurological diseases: may cause chronic arachnoiditis, etc.

Image source: Internet

5. What examinations should be done for ankylosing spondylitis?

The diagnosis of ankylosing spondylitis usually requires a comprehensive physical examination and blood and imaging tests. The doctor will conduct a series of assessments by asking about the medical history, family history, and the duration and extent of symptoms. The doctor may need to further improve the medical history and clinical evaluation:

1) Laboratory tests: These tests can measure inflammatory markers (mainly erythrocyte sedimentation rate and C-reactive protein, etc.) and other indicators to help determine whether an inflammatory response is present.

2) X-ray, CT and MRI examinations: These examinations can detect inflammation, joint destruction and other lesions in the sacroiliac joints, spine and pelvic area. MRI examinations in particular can clarify the degree of disease activity and guide medication.

3) HLA-B27 gene testing: HLA-B27 gene is an important risk factor for ankylosing spondylitis.

6. Can ankylosing arthritis be cured? How to treat it?

There is currently no cure for ankylosing spondylitis, but active treatment is still very necessary. Reasonable and standardized treatment plans can help relieve symptoms, reduce disease progression and reduce disability rates.

Treatments include:

1) Non-drug treatment: It is the basis of ankylosing spondylitis treatment, mainly including: exercise, smoking cessation, other physical therapy, etc. Exercise mainly includes stretching exercises, which can improve joint flexibility and strength and relieve pain and stiffness.

2) Traditional drug treatment: including non-steroidal anti-inflammatory drugs (diclofenac, meloxicam, celecoxib, etoricoxib, etc.) and anti-rheumatic drugs (the more commonly used ones are sulfasalazine, methotrexate, etc.), which can relieve pain and inflammation.

3) Biological agents and small molecule targeted drugs: Biological agents (recombinant human type II tumor necrosis factor receptor-antibody fusion protein for injection, adalimumab, secukinumab, etc.) and small molecule drugs (tofacitinib, upadacitinib, etc.) can reduce disease activity and are currently the most effective treatment drugs. For patients with moderate to severe disease and patients with rapid disease progression, timely use is recommended.

4) Surgical treatment: In some cases, such as severe joint damage in the spine and pelvic area, surgical treatment is possible, mainly including total hip replacement, spinal corrective osteotomy, etc.

Summary: Ankylosing spondylitis is a common inflammatory disease that can cause severe pain and stiffness in the spine and joints, and even severe deformities. Although there is currently no cure, active and standardized treatment can relieve symptoms and reduce the progression of the disease. Therefore, when obvious back pain, stiffness, limited movement, difficulty turning over at night, heel pain, hip pain and other symptoms occur, it is recommended to go to the rheumatology and immunology department for treatment as soon as possible.

References:

[1] Huang Feng, Zhu Jian, Wang Yuhua, et al. Diagnosis and treatment guidelines for ankylosing spondylitis[J]. Chinese Journal of Internal Medicine, 2022, 61(8): 893-900.

[2]Ramiro S, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis, 2023;82:19–34.