What is the ankylosing spondylitis that troubles Jay Chou? An analysis from an orthopedic doctor's professional perspective

Jay Chou wrote in the song "Snail": "I don't feel any pain from all the injuries I've experienced. I will climb up step by step, and when I reach the highest point, I will hold on to the leaves and fly forward. I will let the wind dry my tears and sweat. One day, I will have a day that belongs to me." Speaking of this, as a doctor, I have to mention a disease that once troubled Jay Chou - ankylosing spondylitis.

1. What is ankylosing spondylitis? Ankylosing spondylitis belongs to the category of rheumatic diseases. The cause is still unclear. It is a chronic disease with the spine as the main lesion site, involving the sacroiliac joints, causing spinal ankylosing and fibrosis, and causing varying degrees of eye, lung, muscle, and bone lesions. It is an autoimmune disease.

This disease is common in men aged 20 to 40. The typical symptom is "morning stiffness", which means that the body is stiff and painful when getting up in the morning, and it will gradually ease after movement. Diagnosis can be made by blood test for leukocyte antigens. About 90% of patients have a strong association with HLA-B27. Certain microorganisms (such as Klebsiella) have common antigens with the susceptible person's own tissues, which can trigger an abnormal immune response.

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There is currently no cure, but rehabilitation and medication can be used to slow the course of the disease. If ankylosing spondylitis is not properly controlled, the bones will gradually fuse, causing the patient to have difficulty in movement, hunchbacks, and a shorter stature, which is why these problems are named ankylosing spondylitis.

2. What are the causes of ankylosing spondylitis? The cause of ankylosing spondylitis is not yet completely clear. It may be related to genetics. There are several characteristics for reference.

Most of the patients are young men, aged between 20 and 30, but there are also younger patients. The male to female ratio is about 3:1.

A blood test for the HLA-B27 gene was conducted and approximately 90% of patients had the HLA-B27 gene.

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Disease-prone groups

Young male

Those with the HLA-B27 gene

Family history

There may be no clinical symptoms in the early stage, and some patients may show mild systemic symptoms in the early stage, such as fatigue, weight loss, long-term or intermittent low fever, anorexia, mild anemia, etc. Due to the mild condition, most patients cannot be diagnosed early, resulting in delayed treatment and loss of the best treatment opportunity.

3. What are the symptoms with strong local specificity in patients with ankylosing spondylitis? Morning stiffness: The whole body is stiff when getting up, which will be relieved after physical activity, which is different from general sprains where the pain becomes worse with exercise.

Inflammation of joints: The joints may swell and become painful for up to 3 months, and the most common joints are the hips, shoulders, knees, etc. If not treated actively, the patient's spine will gradually lose its elasticity, and problems such as hunchback and shortening may occur.

Inflammation of tissues around joints: When pain in the spine or joints persists, it may sometimes affect the surrounding ligaments and tendons, causing inflammation and pain.

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4. How does ankylosing spondylitis develop? Ankylosing spondylitis is common in men around 20 years old. Initially, patients will begin to experience symptoms of joint swelling and pain and morning stiffness. Ankylosing spondylitis is very different from common degenerative arthritis. The former will become more painful with rest, while the latter requires more rest to relieve symptoms.

If ankylosing spondylitis is not properly treated and rehabilitated, it will gradually cause osteoporosis and bone fusion of the spine. After the vertebrae fuse, the spine will lose its elasticity and become stiff and rigid. The patient's spinal mobility will be greatly reduced, which will develop into hunchback in the long run and the patient may become shorter.

5. How is ankylosing spondylitis diagnosed? Diagnostic criteria: Onset before age 45, inflammatory lower back pain (characterized by inability to be relieved by rest) combined with morning stiffness lasting for more than 3 months.

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Leukocyte surface antigen: A blood test to detect the HLA-B27 gene.

6. How to treat ankylosing spondylitis? Drug treatment:

Non-inflammatory drugs (NSAIDs): such as aspirin, salicyclic acid, etc. (Celecoxib-type drugs are less harmful to the stomach) are more effective in alleviating symptoms. Although they cannot cure or change the course of the disease, the dosage can be adjusted according to the severity of the patient.

Immunosuppressants: If there is concurrent peripheral arthritis, immunomodulators can be used for treatment, which can improve the inflammatory response of the joints. The disadvantage is that it will increase the risk of infection.

Surgical treatment: For patients with severe spinal deformity, surgery can improve symptoms. If the hip joint is damaged, repair or replacement surgery can be performed.

7. How should I take care of myself after suffering from ankylosing spondylitis? Regular exercise: In principle, any exercise that can move the joints is fine. It is recommended to exercise regularly for 10 to 20 minutes a day, which can move the joints, increase muscle strength, and reduce the pain caused by stiffness in the bones and joints. Swimming, stretching, and dancing are all good choices. Avoid sports with intense collisions such as basketball and rugby, because the patient's spine is usually more fragile, and the probability of osteoporosis and fracture is higher. It is recommended to do gentle exercises mainly to stretch the waist and back.

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Maintain a good posture: Keep your back straight when standing or sitting, expand your chest often, and keep your back upright when sleeping. The pillow should be low to prevent the back from becoming fixedly bent forward and forming the so-called rickets, which causes difficulty in movement and inability to straighten the back.

Conduct regular follow-up checks and keep an eye on your condition.

8. What are the complications of ankylosing spondylitis? Heart: Patients may experience mild aortic insufficiency.

Lungs: Pulmonary fibrosis may occur.

Kidney: 15% of patients may develop type A immunoglobulin nephritis, and patients with severe renal dysfunction still account for a minority.

Eyes: 20% of patients may develop choroiditis (also known as uveitis, the area between the sclera and retina, which is rich in microvessels to provide nutrition to the retina) or iritis (inflammation of the iris and ciliary muscle, located around the pupil).

Gastrointestinal: If ankylosing spondylitis invades the intestinal mucosa, the patient may experience symptoms including diarrhea, bloody stools, or inflammatory colitis.

Reactive arthritis: If the patient has ankylosing spondylitis and has a urinary tract infection or gastrointestinal infection, it may induce arthritis or even aggravate the symptoms of arthritis. Common pathogens include Salmonella, Shigella and Chlamydia.

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IX. Ankylosing spondylitis should be differentiated from rheumatoid arthritis, pyogenic osteoarthritis, and sacroiliac joint tuberculosis. (1) Rheumatoid arthritis: more common in women, mainly affecting the small joints of the limbs, a few involving the spine, often the cervical spine, and rarely involving the sacroiliac joints. If the disease is affected in the late stage, it is often unilateral, with the sacroiliac joint ligament being the most common, with osteoporosis under the articular surface, followed by small cystic bone destruction. Rheumatoid factor positive, HLA-B27 negative.

(2) Pycnogenol: It is more common in young and middle-aged women. The typical manifestation is obvious bone sclerosis in the middle and lower 2/3 of the ilium along the sacroiliac joint. The triangular shape has an upward tip and uniform density. MRI shows low signal in the ilium, normal joint space, sacral surface and articular cartilage, and no bone marrow edema around it.

(3) Sacroiliac joint tuberculosis: It usually occurs unilaterally and often has obvious systemic symptoms. Sacroiliac joint bone destruction, often accompanied by periarticular abscesses. PPT test is positive, HLA-B27 is negative.

(4) Others: When making a diagnosis, there are conditions related to sacroiliitis, such as Reiter syndrome and vertebral osteoarthritis, which need to be further differentiated based on relevant clinical features.

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Please note that no single approach or combination of approaches is appropriate for all patients, and recommended treatments are not absolute; please be sure to discuss your options with your physician.

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