What should I do in the late stage of ankylosing spondylitis?

Written by Li Jing
Rheumatology
Updated on August 31, 2024
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Firstly, ankylosing spondylitis is an autoimmune disease primarily affecting the axial joints, but it can also present with extra-articular manifestations. Severe cases can lead to ankylosis and deformities of the spine, which are complications of late-stage ankylosing spondylitis. At this stage, surgery is needed to manage the activity of the disease. If the activity of the disease is not controlled, even joint replacement can still lead to the progression of the disease and further damage to the joint structures. For severe disabling deformities, spinal orthopedic surgery can be considered, and spinal surgery is required when an acute fracture occurs.

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Written by Li Jing
Rheumatology
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How is ankylosing spondylitis diagnosed?

Ankylosing spondylitis is an autoimmune disease that cannot be cured but can be managed primarily through medication. Its main typical symptoms include stiffness in the neck or pain in the lower back, with the pain becoming more apparent when at rest or after sitting for a long time. Symptoms tend to improve with movement. A typical occurrence is pain that awakens the patient at night. Peripheral joints like the knee joint and heel can also be affected. However, the main symptoms are stiffness in the neck and pain in the lower back. Diagnosing ankylosing spondylitis requires combining symptoms with a positive B27 blood test result, and imaging tests such as CT or MRI of the sacroiliac joints, showing signs of sacroiliitis, narrowing or damage in the sacroiliac joint space, to confirm the diagnosis.

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Written by Li Jing
Rheumatology
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What department should I go to for ankylosing spondylitis?

Ankylosing spondylitis is an idiopathic systemic disease primarily characterized by chronic inflammation of the axial joints, mainly involving the sacroiliac joint. The typical onset age ranges from 10 to 14 years, and it is more common in males. It is not hereditary, but there is a familial predisposition. If there is a family history, and localized pain or discomfort is present, especially if there is difficulty turning over at night, stiffness after waking or after prolonged sitting or standing, which eases with activity, it is important to be alert. This condition falls under rheumatic immune diseases, therefore, it should be managed by a rheumatology immunology department, not orthopedics.

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Written by Yang Ya Meng
Rheumatology
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What to do about ankylosing spondylitis pain?

The medications for treating pain in ankylosing spondylitis fall into three major categories: The first category includes non-steroidal anti-inflammatory drugs, such as sustained-release diclofenac sodium tablets. The second category consists of disease-controlling drugs, which are often immunosuppressants, such as methotrexate and sulfasalazine. Third, if patients still experience significant back pain despite using anti-inflammatory analgesics and disease-controlling drugs, biologic agents can be considered. The main biologics currently include tumor necrosis factor antagonists. (Note: The use of medications should be under the guidance of a doctor.)

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Written by Yang Ya Meng
Rheumatology
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What to check for ankylosing spondylitis?

The examination for ankylosing spondylitis mainly includes blood tests. The main components of the blood tests are erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ANA along with CCP antibodies, and AKA antibodies, and of course, the most crucial test related to the gene - HLA-B27. Imaging exams can include the following: First, an X-ray of the pelvis, or an MRI of the sacroiliac joints. If the disease has been present for a longer time, a CT of the sacroiliac joints can be chosen. If the patient has elevated ESR and CRP, a positive B27, and lesions in the sacroiliac joints, then the diagnosis of ankylosing spondylitis can be confirmed.

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Written by Yang Ya Meng
Rheumatology
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How to control ankylosing spondylitis

The treatment of ankylosing spondylitis mainly consists of three parts: The first part is the use of non-steroidal anti-inflammatory drugs, such as sustained-release diclofenac sodium tablets; the second is the choice of disease control medications, which may include sulfasalazine or methotrexate tablets, especially for patients with peripheral joint pain, immunosuppressive drugs can be chosen. The most effective for ankylosing spondylitis are biologics, but before using biologics, it is necessary to exclude hepatitis, tuberculosis, and cancerous diseases, and the cost of biologics is relatively high. (Please use medications under the guidance of a professional physician and do not self-medicate.)