小结
定义
强直性脊柱炎 (ankylosing spondylitis, AS) 是一种慢性进展性炎性关节病。患者可表现为严重疼痛和脊柱僵硬，最终可导致脊柱融合。在一项对 AS 患者长达 17 年的随访研究中，近 20% 的患者有脊柱完全融合的证据，即竹节样脊柱。[1] 这些患者最终会出现严重残疾。AS 主要累及中轴骨，但是外周关节、附着点（肌腱或韧带附着于骨的位点）和关节外部位，例如：眼部[2] 和肠道[3] 也常被累及。本病的致残水平与类风湿性关节炎相当。[4][5] 在X线片上找到骶髂关节炎的证据才能确诊AS。X线片改变可提示已有的损害，是疾病进展多年后出现的结果。因此建立了放射学阴性的中轴脊柱关节炎(nr-axSpA)的概念，可解释MRI上发现的中轴关节炎的早期表现，以求早期诊断和及时治疗，从而改善患者预后。
[Figure caption and citation for the preceding image starts]: 竹节样脊柱Student BMJ 2002;10:303-352.© BMJ Publishing Group Ltd 2008 [Citation ends].
病史和体格检查
诊断性检查
治疗流程
撰稿人
作者
Consultant
Rheumatology Department
Royal Berkshire NHS Foundation Trust
Reading
UK
利益声明
AC has served on the advisory boards for MSD and Sanofi; contributed to educational events for Janssen, MSD, Novartis, and Celgene; been on the speaker bureau for Janssen, Pfizer, and Novartis; and received travel grants from Abbvie, UCB, and Pfizer to attend educational conferences.
Specialist Registrar in Rheumatology
Royal Berkshire NHS Foundation Trust
Reading
UK
利益声明
JG declares that she has no competing interests.
Dr Antoni Chan and Dr Jessica Gunn would like to gratefully acknowledge Dr Sarah Keidel, Dr Millicent Stone, Dr Raj Sengupta, Dr Athimalaipet V. Ramanan, and Dr Emma Pomeroy, the previous contributors to this topic. SK declares that she has no competing interests. MS is an author of several references cited in this topic. RS declares that he has no competing interests. AR declares that he has no competing interests. EP is an author of a reference cited in this topic.
同行评议者
Professor of Rheumatology
Centre for Rheumatic Diseases
University Department of Medicine
Glasgow Royal Infirmary University Trust
Glasgow
UK
利益声明
RS is an author of a reference cited in this topic.
Consultant Physician and Rheumatologist
Northwick Park Hospital
Harrow
UK
利益声明
AK declares that he has no competing interests.
Consultant
Norfolk and Norwich University Hospital
Norwich and the Cromer & District Hospital
Cromer
UK
利益声明
KG is an author of a reference cited in this topic.
Interventional Spine Physiatrist
Pain Medicine Specialist
Medical Director
Spine Center
Lahey Clinic
Burlington
MA
利益声明
AGC declares that he has no competing interests.
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