强直性脊柱炎

最后审阅: 19 四月 2022
最后更新: 26 一月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 炎性腰背痛
  • 虹膜炎/葡萄膜炎
  • 附着点炎
  • 于青春期晚期及20余岁时发病
  • 男性
  • AS 阳性家族史
更多 关键诊断因素

其他诊断因素

  • 疲劳
  • 睡眠障碍
  • 骶髂关节触痛
  • 呼吸困难
  • 腰椎前曲消失
  • 外周关节受累
  • 脊柱后凸
  • 银屑病
  • 炎性肠病的症状
其他诊断因素

危险因素

  • HLA-B27
  • 内质网氨基肽酶1(ERAP1)以及白细胞介素-23受体(IL23R)基因
  • AS 阳性家族史
  • 男性
  • 肺炎克雷伯杆菌
更多 危险因素

诊断性检查

首要检查

  • 骨盆 X 射线
更多 首要检查

需考虑的检查

  • HLA-B27
  • 核磁共振成像 (MRI)
  • 颈椎X线(侧位)
  • 腰椎X线(侧位)
  • 胸椎X线(侧位)
  • 超声
更多 需考虑的检查

治疗流程

急症处理

伴有疼痛和/或晨僵表现的成年患者

不伴有疼痛和/或晨僵症状的成年患者

儿童

持续性治疗

有疼痛和/或晨僵症状,且对2种NSAID和非药物治疗反应不佳的成年患者

撰稿人

作者

Antoni Chan, MBChB, FRCP, PhD

Consultant

Rheumatology Department

Royal Berkshire NHS Foundation Trust

Reading

UK

利益声明

AC has served on the advisory boards for MSD, Novartis, and Sanofi; contributed to educational events for Janssen, MSD, Novartis, Sanofi, and Celgene; been on the speaker bureau for Janssen, Pfizer, and Novartis; and received travel grants from AbbVie, UCB, Lilly, and Pfizer to attend educational conferences.

Sarah Sacks, MBBS, BSc

Specialist Registrar in Rheumatology

Stoke Mandeville Hospital

Aylesbury

UK

利益声明

SS declares that she has no competing interests.

鸣谢

Dr Antoni Chan and Dr Sarah Sacks would like to gratefully acknowledge Dr Jessica Gunn, Dr Sarah Keidel, Dr Millicent Stone, Dr Raj Sengupta, Dr Athimalaipet V. Ramanan, and Dr Emma Pomeroy, the previous contributors to this topic.

利益声明

JG, SK, RS, and AVR declare that they have no competing interests. MS is an author of several references cited in this topic. EP is an author of a reference cited in this topic.

同行评议者

Roger Sturrock, MD, FRCP

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.

Andrew Keat, MBBS

Consultant Physician and Rheumatologist

Northwick Park Hospital

Harrow

UK

利益声明

AK declares that he has no competing interests.

Karl Gaffney, BCh, BAO (Hons), FRCPI, FRCP

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.

Alexios G. Carayannopoulos, DO, MPH

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.

  • 强直性脊柱炎 images
  • 鉴别诊断

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  • 指南

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