小结
定义
中轴型脊柱关节炎（axial spondyloarthritis, AxSpa）是一种慢性进行性炎性关节病。患者可表现为严重疼痛和脊椎僵硬，最终可导致脊柱和骶髂关节放射影像学改变。此放射影像学改变阶段被称为强直性脊柱炎（ankylosing spondylitis, AS）。此疾病进展可能导致脊柱融合。脊柱完全融合的患者会出现严重残疾。
AS 多累及中轴骨，但也常累及外周关节、附着点（肌腱或韧带附着于骨骼的部位），以及关节以外的部位（如眼部和肠道）。[1][2]
放射学阴性中轴型脊柱关节炎（non-radiographic axial spondyloarthritis, nr-axSpA）指的是在磁共振成像（magnetic resonance imaging, MRI）上可见中轴型炎症，而此炎症并未对骶髂关节造成大量侵蚀性损伤。若骶髂关节呈 MRI 阳性，可将患者分类至 nr-axSpA。[Figure caption and citation for the preceding image starts]: 竹节样脊柱Student BMJ 2002;10:303-352.© BMJ 出版集团有限公司 2008 [Citation ends].
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
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
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
诊断性检查
首要检查
- 骨盆 X 射线
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
治疗流程
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
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.
鉴别诊断
- 骨关节炎
- 弥漫性特发性骨肥厚(DISH)
- 银屑病性关节炎
更多 鉴别诊断指南
- ACR 适用标准：炎性背痛：已知或疑似中轴型脊柱关节炎
- 美国风湿病学会/美国脊柱炎协会/脊柱关节炎研究和治疗网络针对强直性脊柱炎和放射学阴性中轴型脊柱关节炎的治疗建议 2019 年更新版
更多 指南患者教育信息
何为强直性脊柱炎？
强直性脊柱炎：如何有效治疗？
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