Ankylosing spondylitis and its associated uveitis
Introduction
Introduction to ankylosing spondylitis and its associated uveitis 20% to 30% of patients with ankylosing spondylitis (AS) develop anterior uveitis. Ankylosing spondylitis is one of the most common systemic diseases in men with acute anterior uveitis. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Ankylosing spondylitis and its associated uveitis etiology
(1) Causes of the disease
1. Immune genetic factors The data of different countries and regions show that ankylosing spondylitis is closely related to HLA-B27 antigen. Among patients with ankylosing spondylitis alone, more than 67.5% are HLA-B27 antigen positive in tonicity. In patients with spondylitis associated with uveitis, the positive rate of HLA-B27 antigen is as high as 90%. These results indicate that the occurrence of this disease is related to immune genetic factors.
2. Infectious factors The disease may be related to infections such as Klebsiella, Salmonella, Shigella, Yersinia, Chlamydia trachomatis, but there is no such pathogen in the eye tissue of patients with uveitis, which may be The cross-reactivity or autoimmune response caused by these pathogens causes arthritis and uveitis. The bacterial endotoxin is very similar to uveitis associated with ankylosing spondylitis in animal-induced uveitis, suggesting that the infected pathogen may pass Its toxin induces uveitis.
(two) pathogenesis
As for the exact pathogenesis, it is not completely clear.
Prevention
Ankylosing spondylitis and its associated uveitis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Ankylosing spondylitis and its associated uveitis complications Complication
No complications at present.
Symptom
Ankylosing spondylitis and its associated symptoms of uveitis common symptoms morning stiffness, dull pain, eye pain, lacrimal cystic edema, photophobia, uveitis, cough
1. Extraocular performance
(1) lumbosacral pain: the most common symptom of the patient is lumbosacral pain, dull pain, difficult to locate, can radiate to the sputum or thigh, pain often worse when coughing, sneezing or suddenly twisting the back; lumbosacral Pain is most noticeable after getting up in the morning. Early pain can be unilateral, intermittent, and develops into bilateral and persistent.
(2) Spine rigidity and deformity: Another common symptom of the patient is the strong sense of the spine. This kind of performance is most obvious after getting up in the morning, so it is also called morning stiffness. After the activity or exercise, the morning stiffness can be alleviated or alleviated. In severe cases, Restricted thoracic activity, permanent spinal rigidity, loss of normal posture, loss of lumbar lordosis, chest kyphosis, chest flattening, lumbar prominence, and spinal activity are restricted in all planes.
(3) Others: In addition to the involvement of the spine and ankle joints, the knee joint, hip joint, shoulder joint, ankle joint, and elbow joint can be involved.
2. Eye changes
Ocular inflammation caused by ankylosing spondylitis is mainly uveitis. In addition, scleritis and conjunctivitis can be caused in a small number of patients. Scleritis is mostly mild to moderate inflammation, which is characterized by diffuse anterior scleritis, which usually occurs. After the onset of ankylosing spondylitis.
Ankylosing spondylitis associated with uveitis is mainly acute non-granulomatous anterior uveitis, manifested as sudden redness, eye pain, photophobia, tearing, blurred vision, in reactive optic disc edema and macular sac In the case of edema, the patient often has decreased vision. The examination revealed ciliary congestion or mixed hyperemia, a large amount of dusty KP, anterior chamber glimmer (~), anterior chamber inflammatory cells (~), and severe cellular water in severe aqueous humor. Exudate, prone to anterior chamber empyema, because this anterior chamber empyema is often accompanied by a large amount of fibrinous exudation, so anterior chamber empyema is not easy to change with changes in the patient's position.
The posterior segment of the eye is generally unaffected, but occasionally can cause vitreous inflammation, reactive optic discitis or optic disc edema or cystoid macular edema, in a very small number of patients can still cause chorioretinitis, retinal vasculitis, etc., uveitis usually involves double Side, but generally bilateral onset, and bilateral recurrence, although uveitis can occur before ankylosing spondylitis, but most occur after arthritis, anterior uveitis lasts for 4 to 8 weeks If the treatment is correct, no complications or sequelae may occur, but if the treatment is not timely, there may be post-iris adhesions, complicated cataracts, secondary glaucoma and other complications, which may lead to adverse consequences.
Examine
Examination of ankylosing spondylitis and its associated uveitis
ESR is accelerated, C-reactive protein is elevated, generally only indicates that the patient's uveitis may be accompanied by systemic disease, but it is not specific. The rheumatoid factor test is of no value in the diagnosis of this disease, because the ankylosing spondylitis itself It is a seronegative (serial rheumatoid factor negative) spondyloarthropathy, in other words, ankylosing spondylitis itself is negative for rheumatoid factor, so the examination of rheumatoid factor is not helpful for diagnosis, HLA-B27 antigen typing although ankylosing spondylitis No diagnosis, but it is important to determine whether patients have the risk of developing ankylosing spondylitis and to guide clinical treatment and to determine the possibility and prognosis of patients with uveitis recurrence, such as HLA-B27 antigen positive, ankylosing spine The possibility of inflammation is 100 to 150 times greater than that of the negative.
For patients with acute non-granulomatous anterior uveitis, especially male patients, the ankle joint should be routinely filmed. Patients with a history of lumbosacral pain should be X-rayed. Those without a history of this disease should also perform this examination. Some patients with ankylosing spondylitis can have no symptoms in the early stage of the disease and even have obvious ankle changes. However, X-ray examination can determine the lesions of the ankle joint. In our patients, nearly 1/ 3 patients without any symptoms, confirmed by the ankle joint film.
Diagnosis
Diagnosis and differentiation of ankylosing spondylitis and its associated uveitis
The diagnosis of ankylosing spondylitis with uveitis is mainly based on the patient's history of ankle arthritis, X-ray findings and clinical manifestations of recurrent acute non-granulomatous anterior uveitis, acute non-granulomas in young adults. In iridocyclitis, the diagnosis of ankylosing spondylitis should be considered. It should be routinely used for ankle joint radiography. For patients with difficult X-ray results, CT or MRI should be considered and HLA should be performed. -B27 antigen typing test.
Differential diagnosis
The identification of AS should pay attention to the diseases that can cause arthritis and uveitis, many of them, but each has its own characteristics, such as psoriatic arthritis mainly has skin changes, inflammatory bowel disease has gastrointestinal symptoms, mainly with the following Two diseases were identified.
1. Rheumatoid arthritis (RA) In the past, AS was also considered to be a type of rheumatoid arthritis. It has been proved that AS has many aspects different from rheumatoid arthritis. AS mainly invades the central axis and has many male patients. Rheumatoid factor negative, HLA-B27 detection rate is high, AS is more prone to acute anterior uveitis than rheumatoid arthritis, but rheumatoid arthritis mostly invades the distal joint, more common in women, rheumatoid factor is positive, HLA-B27 Almost no more, there are fewer pre- uveitis, and more often, scleritis occurs.
2. Reiter syndrome has arthritis and uveitis, but also latent enteritis, and HLA-B27 is also positive, similar to AS, but the former features conjunctivitis and urethritis, generally can be distinguished, Reiter disease has Urethritis, conjunctivitis, corneal edema, mouth ulcers and nail changes, but AS does not have these changes, and mainly violates the ankle joint.
