ankylosing spondylitis scleritis
Introduction
Introduction to ankylosing spondylitis scleritis Ankylosing spondylitis (AS) is a chronic systemic disease of unknown cause involving the joints of the spine, ankle, and joints. In the early years, it was considered a clinical type of rheumatoid arthritis (RA). In recent years, this disease is considered to be an independent disease completely different from RA. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: conjunctivitis anterior uveitis cataract glaucoma
Cause
Causes of ankylosing spondylitis scleritis
(1) Causes of the disease
The cause is unknown. Recent studies have suggested that the disease is associated with infection, such as campylobacter infection, which may have cross-over or common structure between antigenic residues, but it is difficult to draw conclusions.
(two) pathogenesis
Ankle arthritis is a pathological hallmark of ankylosing spondylitis. Early changes can be seen in synovial hyperplasia and accumulation of lymphoid cells and plasma cells, lymphoid follicle formation, and plasma cells containing IgG, IgA, and IgM.
Prevention
Ankylosing spondylitis scleritis prevention
No effective preventive measures, active treatment, to prevent the occurrence of complications.
Complication
Complications of ankylosing spondylitis scleritis Complications, pre-conjunctivitis, uveitis, cataract, glaucoma
Ocular lesions also include conjunctivitis, uveitis and/or scleritis complicated by cataract, iris adhesion, pupillary atresia, secondary glaucoma and macular edema.
Symptom
Ankylosing spondylitis scleritis symptoms Common symptoms Cystitis uveitis intervertebral disc out of the sclera outer sight visual impairment cardiac hypertrophy chest pain hardening bamboo spine heel pain
Eye performance
The most common eye manifestation of AS is anterior uveitis, occasionally scleritis, and AS scleritis is not more common than the control group.
(1) scleritis: the incidence of scleritis in patients with AS is 0.34% to 0.48%. Sometimes scleritis is the earliest clinical manifestation of AS, even several years before the lesions in other parts, usually AS scleritis is mild to moderate Diffuse anterior scleritis, unless repeated episodes, generally does not progress to necrotizing anterior scleritis, anterior uveitis occurs after scleritis, it is not clear whether uveitis and scleritis are associated or independent of AS Symptoms, or both, patients with recurrent anterior uveitis and diffuse anterior scleritis should be carefully examined for AS.
(2) anterior uveitis: the most common extra-articular manifestation of AS is anterior uveitis, about 25% of patients with AS develop anterior uveitis before or after onset, and the most common body of male patients with anterior uveitis Sexual disease is AS, 17% to 31% of men with anterior uveitis have AS, 50% of anterior uveitis patients and 90% of anterior uveitis with rheumatoid disease are HLA-B27 positive, anterior uveitis The appearance of the AS has nothing to do with the severity of AS, but it is associated with peripheral damage. Usually, AS anterior uveitis progresses to both eyes after repeated episodes of one eye. When anterior uveitis occurs, eye pain, photophobia and mildness may occur. Symptoms such as blurred vision and significant ciliary congestion, gray-white fine-grained KP, anterior chamber cellulose exudation and post-iris adhesion, HLA-B27-positive patients can cause severe fulminant anterior uveal membrane with anterior chamber empyema Inflammation, the posterior segment of the eye is less affected, and occasionally a small number of patients have cystoid edema and retinal vasculitis. AS anterior uveitis usually relieves in 4 to 8 weeks without residual visual impairment, but the lesion can recur, early local Application of glucocorticoids and mydriatic agents Prevent further deterioration and prevent other complications for patients before recurrent uveitis, often we need to consider whether AS.
2. Non-eye performance
The most typical early manifestation of AS is persistent low back pain (at least 3 months), unilateral, occult, blunt or intermittent, with morning stiffness, post-activity reduction, ascending progression of spondylitis, involving waist and chest All the spine of the neck, in addition to low back pain, there are also various spinal pain and limited mobility, patients with hunchback, difficulty breathing, spinal rigidity, only a few patients in the late stage can be the intervertebral disc annulus calcification and vertebral body fusion into a characteristic ligament The bones form a "bamboo spine", the patient may have heel pain (Achilles tendinitis), foot pain (foot fasciitis), chest pain (inflammation of the attachment points of the costal and rib cage), 35% Patients with peripheral arthritis, mostly asymmetry, lower extremities than upper limbs, greater joints than small joints, hips, shoulders, knee joints most common, persistent (10 years or more) pain and adhesion, A lame change can occur.
(1) Cardiovascular: aortic regurgitation, cardiac hypertrophy and abnormal transmission (including complete cardiac block and Adams-Stokes disease), ascending aortitis and pericarditis can be 3.5% to 10% of AS patients The first lesion, cardiac involvement can also be asymptomatic, vasculitis in AS is mainly aortitis, mitral anterior tip thickening and aortic root scar formation is the main tissue change.
(2) Pulmonary: Severe patient-specific lesions can appear in the upper lung field similar to tuberculous infiltration and fibrin-like changes, and gradually form cysts and lung parenchymal destruction. Pulmonary fibrosis is occasionally subclinical, but large Most patients have cough, cough and difficulty breathing, and patients can die from massive hemoptysis.
(3) nervous system: subluxation of the spine, fracture and dislocation can lead to neurological diseases, the most common in the atlas subluxation and cervical spine fracture and dislocation, the late lumbar intervertebral disc prolapse, resulting in compression of the sacral nerve root, the appearance of cauda equina syndrome, manifested as Pain in the lower extremities and buttocks, sensory-dysmotility, incontinence, and emergency laminectomy after diagnosis.
(4) genitourinary system: patients with AS may develop chronic prostatitis, the incidence rate is higher than RA or other general diseases, contrary to the renal damage that RA can manifest, AS has obvious pathological changes of electron and microscopic examination of the kidney, but Glomerular function is not impaired, clinical manifestations are rare, in addition, AS is often accompanied by multiple sclerosis.
Examine
Examination of ankylosing spondylitis scleritis
AS serum alkaline phosphatase (AKP), creatinine phosphokinase and ESR are usually elevated, ESR is not associated with AS severity and prognosis, and the presence of circulating immune complexes (CIC) and IgA Elevation suggests an immune disorder, but rheumatoid factor (RF) and antinuclear antibody (ANA) are negative, and HLA-B27 examination has reference value for the diagnosis of the disease.
Radiological examination
Can diagnose the disease, mainly manifested as subchondral bone plate blur, sclerosis, erosion, joint cavity stenosis, ankle joint stiffness and other ankle arthritis characteristics, the vertebral body side changes square, ligament callus formation, spinal joint Ossification, sclerosis and rigidity, bone erosion and osteitis can be seen at the attachment of tendons and ligaments. Radionuclide and CT scans can be used to detect early AS lesions that are not detected by conventional X-rays, and pulmonary invasive changes can be identified.
2. Ultrasound examination
It is possible to identify organic lesions in the heart and to observe changes in blood rheology.
Diagnosis
Diagnosis and differentiation of ankylosing spondylitis scleritis
The diagnosis of AS is based on the patient's susceptibility, medical history, clinical features, and imaging findings. The most commonly used diagnostic criteria are the so-called New York standards:
1. Lumbar frontal curvature, lateral curvature, and reclining are limited in all three directions.
2. The history of pain at the lumbar vertebrae or dorsal lumbar junction lasted for more than 3 months.
3. Chest expansion is limited, take the fourth intercostal space measurement, chest expansion 2.5cm.
It can also be graded according to the X-ray of the ankle joint (class 0 is normal; level 1 is suspicious; level 2 is slightly changed, small restricted area is eroded or hardened, but joint cavity width is unchanged; level 3 is positive or moderate abnormal, appears Erosion, hardening, joint cavity widening or stenosis or partial rigidity; 4 grades of severe abnormalities, all joints are strong and straight) to judge, the ankle joint changes bilateral 3 or 4, and one of the above 3 items can be diagnosed, Ankle changes 3 or 4, but only 1 side, or 2 or 2 sides and have the above 1st or 2nd and 3rd items can also be diagnosed, the ankle joint changes 3 or 4 sides, but None of the above 3 items, as a suspected case, the above criteria are helpful for diagnosis, but should be considered after all considerations, HLA-B27 can not be used as a screening test for AS, because most HLA-B27 positive people There is no AS, and some patients with AS are negative for HLA-B27. When clinically suspected AS and imaging is difficult to diagnose ankle arthritis, HLA-B27 may increase the possibility of AS diagnosis, but it is still undiagnosed.
