What Is Ankylosing Spondylitis (AS)? Symptoms, Causes, Diagnosis, and Treatment

强直性脊柱炎是主要影响脊柱关节，韧带和肌腱的慢性炎性关节炎的一种形式。具体而言，强直性脊柱炎会引起肠炎 - 肌腱，韧带和骨骼相遇的炎症。

A hallmark of ankylosing spondylitis is inflammation of the sacroiliac joint, the joint between the sacrum, which is the bony structure at the base of the spine, and the bones of the pelvis.

In advanced cases, ankylosing spondylitis can cause new bone to grow in the inflamed areas and the vertebrae of the spine to fuse together.

This can lead to kyphosis, a type of spinal curvature that results in a forward-hunching posture.

强直性脊柱炎的患者在身体的其他部位（包括眼睛）也可能患有炎症 - 导致疾病称为葡萄膜炎。

Inflammation can additionally occur in the heel area as well as the knees, elbows, shoulders, and ribs.

强直性脊柱炎是一组炎症rheumatic diseasesknown as spondylitis, spondyloarthropathy, or spondyloarthritis. After rheumatoid arthritis (RA), ankylosing spondylitis (AS) is one of the most common rheumatic diseases. (1)

The most common symptom of ankylosing spondylitis is lowback pain这种情况逐渐发展，以至于在早期阶段可能不会引起人们的注意。

其他标志和强直性脊柱炎的症状include:

• Fatigue
• Stiffness that is worse in the morning
• 臀部疼痛
• 通过体育锻炼的疼痛和僵硬改善
• Hunched posture
• Difficulty breathing deeply

连直的脊柱炎也可能引起人体其他部位的炎症，包括眼睛，称为葡萄膜炎，主动脉瓣和主动脉（称为主动脉炎）。

Typically, symptoms worsen over time — gradually for some people and more rapidly for others.

了解有关强直性脊柱炎的体征和症状的更多信息

What Does Ankylosing Spondylitis Feel Like?

People with ankylosing spondylitis often feel chronic pain, primarily in the spine, but sometimes also in other joints, including the:

• Heels
• 臀部
• Ribs
• Shoulders
• 小关节

The chronic pain is usually a result of the inflammation caused by AS and can vary from mild to severe. Some people with AS report having an overall sense of discomfort and stiffness all the time. (2)

由于导致夜间更糟的背痛，并且出现后会有所改善。有些人尤其是晚上的下半场，背部疼痛和觉醒的恶化。运动通常会改善疼痛和僵硬，但休息没有改善。（（3)

许多患有臀部疼痛的人，这表明s骨（SI）关节发炎。SI关节位于脊柱的底部，脊柱在那里遇到骨盆。

颈部疼痛是该疾病的另一种可能症状。脊柱炎的妇女可能患有颈部和周围关节疼痛（膝盖，肘部和脚踝疼痛），而脊柱受累的女性比男性更少。（（4)

强直性脊柱炎的确切根本原因尚不清楚，但据信具有很强的遗传成分，可能是环境成分。

Most individuals who have ankylosing spondylitis have a gene variation called HLA-B27.

For example, over 95 percent of Caucasians with ankylosing spondylitis have the HLA-B27 gene variation, while about 50 percent of African Americans with ankylosing spondylitis have it, according to the Spondylitis Association of America.

HLA-B27基因变体频率低的群体的强直性脊柱炎的发生相应低。

But most people with HLA-B27 do not develop ankylosing spondylitis, and it is not known how HLA-B27 increases the risk of developing it. (5)

Little is known about the environmental factors that trigger ankylosing spondylitis. Some researchers believe that bacterial infections may be a factor.

Is Ankylosing Spondylitis an Autoimmune Disease?

无论它的触发因素如何，强直性脊柱炎都是一种“免疫介导的”疾病，这意味着它是由于人体免疫系统的异常活性而引起的。免疫学家不同意这是否是自身免疫性疾病。

Inautoimmune diseases, the body mistakenly attacks a substance, called an antigen, that’s produced by the body. The blood proteins that attack the antigen are called autoantibodies, and they are detectable in a blood sample.

但在患者自身抗体很少发现ankylosing spondylitis, according toJames T. Rosenbaum, MD, writing for the美国脊椎炎协会。

In recent years, scientists have begun to use the term “auto-inflammatory” to refer to inherited diseases that cause repeated episodes of inflammation in the absence of autoantibodies. In these diseases, it appears the immune system is reacting to something other than a self-antigen.

But because ankylosing spondylitis has some autoimmune characteristics and some auto-inflammatory characteristics, many experts believe it falls into both of these categories simultaneously.

There's no single diagnostic test for ankylosing spondylitis. If your symptoms and medical history suggest you may have it, your doctor will likely do the following:

• 进行一次物理考试,包括你的考试脊柱and rib cage
• 命令X-rays and possibly other imaging tests to look for bone or joint changes
• 命令blood teststo look for inflammation and to rule out other forms of arthritis

会误认为纤维肌痛吗？

People with AS may be misdiagnosed withfibromyalgia, a chronic condition defined by pain and tenderness throughout the body that is often also associated with fatigue, anxiety, depression, sleep disturbances, and problems with memory or concentration.

But the pain of fibromyalgia is not associated with tissue inflammation the way AS pain is. Additionally, a key feature of fibromyalgia is that the pain and other symptoms are not explained by another rheumatic or systemic disorder.

Nonetheless, the results of a survey reported in the June 2019 issue of the journal风湿病and Therapyfound that diagnosis delays and misdiagnoses are common among people with AS, and for women, especially, fibromyalgia is among the fairly common misdiagnoses. (6)

That being said, some people with AS also have fibromyalgia. A study published inPain Physicianin November 2019 found that one-third of patients with axial spondyloarthritis — a form of spondyloarthritis in which the predominant symptom is back pain — also have fibromyalgia syndrome. (7)

It’s also been found that coexisting fibromyalgia in adults with inflammatory arthritis, including AS, tends to worsen the arthritis disease activity. (8)

Ankylosing spondylitis is a chronic disease that lasts a lifetime. But the effects of the disease and severity of symptoms vary from person to person. Some people have mild disease, with few symptoms, while others have chronic pain and stiffness that progress over time.

Effective treatment of ankylosing spondylitis can ease pain and stiffness, preserve physical functioning, and maximize quality of life. In some cases, treatment results in disease remission, meaning a person’s AS symptoms have little or no impact on their daily living, and their lab tests show low or no evidence of inflammation.

Ankylosing spondylitis is treated with a combination of medication and physical therapy.

您的医生处方的第一种药物可能是非甾体类抗炎药（NSAID）， 如naproxen (Aleve, Naprosyn)。

If an NSAID doesn't provide enough relief, or if side effects become problematic, your doctor may prescribe a drug belonging to a category called肿瘤坏死因子（TNF）α受体阻滞剂。

TNF alpha-blockers target the immune system and are used to treat rheumatoid arthritis and some other forms of inflammatory arthritis.

Another, newer option is a type of drug called an interleukin 17 (IL-17) inhibitor. IL-17 drugs also target the immune system, but in a different way from TNF alpha-blockers.

Keeping physically active is key to living well with ankylosing spondylitis.

A physical therapist can teach you specialized exercises to encourage flexibility and strengthen your core so you can more easily maintain an upright posture when sitting and standing.

您的物理治疗师可能还可以就更舒适的睡眠姿势建议您。

Learn More About Treatment for Ankylosing Spondylitis: Medication, Exercise, and Surgery Options

骨质减少andosteoporosis- 低骨骼质量或低骨矿物质密度的术语都是强直性脊柱炎的常见并发症，并且都会增加脊柱骨折的风险。

While lack of physical activity may contribute to low bone mass later in the disease, a study published in July 2015 in the journalRMD开放concluded that inflammation plays a key role in bone loss in ankylosing spondylitis. (9)

强直性脊柱炎的其他潜在并发症包括：

• 主动脉炎
• Aortic valve disease
• Disturbances in the heart’s electrical impulses
• Weakened heart muscles
• Reduced blood flow to the heart
• Fibrosis, or scarring, of the upper lobes of the lungs
• 由于胸壁限制呼吸障碍
• Sleep apnea
• 自发气胸（肺塌陷）
• Uveitis

How Ankylosing Spondylitis Causes Aortic Regurgitation

有些患有AS的人会在心脏底部，主动脉瓣周围以及主动脉的起源（主动脉）发出慢性炎症。

Years of chronic inflammation can lead to aortic regurgitation, a condition that occurs when the aortic valve doesn't close properly, causing blood to flow backward.

According to the American Heart Association, over time,untreated aortic regurgitationcan lead tocongestive heart failure，或心脏严重无法正常运作。

A study published in November 2015 in theAmerican Journal of Medicinereported aortic regurgitation may cause symptoms such asdyspnea— uncomfortable or labored breathing — as well as reduced physical capacity and fatigue that might be wrongly interpreted as symptoms related to a person’s ankylosing spondylitis, not to heart problems. (10)

In this particular study, aortic regurgitation was found in 18 percent of the participants with ankylosing spondylitis. In addition, aortic regurgitation was associated with both age and severity of ankylosing spondylitis.

The researchers suggest that routine care in ankylosing spondylitis include monitoring with both echocardiography and electrocardiography. Once diagnosed, symptomatic aortic regurgitation can be treated with medication or by surgical repair or replacement.

Can Ankylosing Spondylitis Cause Costochondritis?

Costochondritis是导致胸部疼痛和压痛的疾病。疼痛发生在一个称为costerther关节的区域，肋骨与胸骨相交。

In people with AS, pain in the thoracic spine and around the chest wall is common and is a result of the inflammatory disease. People often have pain in the sternum, costosternal areas, and sternoclavicular joints. Because of the inflammation, there may be inadequate chest expansion. This finding is common enough that it’s included in criteria for ankylosing spondylitis. (11)

Ankylosing Spondylitis Progression

Ankylosing spondylitis is a progressive disease. People with AS may initially have pain in the lower back, sacroiliac joints, or buttocks area that progresses to other areas, including the hips, shoulders, or neck.

对于某些人来说，如果疾病未经治疗，炎症可能会导致脊柱融合。According to the Mayo Clinic,这种融合会使脊柱柔韧，从而导致弯曲的姿势。

尽管知识受到AS进展的触发因素的限制，但研究人员认为涉及以下预测因子：（（（12)

• Exposure tobisphosphonates， 一种osteoporosis treatment, in women
• 男性的高C反应蛋白水平，炎症的指标
• Obesity in men and women
• 在男人中吸烟

Data from the U.S. National Health and Nutrition Examination Survey (NHANES) estimated that up to 1 percent of adults in the United States may havespondyloarthritis，一个描述关节炎类型的广义术语脊柱, including ankylosing spondylitis. Other groups have projected the number of people with AS to be approximately 1.1 million to 2.7 million Americans. (13)

虽然任何人都可以被诊断出AS，但通常具有以下特征的人：

年轻至中年Most people with ankylosing spondylitis have their first symptoms between the ages of 20 and 40, although about 10 to 20 percent have symptoms before age 18.

种族Ankylosing spondylitis occurs more frequently in Caucasians, while African Americans usually have more severe disease.

Gender与男性相比，男性更常见。最近的估计表明，每个女性都会出现两到三个男人。人们担心妇女由于症状的不同而被诊断不足。

基因Genetics appear to play a role in ankylosing spondylitis. Specifically, people who have a gene that produces a protein called HLA-B27 are at a significantly higher risk of being diagnosed, although only some with this gene actually get AS. Researchers conclude that a combination of genetic and environmental factors are necessary to trigger ankylosing spondylitis. First-degree relatives (parents, siblings, and children) of an affected person have a higher risk than the general population.

强直性脊柱炎是一组炎症rheumatic diseases known as spondylitis, spondyloarthropathy, or axial spondyloarthritis.

Other forms of spondylitis include nonradiographic axial spondylarthritis (nr-axSpA), a condition characterized by back pain and other symptoms but no visible evidence of chronic inflammation onX-ray。在某些情况下，NR-AXSPA后来变成强直性脊柱炎。

Inflammatory back pain是另一个条件是导致背部和臀部pain, similar to ankylosing spondylitis. It may or may not progress to another form of spondyloarthritis.

About 10 percent of people with ankylosing spondylitis also have a form of inflammatory bowel disease, according to the美国脊椎炎协会。Inflammatory bowel disease includes bothCrohn’s diseaseand溃疡性结肠炎。

强直性脊柱炎的患者患有发育的风险较高AA amyloidosis这是一种罕见的疾病，其中异常蛋白质在体内积聚。在AA中amyloidosis具体来说，淀粉样蛋白的积聚往往会发生在肾脏中。抗炎治疗包括TNFα阻滞剂和白介素-1（IL-1）抑制剂，已证明可以抑制导致AA淀粉样变性的蛋白质的血液水平。（（14)

Decades ago, ankylosing spondylitis was treated with radiation (X-rays) to reduce inflammation in the spine. While the treatment had its desired effect, it also increased the risk ofleukemiaand再生障碍性贫血later in life.

虽然放疗后被药物疗法替换为治疗强直性脊柱炎，但研究人员继续研究现代疗法或疾病本身是否可能与更高的癌症风险有关。

So far, study results have been mixed.

At least two studies using data from national Swedish registers have found no increased risk of cancer among people with spondyloarthritis, according to a review published in March 2018 in the journal医学领域。（（15)

一项对2000年至2008年之间被诊断患有强直性脊柱炎的台湾人的研究发现了更高的发生率前列腺and bone cancers in men,colon cancerin women, and blood cancers in both sexes. The study, published in August 2017 in the journalOncology Letters, also found that people with ankylosing spondylitis tended to develop cancer earlier in life than those who don’t have the inflammatory disease. (16)

在美国风湿病学院2018年会上发表的另一项研究发现，美国某些癌症的风险较高，而其他癌症的风险较低。bob sports app beneficiaries age 65 or older with ankylosing spondylitis. The researchers concluded that it was unclear whether thecancer risks与该人群中的疾病或该疾病的治疗有关。（（17)

Thebest dietfor people with ankylosing spondylitis is one that accomplishes the goals of maintaining a healthy weight, strong bones, and an active lifestyle.

A healthy weight is important to protect the joints and keep the immune system functioning well. Excess weight puts added stress on weight-bearing joints — primarily the knees, hips, and ankles but also the low back — and raises the risk ofosteoarthritisin those joints.

RELATED:To Help Knee Osteoarthritis, Lose Weight

体重不足与疲劳有关，贫血, osteoporosis, and a weakened immune system that cannot fight off illnesses effectively. Low body weight is also associated withinfertilityin women of childbearing age.

If you’re having trouble eating because of dental or消化问题，没有食欲，或发现您没有明显的理由减肥，请与您的医生交谈。

Strong bones require adequate calcium and维生素D。While calcium is relatively easy to get in food, vitamin D occurs naturally in only a few, including cold-water fish and egg yolks. To get enough, therefore, it may be necessary to consume foods fortified with vitamin D, such as milk and certain orange juices and cereals. Exposing your skin to sunlight is another way to raise your vitamin D level.

RELATED:10种维生素D丰富的食物可以增加饮食

饮酒过多也会削弱骨骼，因此，如果您想喝酒，请与您的医生谈谈安全额。

减少已知增加体内炎症的食物量可以降低您的肥胖风险，2型糖尿病和心脏病，并可能减轻连杆性脊柱炎的症状。避免的食物包括：（18)

• Sugar-sweetened beverages
• Highlyf处理oods, such as most packaged baked goods
• Foods high in saturated fat, such as full-fat dairy products and red meat

Learn More About Healthy Eating for Ankylosing Spondylitis

最喜欢的患者倡导组织

关节炎基础

From the leading patient arthritis organization, learn what you need to know to live well with ankylosing spondylitis.

CreakyJoints

This online patient community presents straightforward information on ankylosing spondylitis symptoms as well as opportunities to learn, connect, and advocate with others living with all forms of arthritis.

International Foundation for Autoimmune & Autoinflammatory Arthritis

A nonprofit patient advocacy organization focused specifically on autoimmune and auto-inflammatory diseases with arthritis as a main component of the disease, the IFAA works to raise awareness and advance research on these conditions.

国家强直性脊柱炎学会

For United Kingdom residents with ankylosing spondylitis, this is the place to turn for information and support.

美国脊椎炎协会

U.S. residents with ankylosing spondylitis can find information, message boards, and support groups here, as well as webinars and in-person seminars.

Reliable Sources of Ankylosing Spondylitis Information

美国风湿病学院

Learn the basics on spondyloarthritis, a family of inflammatory rheumatic diseases that include ankylosing spondylitis, from this professional rheumatology organization.

关节炎国家研究基金会

通过订阅新闻通讯，请继续进行强直性脊柱炎的研究。

Hospital for Special Surgery

A leading orthopedic hospital, HSS publishes patient information articles on topics related to ankylosing spondylitis and other causes of lower back pain.

梅奥诊所

This trusted source of medical information offers the basics on ankylosing spondylitis, including what to ask your doctor about your condition and its treatment.

关节炎患者的最佳应用

ArthritisPower

ArthritisPower is a mobile and desktop app that allows individuals with arthritis to track, measure, and share their symptoms and treatment outcomes while simultaneously participating in arthritis research. It was created by CreakyJoints (see above) in collaboration with the University of Alabama at Birmingham and supported by a grant from theNational Patient-Centered Clinical Research Network (PCORnet)。

您可以信任的饮食建议

哈佛T.H.陈公共卫生营养资料来源

这种可信赖的营养信息来源可以帮助您选择饮食浓密的骨头，并解释什么使得好选择。

Everything You Need to Know About Lab Tests

LabTestsOnline

Wondering what that lab test is measuring or what the results mean? This is the place to learn what blood and imaging tests may be done for ankylosing spondylitis.