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Genetic Factors
AS exhibits familial clustering. Studies have shown that the probability of first-degree relatives developing AS is as high as 31.3%. The expression of the HLA-B27 gene is highly correlated with AS, but not all HLA-B27 positive individuals will develop AS.
Infection Factors
Research has indicated a certain relationship between AS onset and chronic infections, with the genitourinary and gastrointestinal tracts being the most common susceptible sites. Pathogens such as Chlamydia trachomatis, Shigella, and Salmonella are commonly associated with AS.
Immune Factors
To date, over 100 cytokines and chemokines have been found to be involved in the inflammatory response of AS. Patients with AS exhibit higher levels of immune-inflammatory factors compared to normal individuals, suggesting the involvement of immune factors in the pathogenesis of AS.
Environmental Factors
Patients are sensitive to climate changes, and cold, damp weather and environmental factors, as well as exposure to cold water, can trigger the onset of ankylosing spondylitis.
Lifestyle and Occupational Stress
Certain occupations that involve prolonged sitting, such as long-haul truck driving, can lead to spinal immobility, affecting joint mobility and potentially causing spinal injury due to prolonged vibration and jolting during travel.
Increased Stress on the Spine and Joints
Increased stress on the tendinous attachment points of the muscles can promote or exacerbate the inflammatory response, thereby contributing to the onset of the disease.
Inflammatory Back Pain
Chronic back pain is the most characteristic symptom in early-stage patients, typically manifesting as dull pain in the lower back or spine, often accompanied by morning stiffness, fatigue, and pain at rest. The pain is prominent during the night, upon waking, or after prolonged sitting, and is alleviated by activity. As the condition progresses, patients may experience pain and limited mobility in the thoracic and cervical spine, as well as spinal deformities.
Peripheral Joint Arthritis
Some patients present with peripheral joint arthritis as the primary symptom, mainly characterized by swelling in single or few joints such as the hips, knees, ankles, and shoulders. Adolescents may experience hip joint arthritis as the initial symptom, leading to hip pain and potential hip joint deformities due to rapid skeletal growth during adolescence.
Enthesitis
Enthesitis commonly affects the heel, sole of the foot, as well as the knee joint and the junction of the chest and ribs, often accompanied by tenderness and swelling in the affected areas.
Engage in reasonable exercise, with a preference for aerobic exercise such as walking, Tai Chi, etc., to maintain optimal spinal joint positioning, enhance paraspinal muscle strength, increase lung capacity, and help control the disease.
Choose a firm mattress and adopt a supine sleeping position, avoiding lateral bending. The pillow should be slightly lower. If symptoms of cervical or thoracic spine involvement occur (such as neck pain and restricted chest movement), consider sleeping without a pillow.
Maintain an upright posture while standing and sitting, which helps to preserve normal spinal function.
Provide necessary physical therapy for pain, inflammatory joints, or soft tissues.
For severe AS patients, such as those with significant narrowing of the hip joint space, femoral head necrosis, or significant spinal deformities affecting quality of life, surgical treatment may be considered.
Total Hip Arthroplasty
Regardless of age, total hip arthroplasty is a viable option for patients with refractory hip joint pain, narrow joint space, ankylosis, and deformities. However, the decision to undergo surgical treatment should be made jointly by orthopedic and rheumatology physicians.
Spinal Correction Surgery
Spinal correction surgery involves altering the degree of spinal curvature through procedures such as osteotomy. Due to the high risks associated with such surgeries, they should be carefully considered for patients with less severe spinal deformities.
Internal Traditional Chinese Medicine Treatment
Ankylosing spondylitis falls within the scope of traditional Chinese medicine as "lumbar impediment," "lumbar pain," "bamboo joint wind," "bone impediment," "turtle back wind," "kidney impediment," "limping impediment," and "pregnancy impediment." The disease is generally characterized by underlying deficiency and overt stagnation. The clinical approach primarily involves nourishing the liver and kidneys, tonifying the kidneys and strengthening the governing vessel, and dispelling pathogenic factors. Major components of traditional Chinese medicine include total glycosides of Tripterygium wilfordii, total glycosides of Paeonia lactiflora, and matrine.
External Traditional Chinese Medicine Treatment
Various external treatment methods in traditional Chinese medicine, such as acupuncture, massage, cupping, and medicated fumigation, can alleviate symptoms, improve joint function, and prevent deformities in affected areas.
Due to AS being a chronic, systemic, and systemic inflammatory disease, it can affect organs other than the spine and peripheral joints, leading to corresponding complications in the eyes, heart, lungs, kidneys, and gastrointestinal tract.
Ocular Manifestations
Ocular manifestations, such as acute anterior uveitis and acute iritis, are the most common extra-articular manifestations. Acute conjunctivitis may also occur.
Renal Involvement
Renal damage in AS patients mainly presents as amyloidosis and IgA nephropathy.
Cardiac Involvement
AS patients may develop aortic root and aortic valve lesions, as well as abnormalities in the cardiac conduction system.
Gastrointestinal Manifestations
Gastrointestinal symptoms are related to the disease's gastrointestinal inflammation and mucosal immune responses, as well as potential adverse reactions to NSAIDs. Symptoms may include loss of appetite, nausea, vomiting, diarrhea, rectal bleeding, and abdominal pain.
Pulmonary Involvement
In a minority of patients, advanced stages may lead to irregular fibrotic lesions in the upper lung lobes, manifested as coughing, asthma, and even hemoptysis, potentially accompanied by recurrent pneumonia or pleurisy.
Dietary Recommendations
The diet should be light, balanced, and nutritious, avoiding selective eating and overeating. Emphasis should be placed on hygiene, adequate water intake, and avoidance of urinary retention, as genitourinary and gastrointestinal infections can trigger spondylitis. Consumption of vegetables and fruits should be encouraged to prevent constipation.
Dietary Restrictions
Some patients may experience allergic reactions to certain foods. Therefore, it is important to be aware of any allergy history and avoid foods that may cause allergic reactions.
Rest: Choose a firm mattress and adopt a supine sleeping position, avoiding lateral bending. The pillow should be lower, and if symptoms of cervical or thoracic spine involvement occur, consider sleeping without a pillow. Maintain an upright posture while standing and sitting.
Exercise: Engage in reasonable exercise, primarily aerobic, such as walking, Tai Chi, etc. Avoid excessive physical activity that may cause sustained pain in the affected areas.
Smoking Cessation: According to research, smokers have a poorer prognosis compared to non-smokers. Therefore, smoking is considered one of the adverse prognostic factors.
Women can conceive, undergo pregnancy, and give birth normally, and men can conceive normally, especially for patients in the early stages of the disease with no joint or spinal deformities. If the condition worsens during pregnancy, it is advisable to seek professional treatment advice from rheumatology and immunology specialists and follow their recommendations, considering the timing of conception from the perspective of eugenics.
