强直性脊柱炎：我们已经让您退缩了

强直性脊柱炎

如何治疗强直性脊柱炎的进展

Knowing how this chronic condition evolves can help you stay one step ahead of it.

byLisa M. Basile 卫生作家

December 1, 2022

盖蒂图像/djelics

December 1, 2022

If you live伴有强直性脊柱炎（AS） - 一种炎症性，免疫介导的疾病，可能导致疼痛，不动和疲劳（除其他问题） - 您可能知道这是可预测的或线性的。一个很好的例子：在星期二下午，您可能会感觉很好，但是到了星期三早上，您超级潮流，被疲劳所压迫。

在纽约市哥伦比亚大学医学中心，董事会认证的风湿病学研究员计划副总监兼董事会认证的风湿病学家副总监Teja Kapoor说，这种日常不可预测性代表了这种疾病经常发挥的方式。

“AS is a highly individual disease that doesn’t manifest in the same way for every patient,” Dr. Kapoor explains. “There really are no cut-and-clear stages of AS. There is a spectrum of disease, ranging from mild to very severe, without one type of disease manifestation.”

That means that everything from AS onset and diagnosis to disease progression may look different for every person with the disease, Dr. Kapoor says. Still, there are some general patterns the disease tends to follow. Here’s what you should know.

强直性脊柱炎：发作和诊断

这re is no clear first stage of AS, says Dr. Kapoor. Where one person might first experience only葡萄膜炎- 眼睛的炎症通常被视为- 其他人可能会逐渐或突然在其s骨，臀部或脊柱（AS的所有常见标志）中突然产生极端的刚度或疼痛。

Complicating matters, symptoms of AS (including eye inflammation and joint pain) can mimic different diseases, making diagnosis tricky, according to the美国脊椎炎协会(SAA).

结果，患有同样的人经常会经历诊断的延迟。Kapoor博士说，很多年来他们有普通的背部疼痛或低级疲劳，并没有意识到它实际上是如此。实际上，根据《杂志》上发表的研究，平均诊断延迟将近七年风湿病，并且更有可能发生在没有很多众所周知的人中AS的体征和症状，包括葡萄膜炎，皮肤受累和/或炎症性肠病（IBD）。因此，有些患有疾病后可能会诊断为更先进的阶段的人。

诊断AS的另一个棘手问题？董事会认证的风湿病学家Stella Bard博士说NY关节炎in Brooklyn, NY. “[Tests] show low levels of inflammation, which is why so many people think the pain is in their heads,” says Dr. Bard. “In a disease like AS, you can't always depend on the blood [results].” She says that rheumatologists (the type of doc that treat AS patients) have to consider the complete picture: bloodwork, symptoms, imaging, and family history.

It’s important to know that gender and race may also play into the diagnosis and progression of AS, says Dr. Bard. Women may more frequently present with颈部疼痛，而不是众所周知的下背部疼痛。更重要的是，临床风湿病学发现黑人美国人比白人和拉丁裔美国人更严重。

For all of those reasons, understanding AS and its progression can be tricky.

作为进展：轻度至中度疾病

卡普尔博士说，同样，强直性脊柱炎可能开始温和，然后在某些人中恶化，而其他患有这种慢性疾病的人根本看不到他们的一生进展太多。

“就像一种缓慢的疾病一样，”卡普尔博士说。“有时炎症或关节损害可能需要几年的时间才能出现。”幸运的是，她补充说，疾病管理可以在减慢其进展方面发挥重要作用。

Bard博士说，对于某些人来说，AS的第一个迹象可能是背部疼痛，早晨的僵硬和/或疲劳，以及肠道障碍或眼部炎症。重要的是要注意，患有早期或温和疾病的人可能会经历以上的某些或全部，但是在成像扫描中没有关节炎症或骨融合（例如X射线或MRI）。

Treating Early AS Symptoms

Kapoor博士解释说，在成像上未显示的强直性脊柱炎的早期症状称为非射线照相轴向脊柱炎（NR-AXSPA），这是AS的亚型。根据发表在风湿病。她指出，尽管症状通常不那么严重，但NR-AXSPA患者通常会接受与AS患者相同的药物治疗。

巴德博士说：“我通常会从抗炎的NSAID（例如非处方Motrin）开始使用轻度或早期。”她补充说，如果在高剂量或长期使用，包括胃肠道问题，这些药物可能会产生副作用。她说，通常情况下，对OTC药物反​​应不佳的人是处方的生物制剂。

这biologics approved to treat AS include TNF inhibitors and Interleukin-17 inhibitors, which reduce inflammatory proteins called tumor necrosis factor (TNF), and Interleukin-17 (IL-17) inhibitors, respectively. “Many of my patients have found relief or even remission with these drugs,” Dr. Bard says.

随着某些人的固定能力

By the time AS disease progression gets more advanced, stiffness can turn into immobility, and pain can become debilitating. “When AS becomes more severe you may not be able to move your neck from side to side, you are very stiff, or most of your joints have been replaced because they’re all ankylosed [stiffened or fused] and damaged,” Dr. Bard says.

可能会导致某些人严重残疾。Kybhosis - 上脊柱的曲率，通常导致驼背的出现 - 是一种风险。在一个学习在135人中，有49％的人患有一定程度的脑膜病。

Another severe risk as AS progresses is spinal fusion, says Dr. Kapoor. “In the spine, syndesmophwytes, or bony growths, grows in the corner of the vertebrae. This is what fuses the spinal vertebrae together over time. It typically takes years.”

Kapoor博士说，并不是每个人都会出现脑脊或脊柱融合，但某些人的风险更高。她说：“炎症水平较高的人面临更严重的风险。”她说，具体来说，具有高红细胞沉降率（衡量红细胞移动的速度）以及更高水平的CRP的人。这些可以通过血液检查来测试。

She says that people who test positive for HLA-B27, a protein associated with AS, tend to have more severe disease, as well. You can test negative for HLA-B27 and still have AS, however.

When it comes to disease severity and gender, AS was long thought to affect men more often (and more severely) than women. However, this is a myth, according to风湿病。正如《华尔街日报》解释的那样，尽管男人可能在腰椎进展更大，而女性在颈椎的进展更大。

该杂志还写道：“ NR-AXSPA与揭示了同等疾病负担之间的比较研究，与性别无关。”和美国脊椎炎协会指出，尽管先前的研究“将男性与AS 3：1的女性挂钩，但新研究表明该比率可能接近1：1。”这可能是由于诊断延迟在有AS的女性中。

Treating Advanced AS

Bard博士说，对于严重的AS，生物制剂是黄金标准，但可以与手术，物理疗法或其他控制疼痛的药物结合使用。“药物的目的，例如NSAIDS和生物制剂，是为了防止严重损害 - 因为一旦发生联合损害，只有关节置换手术。对于脊柱，没有太多逆转。”卡普尔博士说。

Otherapproved medications for ASinclude Janus kinase inhibitors (JAKi), which are a class of synthetic (not biologic) disease-modifying anti-rheumatic drugs (DMARDs). Some people with AS also use different kinds of DMARDs, like methotrexate or sulphasalazine Dr. Kapoor says.

Bard博士补充说：“您拥有的疾病活动越多，或者[您]的时间越长，控制越多。”“ AS的长期后果可能是严重的残疾，甚至是由于betway168 caused by to chronic inflammation. It’s so important to treat the disease early."

她提醒人们，如果一种药物不起作用，请不要灰心。Bard博士建议：“我会鼓励那些治疗方法不好的患者寻求新的治疗方法或找到真正支持您的风湿病学家。”

Lifestyle Changes Can Help Fight AS Progression

除药物外，巴德博士强调了整体管理策略的重要性。实际上，脊椎关节炎的整体方法（可以治疗整个人并包括运动和健康实践）是目标的目标SAA。

首先，Bard博士建议如果您吸烟，请戒烟，因为吸烟是与更严重的AS相关。她补充说，您需要继续前进。“药物还不够。您需要每天伸展和锻炼以保持移动。”这SAArecommends focusing on range-of-motion, balance, cardio, and strengthening exercises.

Nutrition is critical, too. “I talk to my AS patients about nutrition all the time,” Dr. Bard says. “You need to eat anti-inflammatory foods, which focus on whole foods, fresh fruits and veggies, and fish.” She stresses cutting out processed carbs and sugary foods and drinks.

In the end, Dr. Kapoor says, “AS really is a spectrum of disease—and the key is catching and treating it early.” From finding a good rheumatologist, to taking your medication on time, plus implementing healthy lifestyle behaviors, you can take control over the progression of your AS.

认识我们的作家

Lisa M. Basile

丽莎·玛丽·巴西勒（Lisa Marie Basile）（她/她）是一位卫生作家，慢性病倡导者，也是一些诗歌和非小说书籍的作者，包括Light Magic for Dark Times。Her work has appeared in纽约时报,自己更多的

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