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Avoid Misunderstandings of Ankylosing Spondylitis
Addtime:2014-06-28 10:04:17 Hit:4626

 

Ankylosing Spondylitis(AS) is a chronic inflammatory disease in sacroiliac joint, spine, paravertebral soft tissue and peripheral joints. It can trigger other diseases begond jionts and lead to poker spine and spine malformation for serious cases.


Due to the insufficient understanding of this disease, some doctors and patients are likely  to misdiagnosis and maltreat it.


Misunderstand 1: Insufficient Understanding of Inflammatory Lumbago and Backache

Inflammatory lumbago and backache is an important clinical feature of ankylosing spondylitis. If a man under the age of 40 suffers from lumbago for over 3 months with morning stiffness and hypnalgia, he may have ankylosing spondylitis. The best choice for him is to ask help from professional docors. However, at this time many patients do nothing or wrongly take folk prescription. In the end, they miss the best time and cause diablility. So early diagnosis and treatment is critical. On the other hand, lots of patients pay little attention to inflammatory lumbago and backache and don't try to find the specific pathogeny, which leads to overtreatment. Actually, the causes of lumbago  is numerous and complicated. For acute lumbago, mechanical lumbago accounts for over 97%, ankylosing spondylitis no more than 0.3%; For chronic lumbago, mechanical lumbago accounts for over 90%, ankylosing spondylitis no more than 3%. Judging from the above information, patients should be cautious to avoid overtreatment.


Misunderstanding 2: Misunderstand the Meaning of HLA-B27 Positive.

Some doctors hold the idea that HLA-B27 Positive stands for ankylosing spondylitis. They are wrong because these doctors don't make their diagnoses by the arthritis standard of 2009 and 2010. In fact, a healthy person also hold 5%-10% HLA-B27 Positive. Doctors should make a full understanding of HLA-B27 Positive through the assistance of clinical and image features. HLA-B27 Positive is a nessary but not sufficent condition during the diagnosis of ankylosing spondylitis.


Misunderstanding 3: Overtreatment or Nagtive Act.

Without realizing the state of ankylosing spondylitis, some patients use drugs blindly and redundantly. Actually, after timely and appropriate treatment,patients of ankylosing spondylitis can recover even better than those of rheumatoid arthritis. As there is little chance for ankylosing spondylitis to trigger other serious diseases, patients' lifetime sustains little influence. However, drug abuse can cause liver and kidney damage or inflammation which may shorten lifetime. Therefore, it is very important to understand the disease and choose safe medicine so as to avoid unproper treatment.


Misunderstanding 4: Ignore the Importance of Functional Exercise.

Moderate functional exercise in the whole treatment process can enhance the performance of spine and joints. Patients should be confident and persistent. Some patients maintain the same gesture for a long time. Although pain ruduces, spine gradually bend, stiff and even cripple.


Misunderstanding 5:  Insufficient understanding of Non-Steroidal Antiinflammatory Drugs

Non-steroidal anti-inflammatory drugs as Fenbid and Celecoxib is more than acesodyne. In fact, they can also work as anti-inflammatory and anti-ossification medicine. Non-steroidal anti-inflammatory drugs can resist ossification indirectly through controlling prostaglandin and leukotrienes. So it' necessary to choose standard and proper medicine and apply medicine according to indications so as to avoid adverse reaction. Such kind of drugs is the first choice for the treatment of ankylosing spondylitis.


Misunderstanding 6: Discount the Importance of AS by Hip Joint Tiredness

Patients should pay extra attention to AS by hip joint tiredness. If patients recieve mistreatment and maldiagnosis, they may cripple in 5 years. So early and active treatment will help the patients recover earlier and effectively.


Misunderstanding 6: Insufficient Understanding of Chinese Medicine

Chinese medicine enjoys the advantages of individualized treatment, security, little side effects and significant effect. Many hospitals like Sun-good TCM Hospital have proved its scientificity, effectiveness and security in clinical practice.


Specialist Introduction

Liu Xiaojia http://www.sun-good.net/en/information.asp?id=125&ClassType=3


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走出强直性脊柱炎诊断和治疗中的误区

                                               

强直性脊柱炎是一种慢性炎症性疾病,主要侵犯骶髂关节、脊柱骨突、脊柱旁软组织及外周关节,并可并发关节外表现,严重者可发生脊柱强直和畸形。


由于医生和患者对本病的认识不足,很容易误诊、误治,本病诊断和治疗中的误区有七:


误区一:对炎性腰背痛认识不足:炎性腰背痛是强直性脊柱炎的重要临床特征,如果一个40岁以下的人起病隐袭,腰背痛3个月以上,有晨僵、夜间痛、活动后疼痛减轻,就要怀疑此人是否是炎性腰背痛,此时,要及时找专科医生进一步诊断。但好多患者忽视了这一时机,消极等待或到非专科就诊或迷信偏方、秘方,结果延误了最佳治疗时机,最后造成了残废。早期诊断,早期治疗,目标治疗,防止致残,这是当前的最新理念。另一方面,由于对炎性腰背痛认识不足,未能按诊疗程序进一步排除一些机械性腰背痛的原因,也可导致过度诊断。其实,下腰痛的原因很多,也很复杂,尤其是急性下腰痛,机械性下腰痛要占97%以上,而强直性脊柱炎只占0.3%以下。而慢性下腰痛,机械性下腰痛占90%以上,而强直性脊柱炎只占3%以下,所以诊断时一定要慎重,不可过度诊断。


误区二:在检查中对HLA-B27阳性的临床意义认识不足:只要HLA-B27阳性就诊断为强直性脊柱炎,未能按09年ASAS提出的中轴型脊柱关节炎的分类标准和2010年提出的外周型脊柱关节炎的分类标准正确诊断。其实,正常的健康人也有5%-10%的HLA-B27阳性,要结合强直性脊柱炎的临床特征、影像学特征,全面理解HLA-B27的意义,即HLA-B27阳性可以作为诊断此病的一个条件,但不是绝对的条件,HLA-B27阴性也不能排除强直性脊柱炎。


误区三:过度治疗或消极等待:不区分强直性脊柱炎处在何阶段,只要一诊断强直性脊柱炎就多种药物一起上。其实,经过早期、规范治疗的强直性脊柱炎绝大多数预后比类风湿性关节炎要好,患者的寿命也不会影响太大,因为本病并发严重的脊柱、关节外脏器损伤的并不高,如果不加区别,生物制剂、非甾体类药物、慢作用药物、雷公藤等药物一起上,如果造成肝、肾损害或严重感染,可能就不一定能活到如期寿命,所以要掌握好本病的病理、病机,个性化治疗,正确选用安全药物,防止治疗过度或不足。


误区四:对功能锻炼的认识不足:适当的功能锻炼要贯彻到整个治疗中,功能锻炼可延缓或防止脊柱、关节进一步融合,锻炼可改善脊柱、关节的功能,要有信心,要坚持,某些患者保持某一姿势,虽然疼痛减轻,但长期下去,脊柱却变弯曲、强直、致残。


误区五:对非甾体类药物的认识不足:认为芬必得、西乐葆……等一些非甾体类药物就是一种止痛药,疼就服,不疼就不服。其实,这类药物不仅能“止痛”,而且还是一个“消炎药”,抗“骨化”药。它可以通过抑制前列腺素、白三烯途径抑制炎症,间接的“抗骨化”作用。所以要规范用药,足量应用。当然,也要选好适应症,严防不良反应发生。此类药不仅是治疗此病的一线药物,而且,也为诊断本病提供一个有用的依据。


误区六:对髋关节受累的强直性脊柱炎重视不够:髋关节受累的强直性脊柱炎一定要格外注意,延误诊断和治疗,5年内将有50%以上患者将要坐轮椅、拄拐杖,所以要早发现早治疗,治疗手段上要更加积极些。


误区七:对中医中药治疗本病的有效性、安全性缺乏了解。中医治疗是个体化治疗,而且可多靶点干预,中药治疗相对安全,副作用小,疗效肯定。这是我国治疗本病的一大优势,神谷等多家大医院已用现代科学手段及临床实践证实了中医药治疗本病的科学性和有效性、安全性。


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