强直性脊柱炎引起骨代谢紊乱的分子学机制

强直性脊柱炎属于风湿免疫科的常见疾患,以累及骶髂关节和中轴骨的自发性炎症为病变特征,除脊柱关节的进行性退化、功能遭受破坏外,全身性骨代谢紊乱贯穿疾病的始末,后期极易导致脆性骨折的发生,严重影响患者身心健康和生活质量。骨质疏松作为强直性脊柱炎最常见的并发症,其本质还是强直性脊柱炎引起的机体内环境紊乱,破骨细胞与成骨细胞之间脱耦联,骨吸收作用强于骨形成,进一步造成骨代谢失衡、骨量丢失。本文在分子生物学层面围绕强直性脊柱炎造成骨代谢紊乱的具体机制展开综述,阐明二者之间的因果关系,为强直性脊柱炎诊疗过程中积极配合抗骨质疏松治疗提供科学依据,以期更好地指导临床。     

强直性脊柱炎的骨密度变化及其临床意义

强直性脊柱炎的骨密度变化及其临床意义王全平王晶于会东刘继中强直性脊柱炎是引起腰背痛和脊柱僵硬的慢性疾病。主要侵犯脊柱关节，骶髂关节，有时累及髋关节，同时也引起脊柱及全身骨质疏松。我们观测了１１３例临床和Ｘ线诊断为强直性脊柱炎患者的骨密度，本文报告观测...     

强直性脊柱炎与腰椎间盘突出症鉴别体会

目的　提高强直性脊柱炎与腰椎间盘突出症鉴别诊断水平。方法　分析 35例强直性脊柱炎被误诊为腰椎间盘突出症的原因 ,从症状、体征、影像学、实验室检查、遗传史方面进行鉴别诊断。结果　 35例均符合强直性脊柱炎修改纽约诊断标准 ,虽有腰椎间盘膨隆、突出影像 ,但与临床体征不一致。结论　过份依赖影像学检查而忽视临床检查 ,对强直性脊柱炎缺乏认识 ,是误诊的根本原因。以临床检查为基础 ,辨证分析影像表现 ,方能提高诊断准确率 ,而不至于漏诊强直性脊柱炎、肿瘤等脊柱相关疑难疾病。     

强直性脊柱炎引起的骨质疏松性椎体骨折风险评估

强直性脊柱炎(AS)除了有椎间盘纤维环及其附近韧带的钙化和骨性强直,还常伴有骨质疏松,发生率为50%～92%.对于骨质疏松来讲,最为常见的骨折形式即为椎体骨折,但单纯骨质疏松症所造成的椎体骨折与AS继发椎体骨折有着不同的特点,如何评估其骨折风险,是一个重要问题.本文就AS造成的骨质疏松及椎体骨折的风险评估方法进展进行了综述.     

非甾体类抗炎药治疗强直性脊柱炎的研究现状及展望

非甾体类抗炎药是治疗强直性脊柱炎的一线药物。随着制药水平和科技的进步,非甾体类抗炎药在制剂类型、服用方法、临床疗效和副作用等方面均有明显改善,对于非甾体类药物治疗强直性脊柱炎方面的研究逐渐增多。就近年来非甾体类抗炎药治疗强直性脊柱炎的作用机制、临床疗效及其副作用等方面进行综述。     

465例强直性脊柱炎患者HLA-B27结果的调查分析

目的通过对465例强直性脊柱炎患者外周血HLA-B27的检测,了解HLA-B27阴阳性患者在强直性脊柱炎中的情况。方法用流式细胞术对强直性脊柱炎患者的HLA-B27进行测定。结果HLA-B27阴性患者占10.5%,HLA-B27阳性患者占89.5%。结论HLA-B27是诊断强直性脊柱炎的一个重要指标,但不能单独从HLA-B27的阴阳性来判断强直性脊柱炎。还需要结合临床进行综合判断。另外我们还发现HLA-B27阴性强直性脊柱炎患者女性比例较高。     

环磷酰胺冲击治疗强直性脊柱炎临床观察

环磷酰胺冲击治疗强直性脊柱炎临床观察杨剑辉，梁俊林，王艳侠强直性脊柱炎（ＡＳ）是严重影响人们生活和劳动能力的慢性进行性疾病，临床治疗缺乏有效方法。大剂量环磷酰胺静脉冲击疗法（ＣＴＸＩＶ）在系统性红斑狼疮［１］、类风湿性关节炎［２］及其它胶原血管病已取...     

以痛风样症状起病的强直性脊柱炎1例

报道1例少见的以痛风样症状起病为主要表现,误诊为痛风的、不典型强直性脊柱炎病例。结合临床资料及文献复习探讨误诊原因。不典型强直性脊柱炎早期可以表现为痛风样症状,而无炎症性腰背僵痛等强直性脊柱炎表现,易被误诊。对于年青患者特别是30岁以下的患者,如果以痛风样症状起病,切不要忘记和强直性脊柱炎作鉴别诊断。     

中医健脾单元疗法对强直性脊柱炎患者疗效、生活质量及心肺功能的影响及机制研究

通过对大量文献的研究,总结强直性脊柱炎的中医病因病机及患者生活质量、心肺功能的变化,分析中医健脾单元疗法在改善强直性脊柱炎患者的疗效、生活质量及心肺功能的机制。深入研究中医健脾单元疗法治疗强直性脊柱炎,将有助于进一步提高其临床效果,降低强直性脊柱炎患者致残的风险,提高生活质量,改善远期预后。     

补肾通络法治疗强直性脊柱炎合并骨质疏松的理论探讨

强直性脊柱炎是临床常见的风湿病,多见于青壮年,病程长,严重影响了患者的生活质量。骨质疏松是强直性脊柱炎常见的合并症,但并未引起足够的重视,且缺乏有效的治疗方法。中医药在认识和治疗强直性脊柱炎合并骨质疏松有着独特的优势,基于本病多虚多瘀的病机特点,发挥补肾通络法在临床治疗过程中的理论指导作用,达到治病求本的目的,为强直性脊柱炎合并骨质疏松的治疗提供理论依据。     

Radiology of seronegative spondyloarthropathies

Radiographic manifestations of the seronegative spondyloarthropathies superficially resemble the findings of rheumatoid arthritis although they differ in both distribution and pattern of disease. Ankylosing spondylitis has a predilection for the axial skeleton; psoriatic arthritis may involve distal interphalangeal joints; and Reiter's syndrome is most commonly associated with asymmetrical lower extremity alterations. The absence of osteoporosis and the presence of bony proliferation are also noted in these disorders. Sacroiliitis and spondylitis, which can be observed in any of these disease, may have distinctive features. In ankylosing spondylitis, bilateral saroiliac joint alterations and typical syndesmophytes are common; in Reiter's syndrome and psoriasis, asymmetrical saroiliac joint changes and bulky spinal outgrowths may be observed. The physician should be aware of typical roentgen findings in each of the spondyloarthropathies.     

Spondyloarthropathies--clinical evaluation and physical therapy

Spondyloarthropathy is a group of chronic autoimmune disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, acute anterior uveitis and undifferentiated spondyloarthropathies. The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. The major goal in the management of patients with rheumatic disorders is to control or cure the disease and to preserve and control function and health status. To measure treatments' efficacy standardized assessment of organ morphology, function, and of health status are required. The instruments for measuring health status or quality of life cover a variety of dimensions of health, including physical, social, and emotional functioning. Measurements used to evaluate the efficacy of treatments in ankylosing spondylitis include spinal and chest movement, duration and severity of morning stiffness, and quality of sleep. Health status indices such as the HAQ or AIMS are not readily applicable to spondyloarthropaties. It is reason to use some others: 1. Functional status measure S-HAQ for patients with spondylitis by adding five items to the HAQ, to cover the activities identified as most problematic; 2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index - DFI) - it is valid and reliable and shows sufficient responsiveness; S-HAQ appears at least as sensitive to change as the Dougados Index; 3. The Leeds Disability Questionnaire assesses disability in ankylosing spondylitis, inquiring about four areas of function: mobility, bending down, reaching up and neck movements, and postures; 4. The Bath Ankylosing Spondylitis Functional Index (BASFI) 10 item self-administered questionnaire to assess function and activities of daily living in patients with ankylosing spondylitis. Physical therapy is one of the most important way to restore function and health status in patients with spondyloarthropathies, esspecially individual kinesitherapy. We use and many other procedures combine them with kinesitherapy (ultrasound, cryotherapy, electrotherapy, laser ...).     

强直性脊柱炎股骨近段形态学改变对全髋关节置换术假体选择的意义

目的分析强直性脊柱炎股骨近段的形态学改变,及其改变对全髋关节置换术假体选择的意义。方法1999年1月~2004年6月,将13例(16髋)强直性脊柱炎患者设为选择组,患者均已出现关节强直,需行全髋关节置换术。另16例(19髋)为对照组,为非强直性脊柱炎患者而拟行全髋关节置换术。两组患者均摄髋关节正侧位X线片,测量Singh指数、髓腔张开指数、皮质形态指数及皮质骨指数,并进行统计学分析。结果选择组Singh指数、髓腔张开指数及皮质形态指数分别为3.81±0.54、2.63±0.41及2.02±0.38,对照组分别为4.63±0.62、3.03±0.27及2.76±0.28,两组比较差异均有统计学意义(P<0.05)。选择组皮质骨指数为1.69±0.69,对照组为2.12±0.24,两组比较差异无统计学意义(P>0.05)。选择组患者髓腔呈烟囱型10例13髋,普通型3例3髋;对照组烟囱型3例3髋,普通型13例16髋。结论强直性脊柱炎的全髋关节置换术应采用骨水泥型人工关节假体,并根据患者髓腔形态使用定制型骨水泥假体,以达到更好的近段固定效果。对于有严重骨质疏松者应按关节翻修术处理。     

Common bone turnover markers in rheumatoid arthritis and ankylosing spondylitis: A literature review

We studied the impact of inflammatory rheumatism and its treatment on the most common bone turnover markers, based on six previously defined questions in a systematic literature review in order to define their place in daily clinical practice. The role of bone is currently considered of particular importance concerning cartilage damage in inflammatory rheumatism (rheumatoid arthritis and ankylosing spondylitis) and the new concept of osteoimmunology has emerged. Some bone turnover markers are available in clinical practice. In spite of rich and extensive literature on bone turnover markers, their use in inflammatory rheumatism or even osteoporosis is not clear, and a systematic literature review became necessary. In spite of a large number of different markers used in literature, few of them that are useful in common practice have been studied in the field of inflammatory rheumatism such as rheumatoid arthritis and ankylosing spondylitis. Although their study enables understanding of the physiopathological mechanisms of osteoporosis in inflammatory rheumatism, their use in current common practice cannot be recommended. Interesting data on the forecast of the structural evolution of rheumatoid arthritis has been found within the framework of clinical research, without any real practical impact today.     

强直性脊柱炎颈椎骨折影像学特点及手术方式选择

目的 探讨强直性脊柱炎(ankyiosing spendylitis AS)合并颈椎骨折的影像学特点和手术方式选择;方法对30例强直性脊柱炎颈椎骨折(ankylosing spondylitis cervical spine fractureASCSF)患者的影像学特点以及前路、后路和前后路联合三种不同手术方式的结果进行分析;结果强直性脊柱炎颈椎骨折多表现为三柱损伤,多合并相对较重的脊髓损伤,影像学特点根据骨折脱位的不同表现不同,骨折多位于椎间隙部位,部分无明显脱位的患者X线和CT检查易漏诊,MRI检查阳性率较高,治疗上首选外科手术稳定融合和脊髓减压,手术方式可根据骨折脱位情况和脊柱强直情况不同选择不同的稳定方式.结论 强直性脊柱炎颈椎骨折一种相对严重的损伤,影像学根据损伤不同表现不同,治疗上以手术稳定脊柱和脊髓减压为主,前路、后路和前后路联合稳定脊柱是主要方式.     

幼年型强直性脊柱炎病人的骨质疏松

目的 探讨幼年型强直性脊柱炎病人的疾病活动性与骨质疏松的关系以及服用强的松对骨质疏松的影响。方法 16例病人按血沉>30 mm/h和<30 mm/h分成两组,用双能X射线吸收法(DEXA)测定他们的腰椎正位和股骨颈的骨密度。比较服用和未服用强的松的两组病人的骨密度。结果 两组病人的C反应蛋白(CRP)有显著差异,高活动性组的腰椎与股骨颈的骨密度都小于低活动性组,股骨颈骨密度的差异在统计学上有显著性意义。服用和未服用强的松的两组病人的腰椎骨密度和股骨颈骨密度无差异。结论 对于幼年型强直性脊柱炎病人,测定股骨颈的骨密度比腰椎更加合适。服用和不服用强的松的两组病人的腰椎和股骨颈骨密度无显著差异,说明病人可以尽早使用强的松以控制炎症。不过持续使用强的松的时间不宜超过半年,剂量不宜超过15 mg/d。     

The kaleidoscopic presentation of the spondyloarthritis concept in a female patient

Spondyloarthritis is a group of chronic joint diseases that share clinical, pathological and genetic features and is divided into distinct diagnostic entities, including ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-associated spondyloarthritis, reactive arthritis, juvenile onset and undifferentiated spondyloarthritis. Since the spectrum of spondyloarthritides is wider than the sum of aforementioned disorders suggests, the term "Spondyloarthritis concept" might prove to be appropriate. Here, we present a case in which many features of the spondyloarthritis concept, but also unexpected osteitis in the skull and tibia, emerge during the disease course. A 45-year-old HLA-B27 positive woman with a family history of psoriasis, a former diagnosis of ankylosing spondylitis, reactive arthritis and fulminating acne, was referred to our department with a painful tibial swelling, symmetrical polyarthritis and severe headache. Conventional radiography and bone scintigraphy demonstrated large osteolytic lesions on the left parietal side of the skull and the right anterior tibia. She was treated with surgery and pamidronate. Etanercept treatment was initiated as the arthritis deteriorated and was replaced by infliximab when new onset Crohn's disease became apparent. This case is the illustration of spondyloarthritis as a disease concept, covering the entire spectrum, from ankylosing spondylitis, urogenital reactive arthritis and psoriatic arthritis to inflammatory bowel disease. Cases like this illustrate that the clinical classification of spondyloarthritis patients into distinct diagnostic entities is bypassing the value of the "concept" and provides support for the new classification criteria that were recently proposed.     

A new look at the epidemiology of ankylosing spondylitis and related syndromes.

Among the rheumatic diseases, non so clearly illustrates the relations between host and environmental factors as the seronegative spondyloarthropathy group of disorders. The strongest association is with the histocompatibility antigen HLA-B27, which accounts for a striking susceptibility to these diseases and is present in over 90% of individuals with idiopathic ankylosing spondylitis. Next in importance appears to be a difference in sex penetrance with males predominating in all categories. The most dramatic sex relationship is with postvenereal Reiter's syndrome which has a male-to-female ratio of nearly 50:1. Another potent host factor is age, with increased predisposition to onset at puberty and young adulthood in HLA-B27-positive patients. Environmental or possibly infectious agent influence are most apparent in Reiter's syndrome, where the antecedent circumstances of venereal contact and bacillary dysentery are frequent precipitating events. Secondary forms of peripheral arthritis, radiographic sacroiliitis, and ankylosing spondylitis frequently occur in psoriasis and inflammatory bowel disease; in the case of peripheral arthritis, there is no or a significantly reduced association with HLA-B27 compared to AS or RS. Secondary factor seem to be contributing to spondyloarthropathy in these disorders. These iterrelations emphasize the powerful effects of host characteristics on the type of rheumatic disease syndrome acquired and provide superb opportunities for more precise understanding of disease pathogenesis and ultimate control through the integration of epidemiologic, clinical, and laboratory research.