Problem description:
If there are good methods and doctors, please introduce them and refuse advertisements.
Analysis:
Comprehensive treatment of ankylosing spondylitis (June 2002 14)
Kou Bolong: Associate Professor, Deputy Director of Joint Disease Diagnosis and Treatment Center of Peking University People's Hospital. Engaged in clinical teaching and research of orthopedics for more than 20 years. He is good at artificial hip replacement and re-replacement, and completes hundreds of artificial hip replacement operations every year. (Left)
Zhang Xuewu: Associate Professor, Department of Rheumatology and Immunology, Peking University People's Hospital. In-depth study on the pathogenesis and treatment of other autoimmune diseases of ankylosing spondylitis, published many papers and participated in the compilation of monographs. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about ankylosing spondylitis.
Moderator: Ankylosing spondylitis is a very serious disease in the impression of ordinary people, so what kind of disease is it?
Ke Bolong: The earliest lesion of ankylosing spondylitis occurred in the facet joints of the spine. With the continuous development of the disease, it will eventually accumulate at the joints of the lower lumbar spine and lower limbs of the spine, such as knee joint, hip joint and ankle joint. As shown in the figure: the patient has stiff spine and stiff hip joint, so he can't sit. When the patient lies flat and his legs are lifted up, his whole body is lifted up, which is a typical manifestation of ankylosing spondylitis.
Moderator: Why does it cause spinal rigidity?
Zhang Xuewu: Let's look at an X-ray, as shown. The inflammation of ankylosing spondylitis is an immune inflammation, which mainly occurs in joints and soft tissues around joints. If inflammation occurs repeatedly, the joint will calcify and ossify, and finally the joint will be unable to move, which will seriously affect the function of the joint.
Moderator: What effects does ankylosing spondylitis have on patients' daily life?
Kou Bolong: Ankylosing spondylitis involving joints will seriously affect the daily life of patients, as shown in the figure. This is a patient with late ankylosing spondylitis. After developing to a certain extent, the joints are stiff and the patients are mostly young people. If the early ankylosing spondylitis is not treated systematically and effectively, it will develop into this situation in the later stage.
Moderator: Does ankylosing spondylitis affect other parts besides joints?
Bolong Ke: Yes, as shown in the figure. For example, this effect is manifested in the spine that can't look up and the ankle that can't stand. Because the muscles are stiff and unable to move, they will shrink and become skinny, so the patient is very painful.
Moderator: Does lying in bed often without exercise have an effect on breathing?
Kou Bolong: In the early stage of ankylosing spondylitis, the respiratory function has been affected because of the pathological changes in the spine. Because the chest can't move, it will definitely affect their breathing. Ankylosing spondylitis may even lead to disability when it develops to the late stage.
Moderator: What is the cause of ankylosing spondylitis?
Zhang Xuewu: The underlying cause of ankylosing spondylitis is still unclear. At present, it is considered that ankylosing spondylitis has a genetic tendency, and a special gene is related to this disease. In addition, the infection of some intestinal bacteria may also be the cause of ankylosing spondylitis.
Moderator: So how to avoid inducing ankylosing spondylitis in daily life?
Zhang Xuewu: Some inducement acts on some individuals with genetic factors, mainly referring to environmental factors, such as trauma, cold and humid environment and so on.
Moderator: Are there many people suffering from this disease in life?
Kou Bolong: According to foreign reports, the incidence is 0.5%-2.5%. In China, the incidence rate is about 4%. The onset age can range from 10 to 45 years old, and the peak of onset is 15 -35 years old. The incidence rate of males is higher than that of females, with males accounting for about 90% of the total incidence rate and females only accounting for 10%.
Moderator: Is there any early situation that can predict the occurrence of ankylosing spondylitis?
Zhang Xuewu: Early symptoms of ankylosing spondylitis are often easily overlooked, including:
Early common symptoms of ankylosing spondylitis
1, unexplained lumbosacral pain
2, morning stiffness phenomenon
3, lower limb joint swelling and pain
4, eye disease-iritis
Moderator: When these early symptoms are found, what kind of examination should be done?
Zhang Xuewu: It is very important to go to the department of rheumatology or orthopedics for X-ray and CT examination after the above symptoms appear in the early stage. Other examinations include medical history inquiry, physical examination, special gene examination, immunoglobulin examination and erythrocyte sedimentation rate.
Moderator: If you are diagnosed as ankylosing spondylitis, how should you treat this disease?
Zhang Xuewu: As long as most patients can be treated at an early stage, establish a good attitude and actively cooperate with the treatment, this disease can be well controlled. The specific processing method comprises the following steps:
Drug treatment of ankylosing spondylitis
1, anti-inflammatory painkillers (indomethacin, ibuprofen, etc. )
2. Slow-acting drug (sulfasalazine)
3. Immunosuppressant (methotrexate)
Take anti-inflammatory painkillers when you have pain. When there is no pain, you can not take anti-inflammatory painkillers, but you must insist on taking slow-acting drugs. In addition, it is necessary to cooperate with functional exercise. If you don't do functional exercise, it is likely to cause stiffness in non-functional positions. As shown in the figure: this is functional rigidity, that is, the spine cannot bend, and the legs and knees cannot bend. As shown in the figure: If the patient is in such a non-functional state, he will be unable to take care of himself, resulting in disability.
Bolong Ke: Functional exercise is emphasized because if you don't keep exercising, the joints will be inflamed repeatedly and finally ossified, which will affect the normal function of the joints.
Moderator: What are the specific exercise methods?
Ke Bolong: The sports methods are 1, cycling 2, swimming 3 and blowing balloons.
Moderator: Do patients with ankylosing spondylitis need to quit smoking?
Kou Bolong: Because most patients with ankylosing spondylitis are young and middle-aged men, smoking will aggravate their illness because of their chest stiffness.
Bolong Ke: In addition, the clinic shows that the younger the patient is, the greater the chance of disability. Some patients may get sick in their thirties and forties, but their illness will progress slower than that of young people.
Moderator: Under what circumstances will surgery be used for treatment?
Bolong Ke: Once rigidity occurs, early surgery should be performed. The purpose of the operation is to improve joint function. As the picture shows, this is a 20-year-old patient with stiff spine, hip joint and knee joint. We solved this problem by joint replacement. He was able to stand up two weeks after operation, and he was able to ride a motorcycle upstairs during the two-year follow-up after operation. Therefore, patients with ankylosing spondylitis should not be too pessimistic. Even in the late stage, they can recover their functions by surgery.
Moderator: Is it even cured after the operation?
Kou Bolong: Ankylosing spondylitis was not cured after joint replacement, but it solved the joint function problem. You should also go to the rheumatology immunology department for further treatment.
Moderator: Why didn't the operation mentioned above target the spine?
Kou Bolong: Because the stiffness of the spine will not have a great impact on daily life, and because the operation of the spine is complicated and has certain risks, if it is really necessary to perform surgery on the spine, it is recommended to go to a large specialized hospital for surgery.
Moderator: Ms. Zhang from Beijing is 48 years old this year. What methods can prevent ankylosing spondylitis?
Zhang Xuewu: The etiology of ankylosing spondylitis is still unknown. From the point of view of prevention, if someone at home suffers from this disease, we should be vigilant, such as cold and humid environment, strenuous exercise and so on. In addition, it is necessary to strengthen the understanding of the disease, and once there is an adverse reaction, it is necessary to go to the hospital for treatment in time.
Moderator: Mr. Liu from Anhui, aged 24. I can't bend down, it hurts. Is it ankylosing spondylitis?
Kou Bolong: The patient's age belongs to the incidence range of ankylosing spondylitis, but we should also consider whether there is pain in the back, that is, lumbosacral region. This kind of unexplained low back pain is recommended to go to the hospital for blood tests. This kind of examination can be done in regular tertiary hospitals.
Moderator: Mr. Hao from Hunan, 45 years old. I am taking medicine to treat ankylosing spondylitis. Is it better to take indomethacin and ibuprofen at the same time
Zhang Xuewu: No, indomethacin and ibuprofen are both anti-inflammatory and painkillers. Theoretically, if an anti-inflammatory drug is not effective, it can be added to a sufficient amount. If it is not good, you should stop taking this medicine and switch to other medicines. Taking two different anti-inflammatory drugs at the same time can not only achieve the purpose of relieving pain, but also produce side effects.
Moderator: Can ankylosing spondylitis be completely cured?
Bolong Ke: At present, the disease can't be completely cured, but if it is found early, it can be controlled to continue or develop slowly. The more young people get sick, the more they need the guidance of functional exercise to prevent serious deformity.
Moderator: Mr. Ju from Qinhuangdao, aged 29. 1998 got ankylosing spondylitis. At that time, I took medicine for treatment, but now I have stopped taking medicine. I feel stiff in the waist recently. Do I have to continue taking the medicine?
Zhang Xuewu: Ankylosing spondylitis is characterized by recurrent attacks during the course of the disease. After systematic treatment, the condition tends to be stable, but it may get worse under some incentives. You should go to the hospital to take blood and take a picture. If the disease does recur, it should be treated systematically.
Moderator: Mr. Zhang from Chengdu, 55 years old. I have had a backache for several years. I was diagnosed with ankylosing spondylitis last year. How should I treat it?
Kou Bolong: The patient's age is not within the age range of onset of ankylosing spondylitis, and he needs to go to the hospital for further diagnosis. Osteoarthropathy in the elderly may also have symptoms of low back pain.
Moderator: Ms. Li Qinghai is 27 years old. I am ankylosing spondylitis 1 year, and now I have basically recovered. Will I get pregnant?
Zhang Xuewu: Ankylosing spondylitis is a disease with hereditary tendency, and it is very likely that the next generation of patients will also suffer from this disease. In addition, ankylosing spondylitis generally does not affect the delivery of pregnant women, but if the hip joint is stiff, caesarean section is generally used during delivery.
Moderator: Mr. Zhao from Jilin, aged 27. I have ankylosing spondylitis 15, and my hip joint has been ankylosing for 8 years. Now I want to have an operation to replace the artificial hip joint. Will it still hurt after the operation?
Kou Bolong: Generally, ankylosing spondylitis is that two joints are stiff at the same time, and surgery can be performed without pain. It should be emphasized that systematic functional exercise should be carried out after the operation. As long as the patient's physical condition permits, this operation should be carried out on both hips at the same time, because the joint function can be restored at the same time after completion. If for some reason only one hip surgery can be done first, then the problem of the other hip joint should be solved as soon as possible. If it is delayed for too long, it will definitely affect joint activity.
Moderator: I am 34 years old and I am in Zhao Nvshi, Yunnan. I have been taking medicine for treatment, and the effect is good. Can I stop taking the medicine?
Zhang Xuewu: It is generally believed that slow-acting drugs should be taken for more than 1 year, and it is ok to stop taking anti-inflammatory and analgesic drugs after painless, but whether they can stop taking drugs in the end needs a comprehensive evaluation by the hospital.
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