Braun J, Pincus T
Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne, Germany.
Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S16-22.
Patients with ankylosing spondylitis (AS) have about a 50% increased risk of mortality on the basis of the limited amount of data available. There is some evidence that the progression of disease is strongest in the first 10 years of disease but it is also clear that the disease keeps on being active for further decades. The overall burden of disease is similar to rheumatoid arthritis but the overall disease duration of AS is longer. Prognostic factors have also not been studied extensively in AS but it seems clear that early hip involvement indicates a worse outcome. The same is true for early limitation of spinal mobility, laboratory evidence of ongoing disease activity (ESR, hypergammaglobulinemia), peripheral arthritis and dactylitis. The significance of organ involvement for the prognosis, especially in the kidney in the form of amyloidosis, and in the heart and lungs, is less clear. Radiation therapy of the spine, which had been performed quite extensively in former decades, has been associated with a mean radiation dose of about double that of atomic bomb survivors and an increased risk of leukemia and mortality. This therapy has been largely abandoned nowadays. Elder rheumatologists report however that the clinical improvement of irradiated patients has been partly impressive.
基于现有有限的数据，强直性脊柱炎（AS）患者的死亡风险增加约50%。有证据表明，疾病进展在发病的头10年最为强烈，但很明显，疾病在接下来的几十年里仍会持续活动。疾病的总体负担与类风湿关节炎相似，但AS的总体病程更长。AS的预后因素也未得到广泛研究，但似乎很明显，早期髋关节受累表明预后较差。脊柱活动度早期受限、疾病持续活动的实验室证据（血沉、高球蛋白血症）、外周关节炎和指（趾）炎也是如此。器官受累对预后的意义，尤其是以淀粉样变性形式累及肾脏以及累及心脏和肺部时，尚不太明确。在过去几十年中广泛开展的脊柱放射治疗，其平均辐射剂量约为原子弹幸存者的两倍，白血病风险和死亡率增加。如今这种治疗方法已基本被摒弃。然而，年长的风湿病学家报告称，接受放疗患者的临床改善部分令人印象深刻。
