Golder Vera, Schachna Lionel
MBBS, Advanced Trainee in Rheumatology, Austin Health, Melbourne, Victoria.
Aust Fam Physician. 2013 Nov;42(11):780-4.
Ankylosing spondylitis (AS) affects one in 200 individuals and is usually diagnosed many years after onset of symptoms. Chronic back pain is common and recognition of early disease requires clinical experience and a high index of suspicion. Further, inflammatory markers are not invariably elevated and radiographic changes are often late findings.
The objective of this review is to address AS and the recently defined disorder of non-radiographic axial spondyloarthritis. The latter is a common early presentation of AS, before the development of radiographic sacroiliitis, and will evolve into typical AS in 50% of patients.
MRI may be particularly useful in evaluating early disease, although chronic changes of sacroiliitis are better seen on plain X-rays. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy and recent studies suggest that regular use among patients with AS slows radiographic progression. Tumour necrosis inhibitor therapy has strikingly improved quality of life for the more than two-thirds of AS patients with an inadequate response to NSAIDs.
强直性脊柱炎（AS）在每200人中就有1人患病，通常在症状出现多年后才得以诊断。慢性背痛很常见，早期疾病的诊断需要临床经验和高度的怀疑指数。此外，炎症标志物并非总是升高，影像学改变往往是晚期表现。
本综述的目的是探讨强直性脊柱炎以及最近定义的非放射学轴向脊柱关节炎疾病。后者是强直性脊柱炎常见的早期表现，在影像学骶髂关节炎出现之前，50%的患者会发展为典型的强直性脊柱炎。
尽管骶髂关节炎的慢性改变在普通X射线上看得更清楚，但磁共振成像（MRI）在评估早期疾病时可能特别有用。非甾体抗炎药（NSAIDs）是一线治疗药物，最近的研究表明，强直性脊柱炎患者定期使用可减缓影像学进展。肿瘤坏死因子抑制剂疗法显著改善了三分之二以上对非甾体抗炎药反应不佳的强直性脊柱炎患者的生活质量。
