赵岩：强直性脊柱炎治疗2007-11.ppt

赵岩 2007 北京协和医院风湿免疫科 AS的自然病程 个体差异大 早期阶段：自然缓解和加重交替 轻的仅累及骶髂关节和腰椎，重的全身关节和关节外器官 AS前期：5-10年；有症状到诊断8.9年 AS起病年龄与确诊年龄分布 AS的临床表现 X线骶髂关节炎是一种后期表现 引发下背痛的原因多种多样 病因分类 机械性:约占97% 内脏疾病:2% 非机械性:占1% 机械性下背痛(97%) 特点 疼痛随活动而加重 可伴背肌紧张和脊柱旁肌肉压痛及背部活动受限 不伴晨僵 先天性脊柱侧弯，腰椎间盘突出等 内脏疾病导致下背痛(2%) 来自盆腔,肾及胃肠病变 特点 在下背部无明确的压痛点 活动或休息对下背痛无明显影响 腹膜后脂肪肉瘤、卵巢乳头状瘤、胃癌等 肿瘤导致下背痛(0.7%) 持续下背痛,以整个夜间重 经卧床、休息或活动均不能缓解 用足量NSAIDs无效 短期内出现下背部活动受限,但无外伤史, 脊柱无骨赘及竹节样变,扩胸度正常 炎性下腰痛的特点 起病年龄40岁 隐袭起病 持续3个月以上 晨僵 活动后减轻 具备以上至少4条对AS的敏感性为95-100% 骨科疾患或正常人有10-15%的假阳性 强直性脊柱炎的诊断(分类)标准和其它常用的评判标准 诊断强直性脊柱炎的纽约标准（1984年修订） 临床标准： 1. 下腰部疼痛至少持续3个月，活动后减轻， 休息后不 消失 2. 腰椎活动受限（矢状面与额状面） 3. 扩胸度较同年龄与性别的正常人减小 肯定AS： 至少1条临床标准 + 3级以上单侧骶髂关节炎或双侧 2级骶髂关节炎 Disease Activity Assessment Bath Ankylosing Spondylitis Functional Index (BASFI) Visual analog scale (VAS) – 10 cm Mean score of 10 questions Questions level of functional disability, including: Ability to bend at the waist and perform tasks Looking over your shoulder without turning your body Standing unsupported for 10 minutes without discomfort Rising from a seated position without the use of an aid Exercising and performing strenuous activity Performing daily activities of living Climbing 12 to 15 steps without aid Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) A self-administered instrument (using 10-cm horizontal visual analog scales) that comprises 6 questions:Over the last one week, how would you describe the overall level of: Fatigue/tiredness AS spinal (back, neck) or hip pain Pain/swelling in joints other than above Level of discomfort from tender areas Morning stiffness from the time you awake How long does morning stiffness last? ASsessment in Ankylosing Spondylitis (ASAS) ASAS 20: An improvement of 20% and absolute improvement of 10 units on a 0–100 scale in 3 of the following 4 domains: Patient global assessment (by VAS global assessment) Pain assessment (the average of VAS total and nocturnal pain scores) Function (represented by