强直性脊柱炎28562.ppt

Clinical Features of AS Sacroiliitis is the hallmark feature of AS1 and the earliest, most consistent findings are traceable to effects of sacroiliitis and enthesitis. Inflammation of the discovertebral, apophyseal, costovertebral, and costotransverse joints of the spine, and paravertebral ligamentous structures are frequently associated with AS. After many years, chronic inflammation can cause bony ankylosis.2 ? Chronic low back pain and stiffness, which typically worsens following a period of prolonged inactivity (eg, morning stiffness), are common presentations.1 Over time, lumbar spine mobility becomes restricted in all planes and posture becomes abnormal because of flattening of the lumbar spine and accentuated dorsal spine kyphosis. Radiographic findings in advanced disease include erosions, sclerosis of adjacent bones, pseudo-widening of the sacroiliac joint space, and fibrosis, calcification, interosseous bridging, and ossification of the sacroiliac joints. Extraskeletal manifestations are also frequently part of the clinical picture.2 Khan MA. Spondyloarthropathies. In: Hunder GG, ed. Atlas of Rheumatology. 3rd ed. Philadelphia, Pa: Lippincott Williams Wilkins; 2002. Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. vol 2, 3rd ed, New York, NY: Mosby; 2003:1161-1181. * * * * * Disease Activity and Disability Assessment Instruments Complete agreement does not exist with regard to the specific instruments that should be used to measure disease activity; however, a questionnaire directed at specialists in the field of AS indicates that many experts prefer the Bath AS Disease Activity Index (BASDAI) and/or the Bath AS Functional Index (BASFI).1,2 The ASsessment in Ankylosing Spondylitis Improvement Criteria (ASAS-IC), a composite of four domains, have also been evaluated recently and were concluded to be strict in defining response and highly specific as w