强直性脊柱炎的诊断与治疗进展Progress on diagnosis and treatment of ankylosing spondylitis
刘越,赵艳梅,夏群
摘要(Abstract):
强直性脊柱炎(ankylosing spondylitis,AS)是一种慢性进行性疾病,炎症性腰背痛和腰背部僵硬在疾病早期常见。随着疾病的进展,晚期可造成腰、背、颈、臀、髋部疼痛以及关节肿痛,严重者甚至发生脊柱畸形和关节强直。AS在我国患病率初步调查为0.3%左右。发病年龄通常在13~31岁,高峰为20~30岁。现代医学对其治疗没有切实有效的治愈方案,早诊断、早治疗可控制疾病恶化进展及防止畸形的产生。本文从AS的发病原因、国际上对AS诊断标准的演变、影像学诊断以及治疗等方面的进展情况进行综述。
关键词(KeyWords): 强直性脊柱炎;诊断;治疗;预后
基金项目(Foundation):
作者(Author): 刘越,赵艳梅,夏群
参考文献(References):
- [1]Chung HY,Machado P,van der Heijde D,et al.HLA-B27 positive patients differ from HLA-B27 negative patients in clinical presentation and imaging:results from the DESIR cohort of patients with recent onset axial spondyloarthritis[J].Ann Rheum Dis,2011,70:1930-1936.
- [2]Khan MA,Mathieu A,Sorrentino R,et al.The pathogenetic role of HLA-B27 and its subtypes[J].Autoimmun Rev,2007,6:183-189.
- [3]Reveille JD,Sims AM,Danoy P,et al.Genome-wide association study of ankylosing spondylitis identifies non-MHC susceptibility loci[J].Nat Genet,2010,42:123-127.
- [4]Pointon JJ,Harvey D,Karaderi T,et al.The chromosome 16q region associated with ankylosing spondylitis includes the candidate gene tumour necrosis factor receptor type 1-associated death domain(TRADD)[J].Ann Rheum Dis,2010,69:1243-1246.
- [5]Pointon JJ,Harvey D,Karaderi T,et al.Elucidating the chromosome 9association with AS:CARD9 is a candidate gene[J].Genes Immun,2010,11:490-496.
- [6]Braun J,Breban M,Maksymowych WP.Therapy for ankylosing spondylitis:new treatment modalities[J].Best Pract Res Clin Rheumatol,2002,16:631-651.
- [7]Zochling J,Bohl-Buhler MH,Baraliakos X,et al.Infection and work stress are potential triggers of ankylosing spondylitis[J].Clin Rheumatol,2006,25:660-666.
- [8]Keller JJ,Kang JH,Lin HC.Association between ankylosing spondylitis and chronic periodontitis:a population-based study[J].Arthritis Rheum,2013,65:167-173.
- [9]Kim JO,Lee JS,Choi JY,et al.The relationship between peripheral arthritis and anti-cyclic citrullinated peptide antibodies in ankylosing spondylitis[J].Joint Bone Spine,2013,80:399-401.
- [10]Lin Q,Lin Z,Gu J,et al.Abnormal high-expression of CD154 on T lymphocytes of ankylosing spondylitis patients is down-regulated by etanercept treatment[J].Rheumatol Int,2010,30:317-323.
- [11]林滇恬,李晓琳,齐晨越,等.强直性脊柱炎患者血清IL 27水平的测定及临床意义[J].中国医科大学学报,2014,1:19-21.
- [12]Harrington LE,Hatton RD,Mangan PR,et al.Interleukin 17-producing CD4+effector T cells develop via a lineage distinct from the T helper type 1 and 2 lineages[J].Nat Immunol,2005,6:1123-1132.
- [13]Xueyi L,Lina C,Zhenbiao W,et al.Levels of circulating Th17 cells and regulatory T cells in ankylosing spondylitis patients with an inadequate response to anti-TNF-alpha therapy[J].J Clin Immunol,2013,33:151-161.
- [14]Kebapcilar L,Bilgir O,Alacacioglu A,et al.Impaired hypothalamopituitary-adrenal axis in patients with ankylosing spondylitis[J].J Endocrinol Invest,2010,33:42-47.
- [15]van der Linden S,Valkenburg HA,Cats A.Evaluation of diagnostic criteria for ankylosing spondylitis.A proposal for modification of the New York criteria[J].Arthritis Rheum,1984,27:361-368.
- [16]O’Shea F,Salonen D,Inman R.The challenge of early diagnosis in ankylosing spondylitis[J].J Rheumatol,2007,34:5-7.
- [17]Rudwaleit M,van der Heijde D,Landewe R,et al.The development of assessment of spondylo arthritis international society classification criteria for axial spondyloarthritis(part II):validation and final selection[J].Ann Rheum Dis,2009,68:777-783.
- [18]Sieper J,Rudwaleit M,Baraliakos X,et al.The assessment of spondylo arthritis international Society(ASAS)handbook:a guide to assess spondyloarthritis[J].Ann Rheum Dis,2009,2:ii1-44.
- [19]Braun J,Baraliakos X.Imaging of axial spondyloarthritis including ankylosing spondylitis[J].Ann Rheum Dis,2011,1:97-103.
- [20]Rudwaleit M,Jurik AG,Hermann KG,et al.Defining active sacroiliitis on magnetic resonance imaging(MRI)for classification of axial spondyloarthritis:a consensual approach by the ASAS/OMERACT MRI group[J].Ann Rheum Dis,2009,68:1520-1527.
- [21]Gong Y,Zheng N,Chen SB,et al.Ten years’experience with needle biopsy in the early diagnosis of sacroiliitis[J].Arthritis Rheum,2012,64:1399-1406.
- [22]中华医学会风湿病学分会.强直性脊柱炎诊断及治疗指南[J].中华风湿病学杂志,2010,14:557-559.
- [23]Wanders A,Dv H,Landewe R,et al.Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis:a randomized clinical trial[J].Arthritis Rheum,2005,52:1756-1765.
- [24]Braun J,van den Berg R,Baraliakos X,et al.2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis[J].Ann Rheum Dis,2011,70:896-904.
- [25]Braun J.Axial spondyloarthritis:thoughts about nomenclature and treatment targets[J].Clin Exp Rheumatol,2012,30:132-135.
- [26]Haroon N,Inman RD,Learch TJ,et al.The impact of tumor necrosis factor alpha inhibitors on radiographic progression in ankylosing spondylitis[J].Arthritis Rheum,2013,65:2645-2654.
- [27]Poddubnyy D,Sieper J.Radiographic progression in ankylosing spondylitis/axial spondyloarthritis:how fast and how clinically meaningful[J].Curr Opin Rheumatol,2012,24:363-369.
- [28]Braun J,Pavelka K,Ramos-Remus C,et al.Clinical efficacy of etanercept versus sulfasalazine in ankylosing spondylitis subjects with peripheral joint involvement[J].J Rheumatol,2012,39:836-840.
- [29]Vastesaeger N,van der Heijde D,Inman RD,et al.Predicting the outcome of ankylosing spondylitis therapy[J].Ann Rheum Dis,2011,70:973-981.
- [30]徐小会,朱锦宇,段永宏,等.全髋关节置换术治疗强直性脊柱炎髋关节骨性强直畸形[J].中国矫形外科杂志,2013:2333-2338.
- [31]马原,余光宇,王鑫,等.椎板V型截骨矫正强直性脊柱后凸畸形的临床效果分析[J].中国矫形外科杂志,2011,24:1941-1943.
- [32]黄玉国,李永民,申勇.强直性脊柱炎脊柱骨折的临床特点和手术治疗策略[J].中国矫形外科杂志,2012,8:644-646.