| The modified New York criteria (1984) for ankylosing spondylitis (AS) is widely used up to date. However, most patients fulfilling the New York criteria have already be in the metaphase or late phase of the disease, consequently losing the chance to be well treated. Thus the early diagnosis and early treatment as well as the diagnostic criteria for early AS are in urgent need.Part I An Analysis on the Clinical Features of Early Ankylosing SpondylitisOBJECTIVE To analyze the clinical data of AS patients at the onset and the first 2 years of disease, aiming to find the clinical features of early AS and to offer clues for the early diagnosis.PATIENTS AND METHODS The clinical data of 184 AS patients (153 males, 31 females, mean disease duration 7.1 +5.4 years) fulfilling the modified New York criteria (1984) were analyzed retrospectively: 1. analyze the main clinical features of all the patients at the onset and in the first 2 years of disease; 2. the conventional radiographies of pelvic and lumbar shot at the onset and in the first 2 years of disease were read blind by two radiologists, meanwhile the sacroiliitis was graded according to New York criteria (1966).RESULTS 1. The mean age at the onset of disease is 23.9 + 9.8 years, and 76.7% of patients began to suffer from the disease before 30 years old;. 2. The first symptom: axial arthritis accounted for 61.4%, peripheral arthritis 34.8% and enthesitis 3.8%. 3. The low back pain was the most common axial symptom (74.5%),while the hip joint pain was the main peripheral symptom (60.9%). 4. -Extra-articular manifestations: 3.8% of patients had heel pain, 18.5% had iritis or iridocyclitis, 4.3% had symptoms of urinary tract, 10.3% had chronic diarrhoea. 5. 23.4% of patients had morning stiffness of the back and lumbar, 67.9% had night pain and 9.2% had positive family history. The pain and stiffness could be relieved after exercise in 35.9% of patients. 6. HLA-B27 was detected in 125 patients, 102 patients were positive (81.6%). 7. Radiographic examination: grade 1 sacroiliitis stood the first place (69.6%), grade 0 accounted for 21.7%, grade 2 8.7%. No grade 3 sacroiliitis was found. 76.1% of patients had hip joint image lesions. 29.9% of the small joints of vertebrae were blur, however vertebrae squaring, calcification of the spine ligament and bamboo spine were not found.CONCLUSION 1. Male patients aged about 30 were apt to suffer from AS. 2.Many patients had axial arthritis as the first symptom, while some had the peripheral arthritis at the beginning. The morning stiffness, inflammatory back pain and night pain were the characteristic manifestations of AS which played a great role in the diagnosis. Patients in early stage seldom had restriction in spine and chest movement. 3. Hip joint involvement should be recognized more, because it might affect the prognosis. 4. The main extra-articular manifestations of AS were enthesitis, iritis or iridocyclitis, urinary tract symptoms and chronic diarrhoea, which might offer clues for the diagnosis. 5. HLA-B27 might be useful to the diagnosis in suspected or atypical patients. 6. In early stage, most sacroiliitis were below grade 2. Although vertebrae squaring, calcification of the spine ligament and bamboo spine were not found, the small joints of vertebrae were blur.Part II A Comparative Study between X-ray Plain Film and CT in the Diagnosis of Ankylosing SpondylitisOBJECTIVE To compare the detection and grade of sacroiliitis by X-ray plain film and CT, aiming to investigate the diagnostic value of CT in the detection ofearly sacroiliitis.PATIENTS AND METHODS The X-ray plain films of pelvic and lumbar and CT scan of sacroiliac joint, shot at the same time or within 3 months, were read blind by two radiologists. The image feature of X-ray plain films and CT were compared, meanwhile they were graded according to New York criteria (1966).RESULTS 1 .Grade 4 sacroiliitis had the highest consilient rate for X-ray plain films and CT (72.2%), grade 3, 2, and 1 70.8%, 48.7%, and 39.4% respectively; grad...
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