The Clinical Study Of Early Dignosis In Patients With Ankylosing Spondylitis

Ankylosing spondylitis is a form of unkown aetiology and systemic disease characterised by chronic inflammation of axial skeletal ankylosis. It generally strikes young people in their teens, which is normally related to family history. The main pathological characteristics shows that almost all AS patients bear sacroiliitis. Accordingly it causes axial spine including sacroiliitis and surrounding tissues erosive inflammation, resulting in extensive fibrous cartilage and being ossified. The inflammation is mainly found in the synovium of axial joint, joint capsule, tendon and ligaments attach to the bone. At the later stage of disease, it develops to ankylosis, severe kyphosis deformation, being difficult to stoop and sacroiliac joint sclerosis or necrosis etc. The treatment of AS is very hard and the status of this disease is extremely difficult to control and irreversible, which leads to patient lose confidence in it. The diagnosis is not difficult when the spine becomes "bamboo spine", however, the status of the disease has reached the later stage. An early treatment is able to prevent further progression of the disease, to reduce or avoid the rate of deformity and improve the quality of patient's life. However, there is, so far, no satisified diagnostic criteria for AS due to the obscure aetiology. The 1961 Roman critieria,1966 New York criteria and the subsequent modified New York criteria are the earliest international general diagnostic criteria for AS. Although the diagnostic criteria is sensitive it can not meet the needs of early diagnosis. Currently there is no internationally established early diagnositc criteria as it needs two sides' gradeâ…¡(or above) radiological sacroiliitis when the inflammation exists a long period of time. Therefore, the early diagnosis happens before the radiological sacroiliitis is defined. The AS diagnosis is difficult to be established if it lacks of defined sacroiliitis. The purpose of early stage AS diagnosis is to find the sacroiliitis as early as possible. It is generally believed that the clinical diagnosis of AS is not reliable, however, we found that almost all AS patients, especial early diagnosis ones all have more obvious two sides positive sacroiliitis through our clinical practices. The previous clinical research also emphasised that the early clinical symptom of AS can not be neglected. Accordingly the present understnading of diagnosis of AS can be changed, e.g. AS can only be diagnosised until there is sacroiliitis radiological change. A clinical diagnostic AS model has been designed by our research group and the prospective testing is carried out by this model.ObjectivesThe early clinical symptom of AS can be mistakingly regarded as buttock pain and the subsequent treatment is wrong since there is no established early diagnosis criteria for AS so far. Based on the characteristics of early diagnosis of AS, we propose that the detailed interrogation and medical check-up, especial the check-up method of sacroiliitis are critical in the early stage of diagnosis of AS. This clinical check-up method directing at sacroiliitis provides valuable clues and evidence for early and preliminary diagnosis of AS with good sensitiveness and specificity, which makes it possilbe for the early diagnosis of AS and use radiological test at the right prupose, reducing the uncessary expenses and resulting in more precise diagnosis.Method1. An investigation on sort and ordering of diseases in orthopedic clinic of township hospital of the delta of the Zhujiang:From August,2005 to June,2006, the data, such as the gender, age and quantity of patients (n=1555) were collected, arranged and analyzed.2. Characteristic Analysis of Ankylosing spondylitis in orthopedic clinic:During October 2005 to June 2008 period,302 patients with AS were involved in this study, and their medical records of were collected and analyzed.3. The Study of Early Clinical Features in Patients with Ankylosing Spondylitis: According to the patient's gender, their clinical symptoms and signs were conducted statistical and analyzed in 51 patients with early AS.4. Application of Physical Examinations of Sacroiliac Joint to Diagnose of Ankylosing Spondylitis:The results of physical examination of sacroiliac joint, imaging findings and laboratory in 70 cases with AS were retrospecively analyzed.5. The Value of 5 kinds of rheumatic blood test in diagnosis of AS:The data of UA, CRP, ASO, RF and ESR were statistical analyzed respectively in 101 patients with AS. 6. The evaluation of early diagnosis model with Ankylosing Spondylitis:Selected and diagnosed 435 patients of unexplained lumbosacral pain during September 2006 to September 2010 using two criteria, and then analyzed the sensitivity and specificity of the two diagnosis criteria.7. The establishment of early diagnosis model with Ankylosing Spondylitis:Clinical doctor valuated and diagnosed 435 patients from out-patient department who were suspected for AS as the symptoms and signs with the benefit of a diagnostic model. Patients were divided into high, medium and low probability groups according to the morbidity of AS. And all patients were made examination of imageology on articulatio sacroiliaca.Result1. An investigation on sort and ordering of diseases in orthopedic clinic of township hospital of the delta of the Zhujiang:In the all of cases, the proportion of different part respectively was soft tissues injury of limb (19.49%), soft tissues injury of spine (17.17%), myofasical pain and other soft tissue injury (16.53%) and non-suppurative arthritis (13.7%). From high to low, the morbidity of age class was 21-30 yrs (30.68%),31-40yrs (25.79%) and 11-20yrs (15.18%).2. Characteristic Analysis of Ankylosing spondylitis in orthopedic clinic:The prevalence rate of AS is not less than 0.37%,â…¢andâ…£grads accounted for 78.2% of all patients. Misdiagnosis rate was 74.5% and confirmed in an average time of 8.9 years.3. The Study of Early Clinical Features in Patients with Ankylosing Spondylitis:hi all patients,52% of the men had resting pain and morning stiffness, in the female were 53.84% and 46.15% respectively. The pain relief after activities in the incidence of men and women were 80% and 96.15%. Positive of physical examination of SI joint was 80%. Distance of finger to floor>10cm, the men and women were 64% and 42%. The positive of Schober test were 20% and 3.84% in the men and women. Thoracal activity<5cm were 8% in the men and 3.84% in the women.The positives of ESR and CRP were 21.57% and 47.06%.4. Application of Physical Examinations of Sacroiliac Joint to Diagnose of Ankylosing Spondylitis:The results of physical examination of sacroiliac joint were positive for all patients. Positive rate of tests of Patrick's and percussion pain were showing significant difference(P<0.05)than the distraction and compression. In the early stage, NRS of patients was higher than that of patients in late period obviously(P<0.05).5. The Value of 5 kinds of rheumatic blood test in diagnosis of AS:The highest positive rates were ESR (48.71%) and CRP (68.32%) respectively, the both positive was 41.58% among them. The positive rate of ASO was 23.76%(24/102), and positive rate of UA was 0.99%(1/101). None of the RF test was positive.6. The evaluation of early diagnosis model with Ankylosing Spondylitis:330 were identified as AS by revised New York criteria in the 435 suspected patients. And the sensitivity and specificity of revised criteria were 98.50% and 80% respectively, and there was statistically significant difference between the two methods(P=0.04). Faber-Patrick test and percussion pain of sacroiliac joint were significant in early period of AS.7. The establishment of early diagnosis model with Ankylosing Spondylitis:330 were confirmed AS of all the 435 cases. Only 3 were excluded from AS according to imageology in 250 cases who were considered AS of high probability, and the final diagnosis rate was up to 98.80%. Only 7 were finally diagnosed AS according to imageology in 70 cases who were considered AS of low probability, down to 10%.Conclusion1. An investigation on sort and ordering of diseases in orthopedic clinic of township hospital of the delta of the Zhujiang:The hospital may adjust work key point according to the disease spectrum, the medical workers should be strengthened to understanding diseases of myofascial pain and AS, also young external labor needs to strengthen their labor protection and safe education.2. Characteristic Analysis of Ankylosing spondylitis in orthopedic clinic:Corollary, a higher prevalence rate of AS in Dongguan City, which be related to the population structure of the higher proportion of young adults. To our hospital as the representative of the township of Dongguan hospitals, diagnosis and treatment of AS can not be optimistic about the situation, the need to enhance the understanding of connective tissue diseases and specialist building.3. The Study of Early Clinical Features in Patients with Ankylosing Spondylitis:The resting pain, morning stiffness and pain relief after activities are important clinical symptoms for early AS. Physical examination of SI joint and distance of finger to floor, tests of CRP and ESR have a high clinical value in diagnosis of AS.4. Application of Physical Examinations of Sacroiliac Joint to Diagnose of Ankylosing Spondylitis:In the diagnose of ankylosing spondylitis, physical examination of sacroiliac joint plays an important role, especially in early diagnose, and cannot be replaced.5. The Value of 5 kinds of rheumatic blood test in diagnosis of AS:The tests of CRP and ESR have a high clinical value in diagnosis of AS.6. The evaluation of early diagnosis model with Ankylosing Spondylitis:The revised criteria was easy to operate and proper for early diagnosis as its high sensitivity and specificity.7. The establishment of early diagnosis model with Ankylosing Spondylitis:Clinical diagnosis is considered to be of high diagnostic value.