Clinical Staging Of Ankylosing Spondylitis

Significance: Ankylosing spondylitis is a common desease in clinics and mainlyonset the young man aged between 15-30. The pathological changes mainly involvesin the sacroiliac joints,the hip joints, intervertebral joints and costovertebralarticulations...etc. This result in limitation of joint's activity and have a high rate ofmalformation, affect the quality of life badly. It is a heavy social burden.The present clinical staging is devide into three period—the early,the middleand the later what according to the damage degree of the sacroiliac joints.This diseasewas hard to have a final diagnosis in the early stage and also hard to cure in the laterstage, the golden period to treatment is the middle stage. How ever, there are somescholars put forward that the current staging system is too simple to reflect the realpathogenetic condition of patient with AS. but researches concerning this field arestill not so much. We found that there are discrepancies between X-rays and clinicalsymptoms of patients with AS. There are some patients are severe limitation ofactivity because involvement of joints, however the X-rays show that there are stilljoints space existing and have no bone bridges over the joints. Through appropriatetreatment(such as medicine, physiotherapy, the silver-quality-needle therapia...etc.), its limitation of functions can get an obvious improvement, prevent the patient frombeing malformation. On this foundation, we form a standpoint of "fibrous ankylosisstage" elementary in clinical staging of AS.After a research of X-ray, the clinic performance of a medium sample of AScases in X-ray. We found that the damage degree of the sacroiliac joints can't be agood arepresentative of involvement degree of hip joint and spine, and the sacroiliacjoint is an amphiarthrodial joint, even a severe involvement such as bony ankylosiswill not bring about a great influence on the function of human body, but the damage of spine, hip joint or other peripheral joints can cause severe result such as physicallydisabled and so on. So we put forward to a new staging system and graduallyoptimized it. the stage depend on the most serious damage part according to the spine, the hip joint, etc. the staging system is consisted of four stages: the early, theprogression, the fibrous ankylosis and the bony ankylosis. It will make the clinicaltreatment more specific—each stage adopt different and suitable treatment.Objectives: To compare the chronic changes between the sacroiliac joints (SIJ)and the spine or the hip joints in conventional radiography of patients with ankylosingspondylitis (AS) and discuss the clinical staging of this disease. After study the X-rayand the clinic symptoms of the AS cases we have collected randomly, analyze thecorrelation of damage severity on X-ray amone sacroiliac joints,spine and hip joints, to discover the present clinic staging system is unreasonable, and put forward to anew one which correspond with the state of illness better.We compared the relativity of two staging system with the Bath AnkylosingSpondylitis Metrology Index(BASMI) and the hip score, and also compare therelativity of two staging system with the Bath Ankylosing Spondylitis DiseaseActivity Index(BASDAI) and the Bath ankylosing spondylitis functionalindex(BASFI), try to find out if the new staging system can be a betterrepresentative of the severity of AS patient's condition. And evaluate merits andshortcoming of each one after some contrast researches of the two staging systems.Methods: We conducted a clinical study enrolling 37 AS patients with completeinformation including anteroposterior and lateral position X-ray of cervicalvertebra,lumbar spine and the pelvis plain film(contain two femoral heads). Allimages of the joints were evaluated twice in blinded manner by two doctors. Thecervical spine, lumbar spine, sacroiliac joints and hip joints were separatelyevaluated by BASRI, and the results were averaged and analyzed by SPSS 13.0. Themaximum score of each location is 4, the minimum one is 0, definite involvementwas defined as a score 2.The second step, we gathering 45 AS patients at random in Nanfang hospitalwhich have complete information we needed. they all have the BASMI and the hipscore Carried on respectively, and staging twice according to the new and the old staging system, then analysis the correlation amone them.The third step, We enrolling 28 AS patients at random in Nanfang hospital whichhave complete information we needed, they all be asked to fill in a questionnaire withall details of the BASDAI and the BASFI, and also staging twice according to thenew and the old staging system, then analysis the correlation amone them.Results: Thirty-seven AS patients (30 male, 7 female, with mean age of 28.49years) were examined, and 81.0% of them had definite involvement of the spine and40.5% of hip involvement. Pearson product-moment correlation coefficient was 0.459between BASRI-SIJ and BASRI-s and 0.465 between BASRI-SIJ andBASRI-h.There are 4 cases have no obvious damage on spine, 7 cases have noobvious damage on hip joints and one case is severe damage on hip than sacroiliacjoints in 10 cases of 2 points on sacroiliac joints. There are 5 cases have light damageon spine, 12 cases have no obvious damage on hip joints and one case is severedamage on hip than sacroiliac joints in 16 cases of 3 points on sacroiliac joints. Thereare also 3 cases have light damage on spine, 3 cases have no obvious damage on hipjoints in 11 cases of 4 points on sacroiliac joints.In 45 sufferers of the second step research, 22 of them were staging by thedamage degree of hip joints, the relativity of hip score between the new and oldstaging system are 0.891 and 0.650; 38 of them were staging by the damage degree ofspine, the relativity of BASMI between the new and old staging system are 0.789 and0.687.In 28 patients of the third step research, The value r of the BASDAI and BASFIto the new staging are 0.540 and 0.648, 0.330 and 0.459 to the old one. The relativitybetween the BASDAI and the BASFI is 0.742.Conclusions: 1,The severity of SIJ changes can not represent the severity ofchanges on the spine and hip well according to the relativity research ofBASRI——the golden standard of radiology on AS, therefore SIJ changes may notbe sufficient evidence for AS staging. 2,we put forward to a new staging systemwhich stage according to the most damage degree among spine,hip joints or otherperiphery joints.3,The new staging system can be a better representative in reflectting the degree of hip and spine function score index.4,At the BASDAI and BASFI givena mark by themselfon a questionare, The new staging system have a good relativity, but the old one has no significance on this.5,After this research, we come to aconclusion that the new staging system is better than the old one on all the scoreindex we adopted, that is to say, the new staging system is practicable in clinic, convenient to make proper choise on treatment, thus reduce the incidence rate ofdisable and should be generalized in the clinic.