我们来谈谈强直性脊柱炎的治疗

If you’re here,你伤害了，这并不好。尽管具有强调脊柱炎（AS）的治疗，但在地平线上有高效的治疗方法。而且，这是令人惊讶的事情：最好的补救措施之一可能是最简单，最便宜的和最安全的。好奇的？阅读更多信息，了解有关一个可以做出真实区别的生活方式改变，以及您需要了解关于突破性生物学的内容以及如何避免避免使用手术。我们有你。

AS Treatment

Our Pro Panel

We went to some of the nation's top experts on ankylosing spondylitis to bring you the most up-to-date information possible:

安卡阿斯卡纳斯医学博士。

Rheumatologist, Director of Rheumatology Clinical Trials

Columbia University Medical Center

New York City

Howard Blumstein, M.D.

风湿病学，医学临床教授

Stony Brook University

Smithtown, NY

乔纳森·格里尔医学博士。

Rheumatologist, Assistant Clinical Professor of Medicine

University of Miami

棕榈滩，佛罗里达州

What Is AS, Anyway?

Let’s review: You know that osteoarthritis causes pain and stiffness in the joints of older people due to wear and tear.

Ankylosing spondylitis（宣布）ank-eye-low-sing spon-dill-eye-tiss)不同的是：它是一种炎症性关节炎，发病年龄要小得多，通常在17到45岁之间。这个hallmark characteristic is chronic inflammation in the sacroiliac (SI) joints, which join the spine to the pelvis. Although AS primarily affects the spine, other areas can become inflamed as well, including the shoulders, hips, ribs, heels, and small joints of the hands and feet, and it can lead to severe, chronic pain and discomfort. In more advanced cases, this inflammation can lead to ankylosis—new bone formation in the spine—causing sections to fuse into a fixed, immobile position.

You may not have heard of AS until now, but the condition is not that uncommon. About 1 out of every 200 adults in the U.S., or 1.1 million people, has AS, according to The Spondylitis Association of America. Once considered primarily a male disease, there is increasing evidence that women may be underdiagnosed and the true ratio of men to women might be closer to 1:1.

特色系列

AS Awareness Month: No Holding Back!

去！

What Are the Best AS Treatments?

Ankylosing spondylitis is a not your usual chronic disorder because one of the first-line treatments isn’t a serious drug or surgery.

事实上，这种补救措施将被视为一个互补的治疗地球上几乎所有其他终身疾病。伙计们，我们谈论的是好的老式运动，以及流汗对患者的好处是巨大的。

更重要的是，另一条初线治疗已经坐在药物内阁中，没有处方则有很大的机会。这将是非甾体抗炎药，否则被称为NSAID。(You know them as aspirin, Aleve (naproxen), and Advil or Motrin (ibuprofen.) It’s not unusual for AS patients to manage on just these two “treatments” for years. Here’s the lowdown on how and why they work, and what you need to know when it’s time to move on to other medication options like biologics.

Exercise

It's a no-brainer that moving your body and getting your blood pumping is good for everyone. Exercise increases strength, endurance, balance, and flexibility. It also improves cardiovascular endurance, reduces high blood pressure, increases good cholesterol (HDL), maximizes bone density, helps in weight management, lowers stress levels, boosts self-esteem, and even has the potential to better the body’s response to medications.

AS patients can add even more to this mega-list of benefits: Exercise loosens up the joints, relieves pain and stiffness, and keeps the spine flexible, while also improving posture, fatigue, and breathing capacity. It’s not a stretch to say exercise will improve your overall function and quality of life.

Huge, right? But before you get nervous about having to train for a marathon, know this: We’re not talking extreme exercise, which isn’t great for people with AS, either. We’re going for a gentler approach here. You’ll need to avoid anything high-impact (running, jumping rope) or risky (black-diamond ski runs). Instead, your routine should include these important exercise components:

• 伸展：这些练习应该每天完成，以通过全方位的议案夺取肌肉和关节。思考颈部，侧和腿筋伸展，甚至是您要做的热身类型的练习before玩运动。瑜伽，也很棒。那些向下的狗可以为下背部奇迹做奇迹。

• Strengthening:您可以使用重量、阻力带,或者仅仅是你r own bodyweight to build muscle. Think: sit-ups, planks, hip and leg extensions, and普拉提。It’s especially important to focus on strengthening your core muscles in your abdomen and back because they support the spine, reducing the stress on it and minimizing back pain. Aim for two to four times a week.

• Balance:This type of exercise should be done three to five times a week to reduce your chances of falling, which is especially important because people with AS have lower bone density and are at increased risk for fractures. Balance moves include single-leg stands, standing up from a chair without using your hands, or standing with one foot in front of the other with your toes touching your heel. The ancient Chinese tradition of Tai Chi also promotes better balance, reduces stress, improves mood, and even helps you sleep better.(You can also try this平衡锻炼。)

• 心血管活动：应对持续的时间进行低抗冲食活动，以增加心灵的血液改善心肺功能.游泳、骑自行车或使用椭圆教练机都是不错的选择。还有：朴素、古老的步行。有氧运动应该每周进行三到五次，每周至少75到150分钟。

Timing is also important. You’re going to need to get moving as soon as you can in the day to loosen up those screaming joints, but you still need to take a gradual approach.

Where to start? Gentle stretching is your best bet, followed by other types of exercise later in the day when you feel better. Ask your doctor about prescribing physical therapy when you’re first diagnosed to help you learn the most effective exercises and proper techniques, as well as ways to improve your posture.

If your posture is poor and your spine begins to fuse, there’s a risk that it will do so in a stooped position—almost as if you’re bending over or forward—which can increase your risk of complications including breathing or cardiovascular problems. But again, building your overall strength and flexibility will go far in helping you prevent complications like this.

药物

非甾体抗炎药（NSAIDs）

These easily available and inexpensive meds work by blocking prostaglandins, a substance in the body that increases inflammation and pain. They have a良好的记录把…当作…来对待。

Over-the-counter options such as ibuprofen, naproxen, and aspirin may be all you need early on—along with exercise, of course—and many patients with milder symptoms are able to utilize them periodically for years before having to move to something else. No one type of NSAID is believed to be better than another for AS, so whichever one works best for you is fine.

在禁止的基础上进行NSAID，通常，大多数人都需要定期服用他们，而是如医生的指示，因为过度使用NSAID可以引起肝脏，肾脏和胃肠道问题。另一个重要的警告：如果你与IBD称为肠病关节炎 - 你肯定应该是nottake NSAIDS (unless your doctor specifically directs you to take them) because they can aggravate IBD symptoms.

It’s not uncommon to need prescription-strength doses of NSAIDs for relief, which means side effects are more likely. The most typical side effects are stomach upset and gastrointestinal issues because NSAIDs can reduce the amount of protective mucus in the stomach, resulting in irritation. Eventually, heartburn, gastritis, ulcers, and bleeding in the digestive tract can occur. Talk to your doctor ASAP if you experience any side effects.

其他非处方药，如抗酸剂和酸还原剂，可能有助于保护你，减轻你的症状，但与你的医生谈谈哪些是合适的。

您应该避免一种类型的酸性减速剂，除非您的医生指示是质子泵抑制剂（PPI），如PREVACID（LANSOLAZOLE）和PRILOSEC（OMEPRAZOLE）。PPI与骨质疏松症的风险增加有关，因为它们降低了钙吸收。这是一个问题，你绝对不需要你已经受到影响的骨密度。另一类NSAID，称为COX-2抑制剂 - 其中包括药物Celeberex（Celecoxib）-May降低了这些GI副作用的风险。

Biologics

These groundbreaking meds are made from living microorganisms, plants, and animal cells, and they're delivered via injection (which you can learn to do yourself at home) or IV infusion at your doctor’s office.

When NSAIDs and exercise are not effective enough to control your symptoms, or the side effects of NSAIDs become too severe, your doctor will likely turn to this class of medication. You may be prescribed a biosimilar, which is aless expensive version that works the same way, similar to a generic medication. There are two main types of biologics (and biosimilars) used to treat AS:

肿瘤坏死因子inhibitors (TNFi)

Also known as anti-TNF agents, these drugs work by binding to and putting the brakes on an inflammation-causing protein known as tumor-necrosis factor alpha (TNF-a). The TNFi biologics approved to treat AS include:

• Cimzia（Certolizumab Pegol）：近6/10的患者在12周内炎症减轻，一些患者在1到2周内症状改善。Cimzia每四周需要注射一次。

• Enbrel（依那西普）：Enbrel是FDA于2003年批准的第一种治疗AS的生物制剂。在使用六个月后，五分之三的成年人都被证明是有效的。46%的患者在两周内炎症减轻，59%的患者在八周内获益。每周需要注射Enbrel。

• Humira (adalimumab):一些患者早在两周就发现炎症减轻，58%的患者在使用三个月后至少改善了20%。每隔一周需要注射Humira。

• 修复（英夫利昔单抗）：About 60% of patients see an improvement in symptoms after six months on Remicade. Infusions are given in three starter injections at 0, 2, and 6 weeks, then as a maintenance dose every six weeks

• 辛波尼/辛波尼咏叹调（戈利穆玛）：More than 73% of patients experience at least a 20% reduction of inflammatory symptoms by 16 weeks. Simponi injections are required every four weeks; Simponi Aria is given as a baseline dose, followed by a second one at four weeks, then every eight weeks thereafter.

IL-17抑制剂

如果TNFI无效，或者您无法容忍副作用（下面更多），则您的下一个选项被称为IL-17抑制剂。他们以与TNFI生物学的方式相同，但靶向称为白细胞介素-17的不同炎症蛋白。两者批准用于治疗：

• cosentyx（secukinumab）：超过60％的人在16周内看到症状至少20％的改善。每四周需要注射。

• Taltz (ixekizumab):Taltz是FDA最新批准的AS生物制剂，已被证明能在16周内显著改善48%患者的炎症症状。Taltz是第一次注射两次的起始剂量，然后每四周注射一次。

副作用和安全

All types of biologics suppress your immune system, so an increased risk of infection may be the biggest side effect you could experience. If you carry a dormant infection, such as tuberculosis or Hepatitis B, it may also become reactivated when you take a biologic.

你需要被测试的these infections before starting treatment, and stay up-to-date on all necessary vaccines, including an annual flu shot. IL-17 inhibitors have also been shown to exacerbate IBD symptoms associated with ulcerative colitis and Crohn's, or bring onIBD新病例，因此它们不适合肠病关节炎的人。

Be sure to discuss these and any other health issues you may have with your rheumatologist. Your doctor can determine if the benefits of biologics outweigh the risks for you.

While they vary by biologic, other side effects may include:

• Bruising

• Chills

• 发烧

• Headache

• Hives

• Itching

• Rashes

• Redness

• Swelling at site of injection

很少，生物制剂 - 特别是TNFIS-可能会增加你的风险：

• Other forms of arthritis

• Liver problems

• Lymphoma

• Lupus-like reaction that includes rash, joint pain, muscle ache and fever

皮质类固醇

毫无疑问，这类药物，简称类固醇，是一种有效的止痛药。不幸的是，口服类固醇，如强的松，如果长期使用，可能会产生严重的全身副作用，这意味着一次超过连续三个月。因此，类固醇通常直接注射到发炎的关节中治疗as。然而，类固醇通常不会注射到脊柱中，所以这种治疗在那些周围关节（肩部、膝盖、脚跟）受到影响时使用。

最后一条关于另外两种药物的说明

虽然在治疗脊髓炎时既不特别有效，但您可能在您的旅程中遇到两种较老的药物。

第一是苏氟碱(brand name Azulfidine) and the other is the chemotherapy drugmethotrexate（品牌名称Rheumatrex）。

这两种药物都可以限制炎症对组织的损害，但美国脊柱炎协会只建议在生物制剂不可用（可能是由于成本原因）或随着时间的推移失效时使用。也就是说，甲氨蝶呤有助于减轻包括眼睛在内的身体其他部位的炎症，它可以通过防止干扰药物工作方式的抗体的产生，帮助生物制剂保持其活力。

手术

Don’t stress about having to go under the knife eventually—odds are you won’t. In all but the most extreme situations, spinal surgery is not used to treat AS because it’s such a high-risk procedure.

Only when AS restricts breathing (rare!) is surgery performed to straighten a spine that has curved forward. In these situations, the surgeon will cut through the vertbrae and reposition them into a straighter, more vertical position.

Medically designed metal (usually titanium) rods, bars, wires, and screws are used to hold the repaired spine in place—usually permanently, although they are sometimes removed later in rare cases if irritation or infection occurs.

Some AS patients may eventually need joint replacement therapy—usually in the knees or hips—for severe damage that makes daily activities like walking or climbing stairs difficult. During this procedure, the surgeon removes the damaged joint and replaces it with one made from metal, plastic, or ceramics.

见见我们的作家

Stephanie Wood

Stephanie Wood is a award-winning freelance writer and former magazine editor specializing in health, nutrition, wellness, and parenting.

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