Ankylosing spondylitis

强直性脊柱炎
  • 文章类型: Case Reports
    葡萄膜炎,作为关节外的表现,在23%的强直性脊柱炎(AS)患者中发现,是一种具有挑战性的疾病。
    作者向医院外介绍了一名32岁的男性,抱怨8年前左眼复发性前葡萄膜炎,患有炎症性腰痛2年。因此,在许多治疗策略失败后诊断为AS,50mg/月皮下Golimumab开始治疗AS和葡萄膜炎的临床缓解。
    美国风湿病学会建议使用依那西普和阿达木单抗治疗AS患者复发性葡萄膜炎。同样,欧洲抗风湿病联盟建议使用英夫利昔单抗,阿达木单抗,或Certolizumab预防葡萄膜炎复发复发。到现在为止,发表了一例关于使用Golimumab治疗AS患者难治性葡萄膜炎的病例.
    发现戈利木单抗在治疗与脊柱关节炎相关的葡萄膜炎中至少有一种免疫抑制药物是有效的。
    UNASSIGNED: Uveitis, as an extra-articular presentation, is found in 23% of patients with ankylosing spondylitis (AS) and is a challenging disease to treat.
    UNASSIGNED: The authors presented a 32-year-old male to the out-hospital, complaining of recurrent anterior uveitis 8 years earlier in his left eye, and suffered from inflammatory lumber pain for 2 years. So a diagnosis of AS after the failure of many therapeutic strategies, 50 mg /month subcutaneous Golimumab was started with clinical remission of AS and uveitis.
    UNASSIGNED: The American College of Rheumatology recommends the use of etanercept and adalimumab in the treatment of recurrent uveitis in AS patients. Similarly, the European League Against Rheumatism recommended using Infliximab, Adalimumab, or Certolizumab to prevent the recurrence of uveitis recurrence. Till now, a case about treating refractory uveitis with Golimumab in AS patients was published.
    UNASSIGNED: Golimumab was found to be effective in the treatment of uveitis associated with spondyloarthritis refractory at least one immunosuppressive drug.
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  • 文章类型: Case Reports
    在接受抗TNF-α药物治疗强直性脊柱炎的患者中,监测紫癜性和缺血性皮肤病变至关重要。此病例强调了识别和解决药物引起的血管炎的重要性,同时强调了迅速评估和探索替代治疗方案以保障患者健康的必要性。
    该病例讨论了一名38岁女性,有强直性脊柱炎(AS)病史,并伴有皮肤病变,包括紫癜性皮肤损伤和右脚手指缺血,在开始使用阿达木单抗治疗后。排除其他潜在原因后,如感染和恶性肿瘤,该患者接受了与使用阿达木单抗相关的中度血管血管炎的诊断.停用阿达木单抗和高剂量糖皮质激素和环磷酰胺静脉脉冲治疗导致她的缺血性病变消退。该病例强调了在新的皮肤病变患者中考虑药物相关副作用的重要性,特别是在风湿性疾病如AS的背景下。
    UNASSIGNED: In patients receiving anti-TNF-α drugs for ankylosing spondylitis, monitoring purpuric and ischemic skin lesions is crucial. This case underscores the significance of identifying and addressing drug-induced vasculitis while stressing the necessity for prompt evaluation and exploration of alternative treatment options to safeguard patient well-being.
    UNASSIGNED: The case discusses a 38-year-old female with a history of ankylosing spondylitis (AS) who presented with skin lesions, including purpuric skin lesions and ischemia of her right foot digits, after initiating treatment with adalimumab. After excluding other potential causes, such as infections and malignancies, the patient received a diagnosis of moderate-sized vascular vasculitis associated with adalimumab use. Discontinuation of adalimumab and treatment with high dose glucocorticoids and intravenous pulse of cyclophosphamide resulted in the resolution of her ischemic lesions. This case underscores the importance of considering drug-related side effects in patients with new skin lesions, particularly in the context of rheumatic diseases such as AS.
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  • 文章类型: Case Reports
    强直性脊柱炎(AS)是一种慢性炎症性关节炎,通常表现在年轻男性中,并可能表现为关节外表现。Takayasu主动脉动脉炎(TA)是一种大血管血管炎,主要影响中青年女性。尽管研究这两种疾病之间潜在关联的研究数量有限,我们报告了一例患者的独特病例,该患者患有强直性脊柱炎和溃疡性结肠炎,随后发展为Takayasu主动脉动脉炎.这一进展最终导致继发性肾淀粉样变性的发展,归因于炎症性病变的组合。
    Ankylosing Spondylitis (AS) is a chronic inflammatory arthritis that typically manifests in young males and may present with extra-articular manifestations. Takayasu aortoarteritis (TA) is a large vessel vasculitis that predominantly affects young and middle-aged females. Despite the limited number of studies examining the potential association between these two diseases, we report a unique case of an individual with ankylosing spondylitis and ulcerative colitis who subsequently developed Takayasu aortoarteritis. This progression ultimately led to the development of secondary renal amyloidosis, attributed to a combination of inflammatory pathologies.
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  • 文章类型: Case Reports
    背景:安德森病变(AL)是强直性脊柱炎(AS)的罕见并发症,以非肿瘤性骨破坏为特征,通常表现为椎体和/或椎间盘区域的骨破坏和硬化。目前,关于AL的病理和病因尚无共识。反复的创伤,炎症本质上是强直性脊柱炎本身自然史的一部分,是AL病因学最广泛认可的理论。然而,在强直性脊柱炎患者中,在Andersen病变(AL)的骨活检中培养的阳性细菌极为罕见。在这里,我们报告了一例罕见的病例,通过宏基因组下一代测序(mNGS)检测从强直性脊柱炎Andersson病变患者中检测出美洲埃温格菌。
    方法:该病例涉及一名39岁男性,有11年AS病史,在胸椎发展AL(T11/12)。经过充分的术前准备,我们成功地进行了一期后路矫正手术,并收集了骨活检样本进行检查.没有发现培养的细菌,病理组织学提示炎性细胞浸润。然而,值得注意的是,我们发现了一种革兰氏阴性细菌,美洲Ewingella,通过MNGS测试。进一步的组织病理学检查提示慢性炎症细胞浸润。一期后路矫正手术后,患者的病情明显改善。在6个月的随访中,疼痛明显减轻,病人恢复正常生活.
    结论:我们通过mNGS在强直性脊柱炎患者Andersson病变(AL)的骨活检中检测到了美洲莫西氏菌。
    BACKGROUND: Andersen\'s lesion (AL) is a rare complication of ankylosing spondylitis (AS), characterized by nonneoplastic bone destruction, typically manifested as bone destruction and sclerosis in the vertebral body and/or intervertebral disc area. At present, there is no consensus on the pathology and etiology of AL. Repeated trauma, inflammation in essence and part of the natural history of Ankylosing spondylitis itself are the most widely recognized theories of the etiology of AL. However, positive bacteria cultured in bone biopsy of Andersen\'s lesion (AL) in Ankylosing spondylitis patients are extremely rare. Herein, we report a rare case of detecting Ewingella americana from a patient with Andersson lesion in ankylosing spondylitis by Metagenomic Next-Generation Sequencing (mNGS) Test.
    METHODS: This case involved a 39-year-old male with a history of AS for 11 years, who developed AL (T11/12) in the thoracic vertebrae. After sufficient preoperative preparation, we successfully performed one-stage posterior approach corrective surgery and collected bone biopsies samples for examination. Cultured bacteria were not found, and pathological histology indicated infiltration of inflammatory cells. However, it is worth noting that we discovered a gram-negative bacterium, the Ewingella americana, through mNGS testing. Further histopathological examination suggests chronic inflammatory cell infiltration. After one-stage posterior approach corrective surgery, the patient\'s condition significantly improved. At the 6-month follow-up, the pain significantly decreased, and the patient returned to normal life.
    CONCLUSIONS: We detected Ewinia americana in the bone biopsies of Andersson lesion (AL) in ankylosing spondylitis patient by mNGS.
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  • 文章类型: Case Reports
    本研究报告了一名50岁肥胖男性患有强直性脊柱炎的病例,Scheuermann的后凸畸形.该患者无症状于颈椎后纵韧带(OPLL)异位骨化;他在轻微的头部外伤后出现四肢瘫痪和呼吸功能不全。尽管OPLL患者的颈椎创伤很常见,据我们所知,这是第一例报告的广泛骨赘,晕厥后致命的结果。在极少数情况下,它可能存在晕厥和潜在的致命结果,特别是当创伤沉淀时。因此,不应不必要地延迟严重椎管狭窄的OPLL治疗.
    The present study reports the case of a 50-year-old obese male with ankylosing spondylitis, Scheuermann\'s kyphosis. The patient was asymptomatic concerning the ectopic ossification of the posterior longitudinal ligament (OPLL) at the cervical spine; he developed quadriparesis and respiratory insufficiency following minor head trauma. Even though trauma to the cervical spine in patients with OPLL is common, to the best of our knowledge, this is the first reported case of an extensive osteophyte with a lethal outcome after syncope. In rare occasions, it may be present with syncope and potentially lethal outcomes, particularly when precipitated by trauma. Therefore, the management of OPLL with significant canal stenosis should not be unnecessarily delayed.
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  • 文章类型: Journal Article
    强直性脊柱炎(AS),原发性硬化性胆管炎(PSC),和自身免疫性胰腺炎(AIP)被称为溃疡性结肠炎(UC)的肠外表现(EIM)。一位74岁的日本男子因为白色大便来我们医院就诊。他30岁时被诊断出患有AS,HLA-B27阳性.根据各种考试结果,怀疑AIP导致胆管狭窄。在临床过程中,他被诊断为UC和PSC。然后,AIP被诊断是因为他有局部胰腺肿大,主胰管不规则狭窄,PSC,胰腺没有肿瘤细胞.患有这四种疾病的病人,AS,AIP,PSC,UC,是非常罕见的。因此,我们报告了一个相当罕见的病例,有三个EIM(AS,PSC,和AIP)的UC。
    Ankylosing spondylitis (AS), primary sclerosing cholangitis (PSC), and autoimmune pancreatitis (AIP) are known as extraintestinal manifestations (EIMs) of ulcerative colitis (UC). A 74-year-old Japanese man visited our hospital because of white stool. He had been diagnosed with AS when he was 30 years old, and he was HLA-B27-positive. Based on various examination results, it was suspected that AIP had caused bile duct stricture. During the clinical course, he was diagnosed with UC and PSC. Then, AIP was diagnosed because he had localized pancreatic enlargement, irregular stenosis of the main pancreatic duct, PSC, and no tumor cells of pancreas. A patient with all four of these diseases, AS, AIP, PSC, and UC, is very rare. Therefore, we report a quite rare case with three EIMs (AS, PSC, and AIP) of UC.
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  • 文章类型: Case Reports
    患有强直性脊柱炎(AS)和SARS-CoV-2感染(COVID-19)的产妇给麻醉师带来了独特的挑战。分娩的神经轴镇痛仍然是产科患者的金标准。然而,在AS患者中,这种方法可能被认为是困难的,也可能是不可能的。全身阿片类药物用于分娩镇痛可以是一种选择,考虑到对母亲和胎儿的潜在呼吸抑制作用,特别是在合并COVID-19的情况下。本文报道了使用静脉瑞芬太尼的患者自控镇痛(PCA)成功治疗此类患者。
    Parturients with both ankylosing spondylitis (AS) and SARS-CoV-2 Infection (COVID-19) present unique challenges to anesthesiologists. Neuraxial analgesia for labor remains the gold standard in obstetric patients. However, in patients with AS, this approach may be deemed difficult to impossible. Administration of systemic opioids for labor analgesia can be an option, bearing in mind the potential respiratory depressant effect to both the mother and the fetus, especially in the setting of concomitant COVID-19. This paper reports the successful management of such a patient using patient-controlled analgesia (PCA) with intravenous remifentanil.
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  • 文章类型: Case Reports
    在日本农村的环境中,本病例报告深入研究了一名诊断为强直性脊柱关节炎(AS)的产后妇女的管理,展示了平衡有效缓解疼痛与母乳喂养的复杂性。该研究强调了一种多方面的方法,包括医疗,社会心理支持,全面的病人教育,这在资源可能稀缺的农村医疗保健中至关重要。最初用双氯芬酸管理,因为它的母乳喂养更安全,患者的治疗最终升级为阿达木单抗,与改善母乳喂养的情况保持一致。这个案例强调了整体的关键作用,家庭医学中的以患者为中心的护理,特别是用于管理孕产妇和儿童健康慢性疾病。它说明了如何整合心理健康支持,承认患者的恐惧,和教育家庭可以显着提高病人的护理和结果。通过这种方法,该报告主张更广泛地应用家庭医学原则,以改善农村地区的妇幼保健服务,展示考虑患者医疗和情感需求的量身定制医疗策略的重要性。
    In a rural Japanese setting, this case report delves into managing a post-partum woman diagnosed with ankylosing spondyloarthritis (AS), showcasing the complexities of balancing effective pain relief with breastfeeding. The study highlights a multifaceted approach that incorporates medical treatment, psychosocial support, and comprehensive patient education, which are essential in rural healthcare where resources may be scarce. Initially managed with diclofenac due to its safer profile for breastfeeding, the patient\'s treatment was eventually escalated to adalimumab, aligning with improved circumstances regarding breastfeeding. This case emphasizes the critical role of holistic, patient-centered care in family medicine, particularly for managing maternal and child health chronic conditions. It illustrates how integrating mental health support, acknowledging patient fears, and educating families can significantly enhance patient care and outcomes. Through this approach, the report advocates for a broader application of family medicine principles to improve maternal and child health services in rural settings, demonstrating the importance of tailored healthcare strategies that consider patients\' medical and emotional needs.
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  • 文章类型: Case Reports
    服用硫唑嘌呤或英夫利昔单抗治疗UC和AS有明显的不良反应风险。这里,我们目前的病例诊断为UC和AS,接受硫唑嘌呤和英夫利昔单抗治疗10个月的患者,随后发展为药物诱发的肌病,影响右侧股内侧肌。
    药物诱发的肌病是一种罕见的肌肉损伤形式,在没有预先存在的肌肉疾病的患者中,当暴露于治疗剂量的某些药物时,会出现这种情况。使用硫唑嘌呤或英夫利昔单抗治疗溃疡性结肠炎(UC)和强直性脊柱炎(AS)具有明显的不良反应风险。包括药物诱发的肌病和机会性感染的易感性增加。然而,在临床实践中,很少报道由硫唑嘌呤和英夫利昔单抗联合使用引起的肌病的发生。这里,我们介绍了一个37岁的男性患者诊断为UC和AS,接受硫唑嘌呤和英夫利昔单抗治疗10个月。尽管通过内窥镜观察到症状的缓解和肠粘膜炎症的改善,患者随后发展为药物诱发的肌病,影响了右股内侧肌。
    UNASSIGNED: Administering azathioprine or infliximab for UC and AS treatment carries a significant risk of adverse reactions. Here, we present the case diagnosed with UC and AS, who received treatment with azathioprine and infliximab for 10 months, and subsequently developed drug-induced myopathy affecting the right vastus medialis muscle.
    UNASSIGNED: Drug-induced myopathy is an uncommon form of muscle injury that can arise in patients without preexisting muscle conditions when exposed to therapeutic doses of certain medications. Administering azathioprine or infliximab for ulcerative colitis (UC) and ankylosing spondylitis (AS) treatment carries a significant risk of adverse reactions, including drug-induced myopathy and increased susceptibility to opportunistic infections. However, occurrences of myopathy induced by the combination of azathioprine and infliximab are rarely reported in clinical practice. Here, we present the case of a 37-year-old male patient diagnosed with UC and AS, who received treatment with azathioprine and infliximab for 10 months. Despite the resolution of symptoms and improvement in intestinal mucosal inflammation observed via endoscopy, the patient subsequently developed drug-induced myopathy affecting the right vastus medialis muscle.
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  • 文章类型: Case Reports
    髓磷脂少突胶质细胞糖蛋白相关疾病(MOGAD)是一种炎症性神经系统疾病。它通过影响视神经和脊髓而随着攻击而发展。双侧或复发性视神经炎是成人患者中最常见的发现。它与系统性自身免疫性疾病如干燥综合征的关联,抗磷脂综合征,自身免疫性甲状腺炎,乳糜泻是罕见的。报告了第一例也是唯一一例患有强直性脊柱炎并有抗肿瘤坏死因子-α(抗TNF-α)使用史的患者的MOGAD。在这里,我们介绍了MOGAD在没有抗TNF-α治疗史的AS患者中共存的情况.
    Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) is an inflammatory neurological disease. It progresses with attacks by affecting the optic nerves and spinal cord. Bilateral or recurrent optic neuritis are the most common findings in adult patients. Its association with systemic autoimmune disorders such as Sjögren syndrome, antiphospholipid syndrome, autoimmune thyroiditis, and celiac disease is rare. The first and only case of MOGAD in a patient with ankylosing spondylitis with a history of anti-tumor necrosis factor-alpha (anti-TNF-α) use was reported. Herein, we present the coexistence of MOGAD in a patient with AS who did not have a history of anti-TNF-α therapy.
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