Persistent low back pain with morning stiffness

Introduction Non-ocular clinical manifestations of ankylosing spondylitis: the most typical early manifestation of persistent low back pain (at least 3 months), unilateral occult, blunt or intermittent, with morning stiffness, reduced after activity . Ankylosing spondylitis (AS) is a chronic systemic disease of unknown cause involving the joints of the spine, ankle, and joints. Studies suggest that the onset of infection is associated with infections such as campylobacter infection and HLA-B27 may have cross-over or common structures between antigenic residues, but it is difficult to draw conclusions.

Cause

The cause is unknown. Studies suggest that the onset of infection is associated with infections such as campylobacter infection and HLA-B27 may have cross-over or common structures between antigenic residues, but it is difficult to draw conclusions.

Pathogenesis: Ankle arthritis is a pathological hallmark of ankylosing spondylitis. Early changes can be seen in synovial hyperplasia and lymphoid cell and plasma cell accumulation of lymphoid follicles, as well as plasma cells containing IgG, IgA and IgM.

an examination

Related inspection

Spine flat film

The diagnosis of AS is based on the patient's susceptibility, medical history, clinical features, and imaging findings. The most commonly used diagnostic criteria are the so-called New York standards:

1. The lumbar frontal curvature and the lateral curvature are limited in all three directions.

2. The history of pain at the lumbar vertebrae or dorsal lumbar junction lasted for more than 3 months.

3. Chest expansion is limited, take the fourth intercostal space measurement, chest expansion 2.5cm.

It can also be graded according to the X-ray changes of the ankle joint (0 grade is normal, grade 1 is suspicious, grade 2 is slightly altered, and there is erosion or hardening in the limited area, but the joint cavity width is unchanged, grade 3 is positive or moderate abnormal, and erosion occurs. Judgment, hardening, joint cavity widening or stenosis or partial rigidity, 4 grades of severe abnormal joints are all strong and straight). The ankle joint changes bilateral 3 or 4, and one of the above 3 items can be diagnosed. Ankle joint changes 3 or 4, but only 1 side, or change 2 level 2 side and have the above 1st or 2nd and 3rd items can also confirm the ankle joint change 3 or 4 sides, but no Any one of the above 3 items is considered as a suspected case.

The above criteria are helpful for diagnosis, but should be considered after all considerations. HLA-B27 cannot be used as a screening test for AS because most HLA-B27 positive individuals do not have AS, while some AS patients have negative HLA-B27. When clinically suspected AS and imaging is difficult to diagnose ankle arthritis, HLA-B27 can increase the possibility of AS diagnosis, but still can not be diagnosed.

Differential diagnosis

Chronic low back pain with lower limb numbness: Lumbar spondylolisthesis is prone to chronic low back pain and radioactive numbness in one or both lower extremities. Lumbar spondylolisthesis refers to a condition in which part or all of the lumbar vertebrae are dislocated. It is generally called the vertebral body in the clinic, and the upper vertebral body is generally slipped forward. The incidence of lumbar spondylolisthesis is 3 to 7% in Europe. There is still no accurate statistical data in China. It is generally believed that routine X-ray examination of patients with low back pain has a tendency to have lumbar spondylolisthesis in about 5% of adults.

Low back pain with sputum pain in the kidney area: acute membranous nephropathy is characterized by sudden onset of low back pain, often more intense, with pain in the kidney area. It is characterized by a sudden onset of low back pain, often more intense, with pain in the kidney area. Urine protein suddenly increased, often with gross hematuria, leukocyteuria, hypertension and acute renal dysfunction. B-ultrasound increased kidney. Bilateral renal vein thrombosis can cause oliguria and acute renal failure.

Sudden onset of severe low back pain: sudden low back pain without a history of obvious trauma, this symptom is often the main symptom of the onset of urinary calculi, common diseases such as kidney stones, ureteral stones and so on.

Sustained abdominal pain or back pain during pregnancy: The severe symptoms of placental abruption are mainly sudden persistent abdominal pain and/or backache and low back pain. After 20 weeks of gestation or during childbirth, the placenta in the normal position is partially or completely detached from the uterine wall before the delivery of the fetus, called placental abruption. Placental abruption is a serious complication in the third trimester of pregnancy. The short-term training course is urgent and rapid. If it is not handled in time, it can endanger the mother and child. The incidence of domestic reports is 4.6 to 21 , and the incidence rate abroad is 5.1 to 23.3 . The incidence is related to whether the placenta is carefully examined after delivery. Some patients with mild placental abruption can have no obvious symptoms before labor. Only when the placenta is examined after delivery, it is found that there is clot blockage in the early exfoliation. Such patients are easily overlooked.

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