Abstract: "Mr. Zhang, 49 years old, has been suffering from repeated low back pain for 20 years, mainly based on waist stiffness. Diagnosed with ankylosing spondylitis by the local hospital, oral treatment with sulfasalazine and diclofenac sodium was given, and the symptoms did not improve significantly....".
Mr. Zhang, 49 years old, has been suffering from repeated low back pain for 20 years, mainly based on morning stiffness in the waist. He had sought medical treatment in a local hospital, diagnosed with ankylosing spondylitis, and was given oral treatment with sulfasalazine and diclofenac sodium, but the symptoms did not improve significantly, and the medication was not taken regularly as prescribed by the doctor.
After adjusting the medication, oral sulfasalazine and subcutaneous injection of recombinant human tumor necrosis factor receptor antibody fusion protein 25mg, the improvement of pain symptoms was still not obvious.
On February 20, 2022, the patient came to our hospital for further treatment due to the aggravation of symptoms for 2 weeks.
Medical Attention:
Blood pressure: 130/80mmHg, heart rate 75 beats/ minute, two lung breath sounds are coarse, no obvious dry and wet rales are heard, wall pillow distance is 3 cm, positive spinal tenderness, mainly lumbosacral pain, lumbar spine range of motion 3 cm, positive tetragrammetry, BASDAI 7 points.
MrI of the sacroiliac joint:
The anterior joint is smooth, and the bilateral sacroiliac joints have low t1W1 and T2W1 lipid pressure hyperinflection in the bone under the surface of the bilateral sacroiliac joint, slightly on the left side, and the flaky lipid inhibition hyperinflection signal in the surrounding soft tissue on the right.
Thoracic and lumbar orthovertebral position:
It shows that the physiological curvature of the lumbar spine is slightly straightened, the physiological curvature of the thoracic spine is present, the bone hyperplasia at the edge of the lumbar vertebral body is altered, there is no obvious narrowing of the intervertebral space, the calcification of the ligaments of the thoracic 12, lumbar 1 and 2 vertebral bodies is marked, and the sacral joint space is blurred and narrowed, slightly on the left side, and no abnormal calcification is seen in the soft tissue.
(Lumbar spine X-ray)
Main diagnosis: ankylosing spondylitis
Other diagnoses: type 2 diabetes mellitus; Hypertension grade 3 (very high risk); Thyroid nodules; Fatty liver; Adrenal nodules.
25 February to 28 March 2022:
Greli (adalimumab injection), subcutaneously, 40 mg every 2 weeks;
Irecoxib is taken orally twice daily. The dose has been reduced to once a day since March 10.
The thoracic range of motion is normal, the distance between the wall pillow is 3 cm to 2 cm, and the spinal tenderness and the quadriplicity experiment are from positive to negative. Laboratory indicators have also declined rapidly.
(Follow-up registration shows rapid decline in inflammatory indicators)
After the patient was discharged from the hospital, he was given a combination of Gloria treatment, and his condition was stable during the medication period, and his symptoms improved significantly.
Due to the epidemic situation and the course of treatment, the patient's imaging has not been reviewed, combined with the current clinical signs and blood tests, the patient's waist morning stiffness and lumbar spine mobility have improved significantly compared with before, and the BASDAI score has dropped significantly from 7 points to 3 points. The treatment effect is remarkable, the condition is stable, and the safety is good.
2019 Chinese Axial Spondyloarthropathy Diagnosis and Treatment Expert Consensus For those who have been treated with at least 2 NSAIDs and have not relieved symptoms or are intolerant to the drug for more than 4 weeks, asdat ≥ 2.1 points or BASDAI ≥ 4 minutes, TNF-α inhibitors (such as Palelli) can be considered.
The treatment of the disease has certain personalized characteristics, and this case is only for the reference of patients. If you are unwell, go to the Rheumatology and Immunology Department of a regular hospital in time for medical treatment.
(Qian Chunping, Deputy Chief Physician)
Qian Chunping, Deputy Chief Physician
- Chinese deputy chief physician of the Department of Rheumatology and Immunology, 71st Army Hospital of the People's Liberation Army
- He specializes in the diagnosis and treatment of common and difficult diseases of rheumatoid system diseases such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and systemic sclerosis.
Tips
*This article is only for the purpose of learning and understanding medical science knowledge, can not be used as a basis for disease diagnosis, patients if unwell, please go to a regular medical institution for medical treatment, please follow the doctor's advice.
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