In recent years, the knowledge or guidelines of clinical experts on ankylosing spondylitis (AS)/ spinal arthritis (SpA) have been constantly updated, but how to better understand and implement it, and patients' independent participation in management is one of the key links to improve the level of diagnosis and treatment. Practice Guide for Patients with Ankylosing Spondylitis/Spinal Arthritis, according to the international standard process, put forward 15 opinions on practice guide for patients with Ankylosing Spondylitis/Spinal Arthritis.

Question: Human leukocyte surface antigen (HLA)? Can B27 positive be diagnosed as AS/SpA?

Viewpoint 1: HLA? AS/SpA( 1A)B27 positive can not be diagnosed.

Question: HLA? B 27 positive AS/SpA, will it be passed on to the next generation?

Question: Why do patients with AS/SpA need to check C-reactive protein (CRP) regularly?

Viewpoint 3: Patients with AS/SPA should be tested for CRP regularly (1c).

Monitoring CRP can help:

(1) Monitoring inflammation: Quantitative scoring method is usually used to judge the degree of inflammation in AS/SpA, such as the disease activity score of ankylosing spondylitis (ASDAS), which includes objective detection index CRP in addition to the evaluation of patients and doctors, so clinical detection of CRP is helpful to judge inflammation, and even has reference value for evaluating painless and asymptomatic AS/SpA patients.

(2) Predicting radiological progress: The higher the CRP level, the more serious the spinal cord inflammation (bone marrow edema) and destructive progress (bone erosion, etc.). ) in terms of imaging.

(3) Predicting the therapeutic response of tumor necrosis factor-α (TNF-α) inhibitors: The higher the CRP level, the more obvious the improvement of symptoms after treatment.

Question: Why do AS/SpA patients need to review MRI?

Viewpoint 4: As/SPA patients need to review MRI regularly (1b).

MRI is widely used in AS/SpA；;

(1) Auxiliary diagnosis: According to the diagnostic grading standard of AS/SpA, MRI showed that bone marrow edema and sacroiliac osteitis could be used as the radiological diagnostic standard of AS/SpA.

(2) Monitoring disease activity: MRI can show acute inflammation, such as bone marrow edema, and the imaging scores of spine and sacroiliac joints can understand the degree of joint inflammation.

(3) Monitoring the destruction of bone structure: MRI can show the signs of bone structure destruction, such as fatty lesions, erosion, sclerosis, rigidity, etc., and can be used to score the spine and sacroiliac joints. MRI evaluation of vertebral angle inflammation and fatty lesions is of certain value in predicting the formation of new osteophyte.

(4) Auxiliary prediction of prognosis and severity of the disease: 1~3 years of regular MRI reexamination shows that osteophyte increases 1~3, which often indicates that the progress of the disease is not effectively controlled and the prognosis is poor.

(5) Evaluation of therapeutic effect of drugs: By evaluating the changes of inflammation and bone structure, the therapeutic effect of various drugs can be evaluated.

Question: Does smoking affect the disease activity and function of patients with AS/SpA?

Viewpoint 5: As/SPA patients should quit smoking (1C).

Question: What are the benefits of physical exercise for AS/SpA patients?

Viewpoint 6: As/SPA patients should insist on physical exercise (2D).

Exercise is the basis of AS/SpA treatment. No matter what kind of exercise, moderate exercise can effectively relieve pain, improve motor function, enhance cardiopulmonary function and improve quality of life.

Question: The first choice for treating AS/SpA.

Viewpoint 7: Non-steroidal anti-inflammatory drugs (NSAIDs)( 1B) are the first choice for AS/SPA patients without contraindications to NSAIDs.

NSAIDs have the following effects on AS/SpA:

(1) Relieve pain, morning stiffness and improve spinal mobility.

(2) Long-term use of NSAIDs can reduce CRP and ESR.

(3) Long-term use of NSAIDs can delay the process of bone structure destruction of spinal joint.

Question: What effect does oral NSAIDs have on the cardiovascular system of AS/SpA patients?

Viewpoint 8: Patients with AS/SPA should regularly monitor cardiovascular risk index (2C) when taking NSAIDs.

Non-steroidal anti-inflammatory drugs may have potential cardiovascular risks, including arrhythmia and elevated blood pressure.

Question: What effect does oral NSAIDs have on the gastrointestinal tract of AS/SpA patients?

Viewpoint 9: As/SPA patients should pay attention to the risk of digestive tract when taking NSAIDs (2B)

NSAIDs reduce the protection and repair ability of gastrointestinal mucosal barrier by inhibiting the production of prostaglandin, which leads to gastrointestinal side effects, such as epigastric discomfort, nausea, vomiting, abdominal pain, abdominal distension, diarrhea and ulcer.

Q: When did patients with AS/SpA receive TNFα inhibitors?

Viewpoint 10: As/SPA patients with poor curative effect can be treated with TNFα inhibitors (1a); AS/SpA patients are relieved after half a year of treatment with TNFα inhibitor, so we can consider reducing maintenance treatment (2C).

Question: Why do AS/SpA patients need to be tested for hepatitis B virus?

Opinion11:patients in as/spa should be screened for HBV before taking medicine (1c).

Routine screening of HBV for patients with AS/SpA is very necessary, because HBV is easily activated when patients with inflammatory diseases, such as patients with hepatitis B in AS/SpA, receive medication including NSAIDs, sulfasalazine and TNFα inhibitors.

Before treatment, we should not only screen, but also suggest that during the treatment, we can regularly review the DNA quantification of HBV according to the condition and doctor's advice for about half a year.

Question: Can AS/SpA patients with HBV be treated with TNFα inhibitors?

Opinion 12: As/SPA patients with chronic hepatitis b should regularly check HBV activation after receiving TNFα inhibitor treatment (2C).

Question: What effect does TNFα inhibitor have on the fertility of patients with AS/SpA?

Opinion 13: TNF α inhibitor has no adverse effect on fertility and pregnancy of AS/SpA patients (2D).

Question: Will AS/SpA patients increase tuberculosis infection after receiving TNFα inhibitors?

Opinion14: patients with as/spa should be screened for tuberculosis infection when receiving TNFα inhibitors (1C).

Due to the disease itself and the influence of many drugs, it is suggested that:

(1) All patients who are going to receive TNFα inhibitors need to ask about the history of tuberculosis in detail, including contact history, treatment and detailed physical examination.

(2) Chest X-ray examination, tuberculin skin test and interferon release test (IGRA), such as T-SPOT test of tuberculosis infection, should be carried out before taking the medicine, and IGRA can be reviewed every six months according to the condition and doctor's advice during the treatment.

(3) During the medication, the skin test of tuberculin or IGRA turned from negative to positive, and it was decided whether to carry out tuberculosis prevention and treatment according to the clinical situation.

Question: What are the benefits of participating in patient associations and patient education for AS/SpA patients?

Opinion 15: it is suggested that patients with As/SPA should join the patient association (1C).

The above contents are excerpted from: Xie Ya, Yang, Lu Qing, etc. A practical guide for patients with ankylosing spondylitis/spinal arthritis [J]. Chinese Journal of Internal Medicine, 2020,59 (07): 51-518.