不典型强直性脊柱炎误诊原因分析OACSTPCD

Objective To analyze the causes and preventive measures of ankylosing spondylitis(AS)misdiagnosed as lumbar disc herniation(LDH)and rheumatic fever(RF).Methods The case data of 1 patient with AS misdiagnosed as LDH and 1 patient with RF from 2021 to 2023 were retrospectively analyzed.Results A 31-year-old male patient presented with pain in the lower back and right lower extremity accompanied by morning stiffness for 3 months.CT examination of lumbar disc showed mild disc herniation at L4-5 and was initially diagnosed as LDH.Afterwards,low fever appeared,erythrocyte subsidence rate(ESR)and C-reactive protein(CRP)were elevated,human leukocyte antigen B27(HLA-B27)was positive,and CT scan of the sacroiliac joint showed worm-eaten-like changes on the surface of both sacroiliac joints,which was diagnosed AS.One pa-tient was a 16-year-old adolescent who presented with swelling and pain in both ankles and knees for more than 1 year,which was aggravated for more than 1 month.Due to anti-streptolysin"O"test(+),and the complicated symptoms of multiple joint pain,he was diagnosed with RF.The symptoms improved after Benzathine Penicillin injection and recurred after discontinua-tion.MRI examination of posterior sacroiliac joint showed local fusion of bilateral sacroiliac joint surfaces,with elevated ESR and CRP.Based on this,AS was diagnosed after exclusion of RF.The duration of misdiagnosis was 3 months and 14 months re-spectively.After diagnosis,the symptoms of 2 patients disappeared after treatment with Sulfasalazine,Methotrexate,and recombi-nant human tumor necrosis factor receptor type Ⅱ antibody fusion protein.They were followed up for 1 to 2 years,and the con-dition was stable.Conclusion Some patients with AS have atypical manifestations in the early stage and are prone to misdiag-nosis.Strengthening the understanding of AS and related diseases,diagnosis and differential diagnosis ability,careful collec-tion of medical history,careful physical examination,early imaging examination of sacroiliac joint and HLA-B27 detection,com-bined with clinical manifestations and other relevant examination results,can help avoid misdiagnosis of this disease.