强直性脊柱炎识别与治疗：从炎性腰背痛到长期用药

先看懂四件事：什么是中轴型脊柱关节炎、怎么识别、怎么检查、怎么治疗Axial Spondyloarthritis

强直性脊柱炎属于中轴型脊柱关节炎，是主要累及骶髂关节与脊柱的慢性炎症性疾病。治疗主线很清晰：先靠炎性腰背痛的特点识别，再用分类标准与影像明确诊断，一线用 NSAIDs，活动度仍高时按指征升级到生物制剂或靶向合成药，同时把运动、骨健康与心血管风险一起管起来。

发病机理：炎症从骶髂关节起步，向脊柱与关节外蔓延Pathogenesis

中轴型脊柱关节炎的炎症以骶髂关节与脊柱为核心，可在数年内造成骨化与活动受限；同一组炎症通路还会累及眼、肠道与皮肤，因此评估不能只看腰背痛。

哪些因素与不良结局相关

两个容易被忽略的问题

怎么检查：MRI、实验室与活动度评估Assessment

怎么治疗：NSAIDs、生物制剂与减停策略Treatment

治疗与管理一览

日常管理：运动、共病与随访Daily Management

十个常见误区Ten Common Misconceptions

参考文献与证据来源References & Evidence

本页共 24 条文献，来自国际共识与指南、随机对照试验、荟萃分析与机制研究，链接指向 PubMed。每条结论后的编号对应下方文献；证据不足或结论不一致之处已在正文标注。

1. 社区流行病学调查（上海 COPCORD 研究：风湿症状、类风湿关节炎、强直性脊柱炎与痛风患病率）Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study. The Journal of rheumatology. 2003;30(10):2245-2251. pubmed.ncbi.nlm.nih.gov/14528524
2. 横断面人群调查（中国南方校园人群中炎性腰背痛与中轴型脊柱关节炎患病率）Tong F, Lv Q, Li A, Fang L, Luo Z, Feng J, Gu J, Lin Z. An epidemiological study of the prevalence rate of inflammatory back pain and axial spondyloarthritis in a university in the south of China. Clinical rheumatology. 2018;37(11):3087-3091. pubmed.ncbi.nlm.nih.gov/29974281
3. 系统评价（强直性脊柱炎的全球患病率）Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford, England). 2014;53(4):650-657. pubmed.ncbi.nlm.nih.gov/24324212
4. 系统评价与荟萃分析（影像学型与临床型中轴型脊柱关节炎的外周及关节外表现患病率）de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis research & therapy. 2016;18():196. pubmed.ncbi.nlm.nih.gov/27586785
5. 系统评价（脊柱关节炎中葡萄膜炎的患病率与特点）Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Annals of the rheumatic diseases. 2008;67(7):955-959. pubmed.ncbi.nlm.nih.gov/17962239
6. 人群研究（炎性腰背痛标准的心理测量学评估）Hwang MC, Kim S, Assassi S, Ogdie A, Weisman MH, Reveille J, Green C. Psychometrics of inflammatory back pain criteria in the US population. EULAR rheumatology open. 2025;1(2):45-50. pubmed.ncbi.nlm.nih.gov/41510560
7. 指南（ASAS-EULAR 2022 中轴型脊柱关节炎管理建议更新）Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, Landewé RBM, Van den Bosch FE, Boteva B, Bremander A, Carron P, Ciurea A, van Gaalen FA, Géher P, Gensler L, Hermann J, de Hooge M, Husakova M, Kiltz U, López-Medina C, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compán V, Nissen MJ, Pimentel-Santos FM, Poddubnyy D, Proft F, Rudwaleit M, Telkman M, Zhao SS, Ziade N, van der Heijde D. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Annals of the rheumatic diseases. 2023;82(1):19-34. pubmed.ncbi.nlm.nih.gov/36270658
8. 叙述性综述（中轴型脊柱关节炎分类标准的经验与展望）Hayward RJ, Machado PM. Classification Criteria in Axial Spondyloarthritis: What Have We Learned; Where Are We Going? Rheumatic diseases clinics of North America. 2020;46(2):259-274. pubmed.ncbi.nlm.nih.gov/32340700
9. 队列研究（脊柱 MRI 阳性作为 ASAS 分类标准影像学依据的价值：SPACE 与 DESIR 队列）Ez-Zaitouni Z, Bakker PA, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M, Fagerli KM, Landewé RB, Ramonda R, Jacobsson LT, Saraux A, Lenczner G, Feydy A, Pialat JB, Thévenin F, van Gaalen FA, van der Heijde D. The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Annals of the rheumatic diseases. 2017;76(10):1731-1736. pubmed.ncbi.nlm.nih.gov/28663306
10. Cochrane 系统评价（NSAIDs 治疗中轴型脊柱关节炎）Kroon FP, van der Burg LR, Ramiro S, Landewé RB, Buchbinder R, Falzon L, van der Heijde D. Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis). The Cochrane database of systematic reviews. 2015;(7):CD010952. pubmed.ncbi.nlm.nih.gov/26186173
11. 随机对照试验（持续与按需 NSAIDs 对强直性脊柱炎放射学进展的影响）Wanders A, Heijde Dv, Landewé R, Béhier JM, Calin A, Olivieri I, Zeidler H, Dougados M. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis and rheumatism. 2005;52(6):1756-1765. pubmed.ncbi.nlm.nih.gov/15934081
12. 起始队列 10 年随访（NSAIDs 与中轴型脊柱关节炎脊柱放射学进展：GESPIC）Torgutalp M, Rios Rodriguez V, Proft F, Protopopov M, Rademacher J, Haibel H, Sieper J, Rudwaleit M, Poddubnyy D. The Impact of Nonsteroidal Anti-Inflammatory Drugs on Radiographic Spinal Progression in Patients With Axial Spondyloarthritis: 10-Year Results From an Inception Cohort. Arthritis & rheumatology (Hoboken, N.J.). 2026;78(3):582-591. pubmed.ncbi.nlm.nih.gov/41310944
13. 随机对照试验（抗 TNF 基础上加用 NSAIDs 与单用抗 TNF 对脊柱结构损伤进展的比较：CONSUL）Proft F, Torgutalp M, Muche B, Rios Rodriguez V, Listing J, Protopopov M, Rademacher J, Haibel H, Spiller L, Weber AK, Verba M, Brandt-Juergens J, Kiltz U, Sieburg M, Jacki S, Sieper J, Poddubnyy D. Comparison of the effect of treatment with NSAIDs added to anti-TNF therapy versus anti-TNF therapy alone on the progression of structural damage in the spine over 2 years in patients with radiographic axial spondyloarthritis from the randomised-controlled CONSUL trial. Annals of the rheumatic diseases. 2024;83(5):599-607. pubmed.ncbi.nlm.nih.gov/38228361
14. 随机对照试验（阿达木单抗治疗强直性脊柱炎：ATLAS）van der Heijde D, Kivitz A, Schiff MH, Sieper J, Dijkmans BA, Braun J, Dougados M, Reveille JD, Wong RL, Kupper H, Davis JC, ATLAS Study Group. Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis and rheumatism. 2006;54(7):2136-2146. pubmed.ncbi.nlm.nih.gov/16802350
15. 随机对照试验（IL-17A 抑制剂司库奇尤单抗治疗强直性脊柱炎：MEASURE 1/2）Baeten D, Sieper J, Braun J, Baraliakos X, Dougados M, Emery P, Deodhar A, Porter B, Martin R, Andersson M, Mpofu S, Richards HB, MEASURE 1 Study Group, MEASURE 2 Study Group. Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. The New England journal of medicine. 2015;373(26):2534-2548. pubmed.ncbi.nlm.nih.gov/26699169
16. 随机对照试验（upadacitinib 治疗活动性强直性脊柱炎：SELECT-AXIS 1）van der Heijde D, Song IH, Pangan AL, Deodhar A, van den Bosch F, Maksymowych WP, Kim TH, Kishimoto M, Everding A, Sui Y, Wang X, Chu AD, Sieper J. Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial. Lancet (London, England). 2019;394(10214):2108-2117. pubmed.ncbi.nlm.nih.gov/31732180
17. 停药随访研究（连续英夫利西单抗治疗 3 年后停药的临床反应，非随机对照）Baraliakos X, Listing J, Brandt J, Zink A, Alten R, Burmester G, Gromnica-Ihle E, Kellner H, Schneider M, Sörensen H, Zeidler H, Rudwaleit M, Sieper J, Braun J. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis research & therapy. 2005;7(3):R439-44. pubmed.ncbi.nlm.nih.gov/15899030
18. 系统评价与荟萃分析（中轴型脊柱关节炎生物制剂减量与停药的疗效）Park HS, Díaz Del Campo P, Plana MN, Polo Y La Borda J, Guerra-Rodríguez M, Moreno M, Cañete JD. Efficacy of withdrawal or tapering of bDMARDs vs. standard regimen in axial spondyloarthritis patients: systematic review and meta-analysis informing the update of the Spanish Society of Rheumatology Guideline. Frontiers in medicine. 2025;12():1621313. pubmed.ncbi.nlm.nih.gov/41001393
19. Cochrane 系统评价（强直性脊柱炎的运动方案）Regnaux JP, Davergne T, Palazzo C, Roren A, Rannou F, Boutron I, Lefevre-Colau MM. Exercise programmes for ankylosing spondylitis. The Cochrane database of systematic reviews. 2019;10():CD011321. pubmed.ncbi.nlm.nih.gov/31578051
20. 项目评估研究（强直性脊柱炎教育与自我管理项目的效果）Inderjeeth CA, Boland E, Connor C, Johnson C, Jacques A, McQuade J. Evaluation of an ankylosing spondylitis education and self-management program: Beneficial effects on ankylosing spondylitis specific outcomes. International journal of rheumatic diseases. 2021;24(3):434-444. pubmed.ncbi.nlm.nih.gov/33694321
21. 随机对照试验（基于 App 的非药物干预改善中轴型脊柱关节炎患者报告结局）Strunz PP, Froehlich M, Heusinger T, le Maire M, Fleischer A, Luetkens KS, Possler P, Gernert M, Labinsky H, Gadeholt O, Leppich R, Schmieder A, Hammel L, Sperlich B, Einsele H, Schmalzing M. An app-based nonpharmacological intervention improves patient-reported disease activity, functionality, and quality of life in patients with axial spondyloarthritis: a randomised controlled trial. Annals of the rheumatic diseases. 2026;85(8):1543-1555. pubmed.ncbi.nlm.nih.gov/41826215
22. 荟萃分析（生物制剂对强直性脊柱炎心血管事件的影响）Yin H, Wang Y, Chen Z, Zhu Y, Lu W, Huang K. Impact of Biologics on Cardiovascular Events in Ankylosing Spondylitis: A Meta-Analysis. International journal of rheumatic diseases. 2026;29(2):e70573. pubmed.ncbi.nlm.nih.gov/41672949
23. 系统评价与荟萃分析（强直性脊柱炎患者骨质疏松与骨折的患病率及相对风险）Liu Y, Ma X, Dai T, Zhang J, Liu Y, Ren W, Bian J. Prevalence and relative risk of fractures and osteoporosis in patients with ankylosing spondylitis: a systematic review and meta-analysis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2026;37(4):821-838. pubmed.ncbi.nlm.nih.gov/41575558
24. 妊娠登记汇总分析（欧洲风湿病妊娠登记网络中轴型脊柱关节炎的妊娠与新生儿结局：EuNeP）Meissner Y, Strangfeld A, Molto A, Forger F, Wallenius M, Costedoat-Chalumeau N, Bjørngaard H, Couderc M, Flipo RM, Guettrot-Imbert G, Haase I, Jakobsen B, Koksvik HSS, Richez C, Sellam J, Weiß A, Zbinden A, Fischer-Betz R, EuNeP collaborator group. Pregnancy and neonatal outcomes in women with axial spondyloarthritis: pooled data analysis from the European Network of Pregnancy Registries in Rheumatology (EuNeP). Annals of the rheumatic diseases. 2022;81(11):1524-1533. pubmed.ncbi.nlm.nih.gov/35961759