What exactly do X-ray examinations look for in patients with ankylosing spondylitis?

When we need to diagnose ankylosing spondylitis, a good examination method is essential, and the most commonly used examination method is X-ray examination
.

What is X-ray examination?

X-ray inspection is an inspection developed based on the penetrability of X-rays and fluorescence effects.
It is the most commonly used and most basic inspection in imaging inspections
.

The advantages of X-ray inspection are that it is easy to operate, low in price, and it can also be observed from multiple angles, and the results can be obtained quickly
.

(Source: Photograph Network)

However, plain X-rays show unclear articular cartilage, meniscus, and soft tissues such as synovium, ligaments, and tendons
.

In addition, plain X-ray films project the three-dimensional human body structure onto a two-dimensional plane for imaging, missing a lot of structure-related information
.

Reminder: X-ray has potential risk of teratogenicity, and patients of childbearing age should pay special attention
.

X-ray assessment criteria for rigidity

Grade 0: The boundary of the sacroiliac joint is obvious, and there is no manifestation of stenosis or widening;

Grade I: The sacroiliac joints appear osteoporosis, slight bone erosion, etc.
, with clear boundaries and widened joint spaces;

(Source: Photograph Network)

Grade Ⅱ: The sacroiliac joint surface is obviously damaged, the boundary is unclear, and there is bone erosion or cystic disease;

Grade III: X-rays indicate bone destruction and reconstruction of the joints, unclear boundaries, obvious cystic lesions, and narrow joint spaces;

Grade V: The examination revealed that the joints were sclerosing lesions, the bone density increased significantly, and there was no joint space or the gap basically disappeared
.

X-ray appearance of rigidity

0 1 Sacroiliac joint

Early manifestations are 2/3 spot-like or plaque-like bone decalcification under the sacroiliac joint, blurred edges, mild subchondral sclerosis, occasional beaded shadows, and unplanned widening of the joint space
.

The mid-term manifestations invade the entire joint, the joint surface is rat-bite or worm-eaten, the edge is jagged, the gap is further enlarged, the sclerosis zone is widened, but the boundary is blurred, and the gap becomes narrow after the lesion is stationary
.

In the late joint space fusion, it disappears and even thick trabecular bone passes through
.

0 2 Spine

Early changes are seen at the upper lumbar or thoracolumbar junction, manifested as osteoporosis of the vertebrae, blurred and disappeared inter-articular joints, and the anterior edge of the lateral vertebrae loses normal depression and tends to be square.
Calcification of the annulus fibrosus and paravertebral ligaments, initially sporadic, and finally continuous "bamboo-like" rigidity, normal or narrowed intervertebral space, calcification of the intervertebral joints on the frontal line, there are two parallel longitudinal dense bands , The supraspinous and interspinous ligament calcification is manifested as a single median dense belt running along the interspinous process
.

0 3 hip

The femoral skull is loose, eroded, and destroyed, and there may be a large amount of bone hyperplasia at the edge of the joint, the joint space is blurred, narrow or even disappear

references:

[1] Wang Jianjun, Guo Xiyuan.

[2]Zhu Zhengbin, Dong Jiangning.

[3] Zhang Meifeng, Huang Hongbin, Gao Yunzhen.

Expert introduction

Huang Runyue

Professor of Integrated Traditional Chinese and Western Medicine Clinical Medicine

PhD Tutor

Academic inheritor of Professor Li Jiren, master of traditional Chinese medicine, head of the research team of rheumatism and immunity in Guangdong Provincial Hospital of Traditional Chinese Medicine, deputy chairman of the Youth Committee of the Immunology Branch of the Chinese Society of Chinese Medicine, deputy chairman of the Rheumatology Committee of the Guangdong Society of Chinese Medicine, and a Dutch visiting scholar sent by the government.

Good at: diagnosis and treatment of gout, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic lupus erythematosus, Sjogren’s syndrome and other rheumatic immune diseases with integrated Chinese and Western medicine