非甾体抗炎药有效到底有效还是无效？

Case Description

A 33-year-old male with a past medical history of uveitis, psoriasis, and a recent surgical history of open inguinal hernia repair presented to the clinic for evaluation of chronic, dull, lower back, and bilateral hip pain, which started insidiously and which was aggravated with rest and alleviated by exercise. The pain was located in the bilateral sacroiliac (SI) joints and was non-radiating, not associated with numbness, tingling, and kept changing in sensation or with motor weakness.The patient reported a family history of similar problems. On examination, he was found to have bilateral SI joint tenderness with limited external rotation and abduction of the hips bilaterally.

病例描述

男性，33 岁，既往有葡萄膜炎、银屑病病史，近期行开放性腹股沟疝修补术，因腰背及双侧髋部慢性钝痛就诊，起病隐匿，休息后加重，运动后缓解。疼痛位于双侧骶髂关节（sacroiliac，SI）区域，无放射性，不伴有麻木、有刺痛，疼痛不断变化，或伴运动乏力。患者报告有类似问题家族史。检查发现双侧SI关节压痛，双侧髋关节外旋和外展受限。

On initial evaluation by the primary care physician (PCP), the patient was prescribed nonsteroidal anti-infammatory drugs (NSAIDs) with minimal improvement, and after lumbar spine imaging demonstrated SI joint arthropathy, the patient was sent home and referred to the pain clinic for persistence of pain and suspicion of SI joint infammation. After being evaluated in the pain clinic, the patient had an AP X-ray of the pelvis taken that was inconclusive. Subsequently, an MRI of the lower lumbar spine (as being the most symptomatic region) was performed, which demonstrated sacroiliitis.

初级保健医生（primary care physician，PCP）初步评估后，给予患者非甾体抗炎药（nonsteroidal anti-infammatory drugs，NSAIDs），缓解极小，腰椎平片显示SI关节病变，患者因疼痛持续和怀疑SI关节炎而转诊到疼痛门诊。在疼痛门诊评估后，患者接受了骨盆正位片检查，结果不明确。随后，进行了下腰椎（症状最严重区域）的MRI检查，显示为骶髂关节炎。

What Is Your Preliminary Diagnosis?

SI joint infammation due to ankylosing spondylitis (AS).

初步诊断？

强直性脊柱炎（ankylosing spondylitis，AS）引起的骶髂关节炎。

How Is the Diagnosis Confrmed?

The diagnosis of this clinical condition can be confrmed in two steps: the frst step involves a detailed history that identifes lower back pain (LBP) of >3 month’s duration, age of onset before 45 years, AP radiograph of the pelvis that demonstrates sacroiliitis, and involvement of the SI joint. The second step involved in the diagnosis is taken into account in the patient population in whom imaging is inconclusive.Clinicians have looked at 11 pertinent clinical features (LBP, heel pain, improvement with NSAIDs, uveitis, dactylitis, elevated acute phase reactants such as ESR and CRP, psoriasis, alternating buttock pain, asymmetric arthritis, and Infamatory Bowel Disease -IBD) and presence of 4 out of the 11 features is required to confrm the diagnosis [1]. In the case described, the patient demonstrated both sacroiliitis on the pelvic AP flm and uveitis, psoriasis, and improvement with NSAIDs.

如何确诊？

该临床情况的诊断可分为两步：第一步包括详细询问病史，患者确认腰痛（lower back pain，LBP）持续＞3个月，发病年龄＜45岁，骨盆正位片显示骶髂炎及累及SI关节。第二步是影像学不明确时，临床医生观察11个相关的临床特征（腰痛、足跟痛、非甾体抗炎药有效、葡萄膜炎、指(趾)炎、急性期血沉和CRP升高、银屑病、臀部交替疼痛、不对称的关节炎和炎症性肠病（Infamatory Bowel Disease，IBD）），当11种临床表现有4个可确诊[1]。此病例患者盆腔正位片上表现为骶髂炎，患者还有葡萄膜炎、银屑病和非甾体抗炎药改善。

minimal improvement 我认为是等于无缓解，为啥下面又说改善