Ankylosing spondylitis (AS) is a chronic and systemic inflammatory disease, which needs close attention to prevent comorbidity. Therefore, the AS team care attaches great importance to interdisciplinary cooperation for extra-articular manifestations, such as uveitis to be referred to ophthalmology, examination of lipid profile and cardiovascular disease risk assessment, consultation with the cardiology department when necessary, and timely arranging bone mineral density examination and early intervention prevention and treatment strategies to avoid osteoporotic fractures. For common comorbidities, we have worked with doctors from relevant departments on a regular basis. Through regular discussion and multidisciplinary care, we remind non-rheumatic specialists such as cardiologist and orthopedist to understand the importance of AS-related comorbidities, and develop the most appropriate holistic care for patients. We can help to arrange referral in the AS clinic, so that patients do not need to seek help from each outpatient department.

AS treatment emphasizes multidisciplinary care and interdisciplinary cooperation in China Medical University Hospital (CMUH). In addition to rheumatology and immunology specialists and case managers, it also includes dieticians, physical therapists, pharmacists, functional therapists and even herbalists. If the patients need to be treated in different departments, they can be directly arranged through the clinic’s computer, thus saving time for patients to make an appointment.

Prevent the crisis of AS comorbidities

Many AS patients lack the awareness of comorbidity, thinking that it is an individual case without associating it with AS, or ignoring that fact that continuous treatment can help reduce the risk of comorbidity. For example, the risk of cardiovascular disease in patients with AS is 2.2 times that of the general population, and the onset age is 5-10 years earlier on average. There was a patient who had poor AS condition control and had a long-term smoking habit. He ignored the doctor's advice to give up smoking and prevent cardiovascular disease. As a result, he was only in his 40s and at the peak of his career when he suddenly had an ischemic stroke.

Therefore, in order to improve patients' understanding of AS-related comorbidities, the team members in the Center of Rheumatology and Immunology of CMUH provide multidisciplinary care and the education articles for AS patients with multiple information through the Internet and mobile Apps, and building the ability of self-care. In addition, at least once a year, there is a large meeting of patients with face-to-face interaction to make the relationship between doctors and patients closer. Patients can also form a group to support each other in their fight against the disease.

Help patients balance work and treatment

The majority of AS patients are male, and most of them develop the disease at productive ages. To help patients balance work and treatment, the case management team will assist in the coordination of registration, health education and working hours, and apply for the prescription for chronic diseases under the ideal condition of disease control to reduce their pressure of return visit time. If the patient is eligible for the health insurance benefits, the team will assist the patient to apply for more advanced therapeutic drugs (e.g. biological agents) as soon as possible to control the disease activity, so that the patient can return to workplace and family life as soon as possible, and improve their quality of life.

To encourage patients to learn self-care and reduce the time for going to and from the hospital clinic, we offer simple rehabilitation exercise that patients can do at home through health education, and has built a "CMUH Click" App, which can query the important information of medical news and disease management through mobile phones at any time. We hope to open up and let patients establish personal data to achieve two-way interaction. The relevant content is provided by our team members, and updated in real time on the Central Asia Health Network and on the multimedia machines in the waiting room to achieve cross-platform medical information integration.

Optimal exercise (such as Taiji) can relieve pain and improve flexibility

Optimal exercise is essential for AS patients to maintain the range of motion of spinal joints. Combining with the characteristics of CMUH in traditional Chinese medicine, it is recommended that patients practice taijiquan exercise to achieve the effect of circulation of qi and blood by controlling the tension and driving the body to do very gentle and smooth stretching, so as to avoid sports injuries. After instructing the patients to practice the joint exercise in Taijiquan, we also found that it can ease the pain. At present, the school has set up an open Taijiquan club, which welcomes the participation of patients and the general public.