强直性脊柱炎（AS）

强直性脊柱炎（AS）（ANK-EE-Lo-lo-Zing Spon-Dee-Li-Tus）是一种关节炎，主要通过引起脊柱炎症而影响背部。这会使您的背部，肋骨和颈部僵硬而痛苦。

它通常从十几岁或20多岁的人开始。

为了应对炎症，人体周围脊柱的骨骼周围产生额外的钙。这会使额外的骨骼生长，并使您的背部和颈部变得更加僵硬。

在极少数情况下，脊柱的某些骨骼可能会链接，或者由于额外的钙而融合在一起。在严重的情况下，这可能会使脊柱曲线进一步向前。如果您：

• keep active
• have effective medical treatment
• try to maintain a good posture.

虽然它主要影响颈部和背部，但它也可能导致体内其他地方（包括臀部，肩膀和脚部）的疼痛和僵硬。

We don’t yet know what causes ankylosing spondylitis. To some extent it’s related to your genes, but the condition isn’t passed directly from a parent to their children. You can’t catch it from anyone else.

与强直性脊柱炎有关的疾病

Ankylosing spondylitis is a type of spondyloarthritis (spon-dee-lo-arth-rye-tus). This is the name for a group of conditions with similar symptoms – mainly pain and stiffness around the spine.

Here are some other types of spondyloarthritis:

• 非射线照相术（非拉迪奥颗粒）轴向脊椎关节炎 - 主要症状类似于强直性脊柱炎 - 脊柱周围的疼痛和僵硬。但是，在X射线上可以看到背部的身体变化。有些患有这种疾病的人后来被诊断出患有强直性脊柱炎。
• 银屑病（对不起）脊椎关节炎是一种形式psoriatic arthritis这可能与皮肤病牛皮癣一起发生。牛皮癣的人会得到红色，鳞片状的皮肤。
• 与炎症性肠病相关的脊椎关节炎，这也称为肠性疾病（En-tur-O-Path-path）关节炎。这与肠子有关Crohn’s diseaseor溃疡性结肠炎。肠道是消化系统的一部分，有助于分解我们吃的食物。
• Reactive arthritisis diagnosed when your arthritis is a reaction to an infection.
• 相关的肠炎（thur-si-tus）幼年特发性关节炎时使用的名称是儿童和青少年重击吗op inflammation in entheses, the sites where tendons and ligaments attach to bones.

这rest of this content refers to ankylosing spondylitis. However, the treatment and self-management advice is very similar for people with other types of spondyloarthritis.

在早期，强直性脊柱炎可能导致::

• stiffness and pain in your lower back in the early morning that lasts at least 30 minutes and then eases through the day or with activity
• 夜晚唤醒你的痛苦
• pain in one or both buttocks and sometimes the backs of the thighs.

这condition can sometimes be mistaken for common backache.

常见的背痛通常会出现短而痛苦的咒语。但是强直性脊柱炎的疼痛可能会持久。

You may also have neck, shoulder, hip or thigh pain, which is worse when you’ve not been active for a time, for example if you sit for long periods working at a desk. Some people have pain, stiffness and swelling in their knees or ankles.

这pain and stiffness can vary over time. If most of the spine is affected, it can cause difficulty with activities that involve bending, twisting or turning.

Other possible symptoms include:

• soreness at the heel or in the arch of your foot
• 手指或脚趾疼痛和肿胀
• tenderness at the base of your pelvis, which can make sitting on a hard chair uncomfortable
• 胸痛或胸部周围的紧绷感。这可能使深呼吸困难。您的肋骨可能会感到非常嫩，您可能会发现您的肋骨甚至在轻柔的活动后都没有呼吸。咳嗽或打喷嚏可能会引起不适或疼痛。
• 肠炎。强直性脊柱炎的人会出现被称为炎症性肠病（IBD）或结肠炎的肠问题。如果您的腹泻已超过两个星期或血腥或黏糊糊的po，看医生是个好主意。
• fatigue, which is severe tiredness that doesn’t improve with sleep or rest. This can be caused by the condition itself, as well as by anaemia. This is when people have a lack of red blood cells, which carry oxygen around the body.
• 抑郁和焦虑。
• 眼睛的炎症，称为葡萄膜炎或肠炎。最初的迹象通常是痛苦的，有时是红眼睛。看明亮的灯光可能会变得不舒服。

如果您的一只或两只眼睛疼痛或红色，或者您的视力有所改变，例如部分视力，视力模糊，浮动器或对光的敏感性，那么尽快获得医疗帮助非常重要。最好的去处是眼球伤亡部门。您的眼镜师将能够告诉您最近的光学师。您也可以去GP手术或事故和急诊科。治疗通常是类固醇眼滴，通常非常有效。

如果您长时间患有强直性脊柱炎，或者背部的骨骼融合在一起，则可能有骨头骨折的危险。脊椎骨折的骨骼会导致神经损伤。

It’s very important that a doctor treating you following a fall or an accident knows that you have ankylosing spondylitis.

如果您的脊柱或新的弱点，麻木或刺痛的疼痛有新的疼痛，请告诉医生非常重要。

Some people with ankylosing spondylitis develop骨质疏松症, a condition that causes bones to thin and be more likely to fracture.

如果您患有强直性脊柱炎或任何类型的脊柱炎，它可能会使您更容易受到心脏病发作或中风等问题的风险。服用药物来减少炎症，并吃健康的饮食，而不是定期吸烟和锻炼会降低这种风险。

Rarely, the top of your lungs may become scarred if your chest is affected by ankylosing spondylitis.

尽管这些问题可能在强直性脊柱炎的人中发生，但很少见。

强直性脊柱炎的症状可能类似于更常见的背部问题，尤其是在早期。

Because of this, many people put up with the pain for some time before seeking help. It’s important to see a doctor as soon as possible if you suspect you have ankylosing spondylitis.

通常是由rheumatologist，这些医生专门研究影响关节，骨骼和肌肉的疾病。

这re is no one test that can show for certain that you have ankylosing spondylitis. A diagnosis will be made based on several things, including:

• the history of your condition and the symptoms you’ve experienced, including whether pain and discomfort is waking you up during the second half of the night
• a physical examination
• 血液检查，可能显示炎症
• X射线或磁共振成像（MRI）扫描
• 你的年龄。它可以在任何年龄段被诊断出来，但大多数通常是在40岁之前开始的，而且通常还年轻。

有疾病活动和疼痛评分可以帮助医生诊断强迫症。您的医生会问您是否有关键症状，例如肿胀和疼痛的关节，尤其是脊柱周围，以及fatigue。You’ll be asked if you have pain in the mornings and how long for. Your answer to these questions could help lead to a diagnosis.

血液测试可以确认您是否具有HLA-B27基因。大多数患有强直性脊柱炎的患者对HLA-B27进行阳性，但是许多没有这种状况的人也是如此。阳性测试可能表明某人患有强直性脊柱炎，但不能确认诊断。

多种治疗可以减慢其速度并治疗疼痛和僵硬。锻炼和密切注意姿势对于保持脊柱手机并帮助您过正常生活同样重要。

以下一些药物只能由风湿病顾问开处方。

药物治疗

止痛药and non-steroidal anti-inflammatory drugs (NSAIDs)

止痛药，例如扑热息痛和non-steroidal anti-inflammatory drugs (NSAIDs), such asibuprofen, are usually the first choice of treatment for ankylosing spondylitis.

对于患有抗炎药无法控制的症状的人来说，其他药物可以帮助减轻疼痛或限制疾病的影响。

疾病改良的抗风湿药（DMARDS）

诸如sulfasalazineandmethotrexate，可以治疗您的手臂和腿部关节炎，尽管它们通常不适合脊柱症状。

这se drugs, calleddisease-modifying anti-rheumatic drugs (DMARDs), can reduce the amount of inflammation that happens in your body. This means that as well as treating symptoms, they can help prevent joint damage.

这se drugs can sometimes take several weeks or months to take effect. When they do take effect, they can make a big difference to your pain and stiffness. They’re often long-term treatments.

服用DMARDS时，您需要定期检查和血液检查以监测其作用。

生物疗法

生物疗法是对某些强直性脊柱炎和相关疾病的新疗法，对某些人可能非常有效。

这些药物比较旧的DMARD具有更有针对性的方法来阻止炎症。

这y aren’t suitable for everyone and can only be prescribed if your condition can’t be controlled with anti-inflammatory drugs and physiotherapy.

有一组称为抗TNF药物的生物疗法。以下可以治疗强直性脊柱炎：

• etanercept
• adalimumab
• certolizumab pegol
• golimumab。

secukinumabis a different type of biological therapy that can also treat ankylosing spondylitis. It’s one of a new family of biological therapies called interleukin, or IL-17 inhibitors. This drug also works by reducing or slowing inflammation.

这se drugs are given as an injection, which you, or a partner, relative or friend can learn to do.

将监测生物疗法的影响，您需要定期填写问卷，以检查您对治疗的反应程度。

Steroids

Steroids can be used as a short-term treatment for flare-ups. They’re usually given as aninjectioninto a swollen joint or as a slow-release injection into a muscle. They can also treat painful tendons, for example at the heel, although they aren’t repeated too often as they can cause tendon weakness.

Occasionally, you may be given a course of steroid tablets called prednisolone. While these treatments can be very effective at improving pain and stiffness, you may develop side-effects if you use them for long periods.

If you’ve been prescribed类固醇片，与您的医生谈谈副作用的风险以及如何减少获得它们的机会。与任何药物一样，请立即向医生报告任何副作用。

如果您发炎，通常会用类固醇眼滴治疗。在更严重的眼部炎症情况下，可以将类固醇作为片剂或注射到眼睛。

Physical therapies

Physiotherapyis a very important part of the treatment for ankylosing spondylitis. Aphysiotherapist可以整理一项锻炼程序，以提高肌肉力量，并帮助您保持脊椎和其他关节的流动性。

锻炼背部和颈部尤其重要，以避免它们僵硬到弯曲的位置。

物理治疗师将为您提供有关如何保持良好姿势的建议，并可能能够为您提供水疗，也称为水生疗法。这涉及在特殊的温水池中对脊柱，臀部和肩膀进行的特定运动。

许多患有强直性脊柱炎的人发现这种疗法有帮助，并在当地的游泳池或当地继续他们的计划国家强直性脊柱炎学会（NASS）团体。

Surgery

Most people with ankylosing spondylitis don’t need surgery, although some people may need a时髦的orknee replacement如果这些关节受到严重影响。这可以消除疼痛并改善流动性。

If you’re concerned about your spine being bent, raise this with yourrheumatologist。Any decision about surgery is difficult and should also involve an experienced spinal surgeon. Though it’s very rare for people to need surgery on their back because of ankylosing spondylitis, it can dramatically improve some people’s lives.

药物治疗可以帮助控制强迫症。您还可以做很多事情来帮助改善症状。

保持积极和关注姿势可以极大地帮助您最大程度地减少这种情况的长期影响。

保持活跃

If you have ankylosing spondylitis,保持活跃can really help you manage your condition.

定期运动非常适合背部运动范围，并阻止脊柱僵硬。开始缓慢，逐渐建立您进行的运动量。

过多的休息会增加脊柱的僵硬。

如果您很痛苦并发现难以运动，请与您的医生或physiotherapist。

除了对您的背部有益外，运动对您的心脏和肺部以及整体健康都很重要。它还可以提高您的心情并增强您的信心。

Specific simple exercises for your back, chest and limbs will help keep them supple. You may find stretching exercises after a hot shower or bath are especially helpful to ease stiffness in the morning.

Try to do at least some exercise each day. Remember you can takepainkillersbeforehand to help you exercise.

我们有examples of exercises帮助提高力量和灵活性。尝试每天做。

Pilates,瑜伽andt’ai chi可能有用，因为这些可以帮助姿势，力量和灵活性。如果您对特定活动有任何疑问或疑问，您可以向物理治疗师咨询建议。如果您上课，请告诉教练您的病情。

Swimming is one of the best forms of exercise because it uses lots of muscles and joints without jarring them. And the water supports the weight of your body. Swimming provides a great overall workout that improves your strength, stamina and flexibility.

Speak to your physiotherapist or a swimming instructor if you have discomfort when swimming, as a different stroke or slight change to your technique could help.

As an alternative to swimming, your local pool might run aerobic classes in shallow or deep water which you could try.

这re are many types of exercise that will help maintain your mobility and improve your overall health. The key is to find something you enjoy as this will help you to keep doing it.

这国家强直性脊柱炎学会（NASS）由物理治疗师在全国各地的物理治疗师运营的定期运动课程。NASS还可以提供有关基于健身房的练习，练习DVD和移动应用程序的信息。

工作

Most people with ankylosing spondylitis can继续工作。You may need some changes to your working environment or roles you carry out, especially if you have a physically demanding job.

Talking to people at your workplace about your condition is a good idea. This could be your line manager or human resources department. If your organisation has its own occupational health service, or can provide access to one, this could be a very useful avenue for you.

要求进行工作场所评估并告诉执行您的强直性脊柱炎的人是个好主意。

由于《平等法》（2010年），法律工作场所必须确保诸如强直性脊柱炎这样的疾病不会阻止任何人成功或舒适的工作。

强直性脊柱炎不会自动覆盖这条法律但是，这就是影响您执行日常任务的能力。这是基于如果您不服用任何药物的管理方式。因此，要问自己的一个好问题是，如果您没有服用任何药物，您是否可以轻松地完成诸如自己打扮之类的任务？

您的雇主可能需要对您的工作环境进行一些合理的调整，以帮助您完成工作。但是，您或他们都可以向政府申请以进行这些调整的资金Access to Work scheme。

您的雇主可能能够提供灵活的工作，例如更改工作时间或允许您至少在一周中的某些时间内在家工作。

It’s important to remember that you have rights and options.

尝试在您的工作日中建立短暂的锻炼法术。四处走动并定期进行伸展会对您有所帮助。尽量不要在相同的位置持续太久。

性，怀孕和强直性脊柱炎

Sex如果您患有强直性脊柱炎，可能会很痛苦。如果是这样，请尝试事先服用一些止痛药并尝试不同的位置。

强直性脊柱炎会使您感到疲倦，因此，重要的伴侣了解您的病情如何影响您。良好的沟通可以帮助您维持积极的性生活，咨询有时可以使双方受益。

It’s fine to use the contraceptive pill if you have ankylosing spondylitis, but you should tell your doctor you’re taking it.

If you’re thinking of starting a family, it’s very important for both men and women with ankylosing spondylitis to discuss medication with a doctor beforehand.

Some drugs such asmethotrexate应该在一个女人试图怀孕之前几个月停止。最新的研究表明，男性在与伴侣一起尝试婴儿时要服用甲氨蝶呤。

生物疗法seem to be safe in the earlier stages of pregnancy but are then stopped later in pregnancy.

If you become pregnant while using a conventional DMARD such as methotrexate or a biological therapy, discuss this with your rheumatology team as soon as possible.

通常，怀孕不会给母亲或婴儿带来任何特殊问题，尽管在怀孕期间可能无法缓解脊柱炎的症状。如果您的脊柱非常僵硬，则在分娩时可能不可能进行硬膜外麻醉。这是向后注射，阻止人们在身体的一部分感到疼痛。

If your condition makes it difficult to open your legs, it’s a good idea to think ahead about the delivery and to discuss with the team at your antenatal appointments whether a Caesarean section might be better. This is an operation to deliver a baby through a cut made in a woman’s tummy and womb.

我的孩子会出现强直性脊柱炎吗？

如果您的强直性脊柱炎，您的孩子也很可能会发展出来。它在家庭中的运作方式并不简单，因此，如果您想生孩子并担心这一点，最好与您的专家交谈是个好主意。

Parents with ankylosing spondylitis sometimes ask if their children should have the HLA-B27 test to see whether they might develop the condition in the future. This isn’t recommended because there’s no way of knowing whether a child will develop ankylosing spondylitis even if they do have the gene.

睡觉

疲倦和夜晚疼痛会影响强直性脊柱炎的人。高品质sleep可以帮助您更好地控制疼痛。

这re are many positive steps you can take to help you get good sleep. For example:

• 睡觉前有温暖的浴
• a hot water bottle or an electric blanket could also be soothing and provide some pain relief
• 从中午开始，用咖啡因切出食物和饮料，例如茶，咖啡，可乐，能量饮料和巧克力。在此期间，避免咖啡因的药物。
• getting into a good routine of going to bed at the same time each evening, and getting up at the same time each morning – even if your sleep was disturbed
• not sleeping during the day, as this can disturb your sleep pattern
• 保持卧室清洁，整洁和整洁，并保持床上用品清洁 - 因为这将帮助您放松更多
• not watching TV, or looking at any type of electrical or computer screen for at least one hour before you go to bed
• not having a big meal in the two hours before you go to bed
• regular exercise, especially exercise that gets you at least a bit out of breath, can help you get good sleep. It’s best not to exercise within two hours of going to bed.

A medium-firm bed will be more comfortable than one that’s too soft, although the mattress should have some give in it so that it moulds to the shape of your spine.

有些人发现记忆泡沫床垫，床垫套和枕头有助于支撑他们的身体，尤其是脊柱。

Your head and neck should stay in line with the rest of your body when you’re in bed. Too many or not enough pillows could strain your neck.

如果您继续睡觉问题，请与您的医生交谈。

Feet and footwear

People with ankylosing spondylitis may developplantar fasciitis, a condition that causes pain in the heel or arch of the foot. If your脚受到影响，您可能会受益于您的定制鞋垫shoes。这些也可以称为矫形器。这样的鞋垫可能有助于使您的下肢保持正确的位置，并减轻臀部，骨盆或下背部的疼痛。

Apodiatrist是训练有素的脚专家，可以评估并建议您是否需要定制的鞋垫。Sorbothane鞋垫或凝胶脚跟垫可以提供填充物，并且可能足以减轻您的不适感。这些可以在您当地的化学家或体育商店中找到。

姿势

In serious cases ankylosing spondylitis can affect your posture, or the position in which you hold your body. It may cause the spine to bend too much, and this can put extra strain on your spine.

Here are some tips for having a good posture:

• 放松您的肩膀并将其保持回去，而不是向前弯腰。
• 保持下巴。

坐下时：

• 不要依靠肘部。
• 与低矮，柔软的软垫椅子或沙发相比，精装，直立椅或直背摇椅更适合您的姿势。
• 坐在办公室椅子上时，臀部应该触摸椅子的后部。
• Try using a cushion behind your lower back to give extra support or a custom-made lumbar support.
• When working at a computer desk or workstation, don’t stoop or stretch to reach things. Make sure everything you need is within easy reach.
• Make sure your seat is at the correct height.
• 保持膝盖成直角 - 如果需要的话，请休息一下。
• Don’t sit in one position for too long without moving your back.

If you can, try to lie on your back on the floor sometime during the day. This will help stretch out the front of your hips and improve your posture. You might like to use pillows to support your head, but try to keep the number of pillows to a minimum. Don’t place a pillow under your knees – stretching your knees out fully helps to maintain flexibility.

Aphysiotherapist可以提供进一步的建议和练习帮助with your posture.

Check your posture

You can check your posture by standing with your back against a flat wall within view of a full-size mirror.

尽可能保持脚跟，底部和肩膀靠近墙壁。保持这个位置五秒钟，然后放松一下，尝试连续三遍。定期执行此操作，也许每月一次，并记录您在镜子中注意到的任何差异。例如：

• How does your back look?
• Is there change to the natural curve of your spine?
• 你能把高跟鞋靠在墙上吗？
• Note the distance from the back of your head to the wall.

将您注意到的任何更改报告给医生。如果您或其他人可以为您进行此练习的照片拍照，则可以帮助监视姿势的任何更改。每次都必须每次从完全相同的位置和角度拍摄。如果您在此练习方面遇到困难，请向您的物理治疗师或医生寻求建议。

Driving

Driving如果您患有强直性脊柱炎，那应该不是问题，但是有几点要记住：

• 在漫长的旅程中，不时在一个安全的地方停留五分钟，然后下车伸展并快速行走。
• 如果您的脖子或背部非常僵硬，那么倒入停车位可能会更加困难。可以安装特殊的镜子和停车传感器来帮助解决此问题。你应该通知Driver & Vehicle Licensing Agency (DVLA)如果您使用合适的改编，则您的病情。
• If your neck is stiff, it will be more prone to injury. Make sure your headrest is correctly adjusted and that you keep your head back against it.
• If you can’t walk very far, you may be eligible for a Blue Badge, which entitles you to use disabled drivers’ parking spaces.

您的地方议会可以为您提供有关蓝色徽章停车计划的信息。这国家强直性脊柱炎学会（NASS）can also provide guidance on this and about special mirrors.

饮食和营养

No particular foods have been found to make ankylosing spondylitis either better or worse.

However, eating a low-fat, healthy and balanced饮食will help you stay a healthy weight for you and is also good for your heart and general health. Being overweight will increase the strain on your back and other joints.

Because ankylosing spondylitis can increase your risk of the condition osteoporosis, which makes bones thinner, it’s important you get enough calcium and vitamin D, to keep your bones healthy.

维生素D的最佳来源是来自阳光照在the skin. However, because we can’t guarantee sunshine all year round in the UK, it’s recommended we should all take vitamin D supplements daily in the autumn and winter months.

People at risk of not getting enough vitamin D from the sunshine are encouraged to take vitamin D supplements all year round. This includes people who:

• 不要在户外花很多时间
• wear clothes that cover all their skin
• 皮肤深色，因为较深的皮肤不太擅长吸收阳光的维生素D。

Calcium is very important to make strong bones. The best forms of calcium are:

• 奶制品如牛奶,切ese and yoghurt – low-fat ones are best
• 由大豆，米或燕麦制成的富含钙的奶
• fish that are eaten with the bones, such as tinned sardines.

Many diets have been recommended for people with ankylosing spondylitis, including avoiding certain food types. There’s no convincing evidence that these work, and there’s a chance you could miss out on essential nutrients. If you’re keen to try any of these diets it would be a good idea to discuss it with a dietitian or your doctor first.

停止吸烟

如果您患有强直性脊柱炎并且吸烟，那么停止吸烟将是您可以做的最好的事情之一。

患有强直性脊柱炎或任何类型的脊椎关节炎，可能会使您更有患心脏病发作或中风的风险。它也可能引起肺部问题，因为它可以减少胸部关节的运动。

吸烟可能会使您有更多的心脏或肺部问题的风险，并使它们变得更糟。吸烟也可以使强直性脊柱炎的其他症状恶化。也有证据表明它可以降低治疗的有效性。

Smoking is more likely to cause the bones in the spine fuse together.

停止吸烟可能很困难。但是，有了决心和持久性，您可以成功。如果您努力停止吸烟，您的医生或风湿病团队将能够提供帮助。NHS有信息，advice and support online to help。

补充医学

Generally speaking,complementary and alternative treatmentsare usually safe. However, you should always talk to your doctor before starting treatment, as there are some risks associated with specific therapies. It’s important to go to a legally registered therapist, or one with a set ethical code who is fully insured.

If you decide to try therapies or supplements, you should be critical of what they’re doing for you and base your decision to continue on whether you notice any improvement.

Acupuncturecan help relieve pain but won’t have any effect on the way the condition progresses. Very fine needles are inserted at a number of sites around the body but not necessarily at the painful area. Pain relief is obtained by interfering with pain signals to the brain and by causing the release of natural painkillers, called endorphins. To be successful, you might need to have several sessions.

Spinal manipulation is not helpful or safe for people with ankylosing spondylitis as it could result in permanent damage to your spine or spinal cord. Manipulation is a type of manual therapy used to adjust parts of the body, joints and muscles to treat stiffness and deformity. It’s sometimes used in physiotherapy, chiropractic, osteopathy and orthopaedics.

Previous research has shown that ankylosing spondylitis has a strong genetic component and we’re currently funding several research projects to further understand this. Previously, we part funded research that identified a specific gene, called IL23R, that’s linked to the condition. We’re now funding a follow-on project to investigate how changes in this gene lead to the development of ankylosing spondylitis.

我们还支持一项研究，该研究正在研究一个名为Runx3的基因。研究人员正在研究该分子是否可以用药物靶向。这项研究的结果可能导致新的，更有效的药物治疗的发展。

We’re funding a project investigating the protein HLA-B27. This protein is found in over 90% of people with ankylosing spondylitis. It’s thought that HLA-B27 proteins tend to fold incorrectly inside cells, which may lead to the immune system releasing chemicals that cause inflammation. This research aims to generate HLA-B27 specific treatments that overcome the problems associated with current treatment options.

We’re also supporting research which aims to uncover the link between inflammation of the intestine and ankylosing spondylitis. There’s strong evidence from previous research that the health of the intestine can influence the condition. This research aims to explain how and why this happens, and to identify groups of patients most affected by intestinal inflammation. This could lead to new and improved treatments for this condition.

我刚刚在秘鲁的马努国家公园的亚马逊雨林中呆了六个月。

For the first three months we learned how to recognise different vegetation, animals and reptiles. Then we trained new volunteers.

A big challenge was not having medication out there, the hot and humid climate helped. Hiking in the jungle six days a week was great for my fitness.

只要我记得，我就想访问亚马逊。这是地球上最令人惊叹的地方之一，它达到了我的期望。但这很快消失了。

Even though I’m back in the UK, I’m staying off my medication as much as I can. I’m trying to control it through exercise and stretching. I do yoga, which is good for stretching and relaxing. I’ve also started running.

这exercise I did in the jungle was really good. It drove home how important exercise is and no matter how you feel it’s good to do some. In the long run, it will really help.

这re were times before I left and when I first started, I considered cancelling the whole thing. Having arthritis and diabetes and going to such a remote place was scary.

I had a lot of self-doubt. Once I’d been out there for a bit, I knew the days that I should say no to doing things, I knew how to manage it.

Life is for living, and you’ve got to make the most of it.

If that means hobbling around a rainforest, a bit of discomfort is worth it for a once-in-a-life time experience.

If you’re young and have a condition like ankylosing spondylitis, you shouldn’t think it’s the end of the world.

关键是要对自己有信心，您足够坚强，可以克服障碍。但同样，要现实和抢占可能困难的事情，并采取措施克服或避免潜在问题。

It can be difficult, and there will be days when you won’t want to get out of bed, when everything hurts, and it sucks, but you have to break through it.

一旦您开始移动，肾上腺素就会接管，它落在了您的脑海中。

I cannot emphasise strongly enough that you should use the people around you for support. It can take a lot of strength to ask for help, but it’s important to.

在秘鲁，我得到了很多支持，没有人们的帮助，我无法做很多事情。在丛林中，我的朋友们在远足时抬起我的书包，如果我的脖子或背部受伤。

I made so many friends for life.

For pictures and information of Ben’s travels and work in the Amazon,访问他的网站。