Two patients, referred to as patient S and patient L, were enrolled in this study. The study was approved by The Ethics Committee of Shandong Academy of Medical Sciences. Their symptoms fulfilled the modified New York criteria for AS (16). They had histories of AS for 12 years and 3 years, respectively. The patients were substantially impaired by back pain and spinal immobility. Physical examination revealed the heart, lungs and abdomen to be normal. Their eyes were normal without acute anterior uveitis. Routine laboratory tests were within the normal range except for erythrocyte sedimentation rate (ESR) in patient S. The ESRs of patient S and L were 36 mm/h and 12 mm/h (reference: 0-20 mm/h), respectively. Analyses to detect RF and anti-cyclic citrullinated peptide (anti-CCP) antibodies were both negative. The calcium concentration of patient S was 3.05 mmol/L, which is higher than normal range (2.1-2.7 mmol/L). We measured disease activity using the Bath AS disease activity index (BASDAI), which is a questionnaire that assesses fatigue; neck, back and hip pain; peripheral joint pain and swelling; discomfort; and severity and duration of morning stiffness (17, 18). The BASDAI consists of a 1 through 10 scale (1 being no problem and 10 being the worst problem) that is used to assess the five major symptoms of AS. The resulting 0 to 50 score is divided by the five symptoms to give a final 0 - 10 BASDAI score. The BASDAI scores of patients S and L were 5.4 and 2.4, respectively. We also measured physical function of the two patients using BASFI (Bath ankylosing spondylitis functional index). The BASFI is a physical function questionnaire that evaluates dressing, bending, mobility, standing, stairs and full-day activities (19). The higher the BASFI score, the more severely the patient's functioning is limited by their AS (1 being no problem and 10 being the worst problem). The BASFI scores of patients S and L were 2.7 and 1.2, respectively. We examined sacroiliac joints of the patients with computed tomography (CT) and plain x-ray film. The results revealed bilateral sacroiliitis with sclerosis and narrowing of the sacroiliac joints. One sacroiliac joint of patient S became bony fusion. The articular surfaces were blurred and seemed serrated. Small erosions were observed at the corners of the vertebral bodies in the spine, indicative of early-stage spondylitis. The above observation indicates that patients S and L had active AS at stage II, based on the protocol of Braun et al. (20). Table 1 summarizes the information regarding the two patients. These two patients had previously had unsatisfactory therapy with at least one NSAID. The patients had also been treated with DMARDs such as sulfasalazine and methotrexate. These therapies had been discontinued at least six months before the first use of methazolamide.. when laparoscopy hit the scientific stage, there was a slow rise in the
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