Top-Ten Tips for Effective Imaging of Axial Spondyloarthritis

2019 ◽  
Vol 23 (04) ◽  
pp. 376-391
Author(s):  
Monique Reijnierse ◽  
Iris Eshed ◽  
Floris van Gaalen
Keyword(s):  
Early Diagnosis ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Human Leukocyte ◽  
Sacroiliac Joints ◽  
Leukocyte Antigen ◽  
Treatment Regimens ◽  
Current Review ◽  
Chronic Inflammatory Condition ◽  
New Treatment

AbstractAxial spondyloarthritis (axSpA) is a chronic inflammatory condition that encompasses ankylosing spondylitis as well as nonradiographic axSpA and can lead to chronic pain, structural damage, and disability. The disease is strongly associated with the presence of human leukocyte antigen-B27. Early diagnosis of axSpA is significant due to new treatment regimens leading to reduction of inflammation and potentially delaying disease progression. Imaging of the sacroiliac joints and the spine plays an important role in the early diagnosis of spondyloarthritis. In the current review, the top-ten tips for the effective imaging of axSpA are presented to help both radiologists and rheumatologists in using imaging properly and effectively in their clinical practice.

Epidemiology of axial spondyloarthritis

2016 ◽  
Author(s):  
Lianne Gensler ◽  
Michael Weisman ◽  
Liron Caplan
Keyword(s):  
External Validity ◽  
Inflammatory Arthritis ◽  
Axial Spondyloarthritis ◽  
Strong Association ◽  
Human Leukocyte ◽  
Epidemiological Studies ◽  
Hla B27 ◽  
Sacroiliac Joints ◽  
Leukocyte Antigen ◽  
Inflammatory Bowel

Axial spondyloarthritis (axSpA) is an inflammatory arthritis of the sacroiliac joints and spine. The prototype is ankylosing spondylitis, the radiographic form of the disease; however, more recently, an earlier or less-differentiated presentation has been described termed non-radiographic axial spondyloarthritis (nr-axSpA). Extra-articular manifestations commonly include anterior uveitis, inflammatory bowel disease, and psoriasis. There is a strong association with the human leukocyte antigen B27 (HLA-B27) allele, and the prevalence of the disease tends to follow the frequency of the allele. Epidemiological studies in axSpA are relevant in the population studied and therefore have limited external validity. This chapter describes the epidemiology of axSpA.

scholarly journals 1267Prevalence and HLA-B27 Positivity Rate among Patients with Ankylosing Spondylitis/Non-Radiographic Axial Spondyloarthritis in Japan

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Yuri Matsubara ◽  
Yosikazu Nakamura ◽  
Tetsuya Tomita
Keyword(s):  
Ankylosing Spondylitis ◽  
Axial Spondyloarthritis ◽  
Age Of Onset ◽  
Human Leukocyte ◽  
Nationwide Survey ◽  
Hla B27 ◽  
Sacroiliac Joints ◽  
Radiographic Findings ◽  
Leukocyte Antigen ◽  
To Receive

Abstract Background Ankylosing spondylitis (AS) causes severe chronic inflammation of the spine and sacroiliac joints, leading to severe physical dysfunctions. Non-radiographic axial spondyloarthritis (nr-ax SpA) is a newly categorized disease in SpA that shows SpA without definite radiographic findings in sacroiliac joint. Although human leukocyte antigen (HLA) positivity is related to these diseases, little is known about the prevalence of these diseases and HLA-B27 positivity in Japan. Methods A nationwide survey was conducted from January to December 2017. 2221/8456 facilities (26.3%) were selected randomly as a target sample, comprising all three departments: orthopedics, pediatrics, and rheumatology. We estimated the number of these patients by using response and extraction rate, and calculated the HLA-B27 positivity rate. Results We estimated the prevalence of AS and nr-ax SpA as 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively. HLA-B27 test was performed in 60% of patients with AS, of which 55.5% being HLA-B27 positive; however, they were less likely to receive HLA-B27 test if their estimated age of onset was over 50 years. Conclusions The prevalence in AS and nr-ax SpA and their HLA-B27 positivity rate in Japan were lower compared to other countries. Further studies will be required to reveal the association between HLA-B27 and the clinical features. Key messages The prevalence of AS and nr-ax SpA in Japan are estimated to be 2.6/100,000 (0.0026%) and 0.6/100,000 (0.0006%), respectively, and are lower than those in other countries. In addition, HLA-B27 positivity rate was lower.

scholarly journals Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort

2017 ◽  
Vol 76 (11) ◽  
pp. 1823-1828 ◽  
Author(s):  
Maxime Dougados ◽  
Alexandre Sepriano ◽  
Anna Molto ◽  
Miranda van Lunteren ◽  
Sofia Ramiro ◽  
...  
Keyword(s):  
New York ◽  
Structural Damage ◽  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Human Leukocyte ◽  
Hla B27 ◽  
Recent Onset ◽  
Leukocyte Antigen ◽  
Radiographic Changes ◽  
Generalised Estimating Equations

ObjectiveTo estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression.MethodsX-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations.ResultsIn 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients.ConclusionsFive-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.

Axial Spondyloarthritis and New Bone Formation

2021 ◽  
Vol 30 (04) ◽  
pp. 311-318
Author(s):  
Uta Syrbe
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Clinical Symptoms ◽  
Research Work ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Spine Mobility ◽  
Vertebral Bodies ◽  
Inflammatory Changes

AbstractAxial spondyloarthritis is an inflammatory disease of the axial skeleton. Its pathogenesis is only partly understood. At the beginning, there are inflammatory changes in the sacroiliac joints which are followed by inflammation in vertebral bodies and in facet joints. Low back pain occurring in the morning hours is the dominant clinical symptom. In the early phase, inflammatory changes are detectably by MRI. Inflammation promotes a process of joint remodelling in the sacroiliac joints which leads to erosions, sclerosis and bony bridging, i. e. ankylosis, which are detectable by X-ray. In the spine, vertical osteophytes developing at sites of previous inflammation connect vertebral bodies as syndesmophytes. Additional ossification of longitudinal ligaments contributes to the so-called bamboo spine. Ossification of the spine promotes fixation of a severe kyphosis of the thoracic spine which strongly impairs spine mobility and quality of life. High disease activity seems a prominent risk factor for development of structural damage. However, although NSAIDs improve clinical symptoms, they do not reduce new bone formation. In contrast, TNFα and IL-17 inhibitors seem to retard new bone formation apart from their clinical efficacy. Research work of the last years identified immunological pathways of inflammation. However, the trigger and cellular components of the immune reaction in the bone marrow are still poorly defined. Osteoclasts are involved in the destruction of the subchondral bone, while osteoblasts facilitate new bone formation and cartilage ossification. This review gives an overview about diagnostics and therapy of axSpA and about risk factors for the development of structural damage. Concepts about the immune pathogenesis and joint remodeling in AS are given under recognition of genetic and histopathological studies.

Imaging in axial spondyloarthritis

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
New York ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Imaging Modalities ◽  
X Rays ◽  
Mri Imaging ◽  
Sacroiliac Joints ◽  
X Ray ◽  
X Ray Imaging ◽  
Imaging Results

Imaging has always been a key component in the diagnosis of ankylosing spondylitis as part of the modified New York criteria. With the increased availability of MRI and the development of the ASAS axial spondyloarthritis (axSpA) criteria, there has been a shift from x-ray imaging of structural damage to MRI imaging of inflammation. This information can help in both the diagnosis of axSpA and in guiding treatment decisions in patients with this diagnosis. However, imaging results must be evaluated in the context of the clinical picture and should not be acted on in isolation. Here we review the key imaging modalities used in axSpA, with the main focus on x-rays and MRI of the sacroiliac joints, spine, and peripheral structures. Advances in technology are also likely to lead to the development of even better imaging modalities for axSpA in future.

What are axial spondyloarthritis and ankylosing spondylitis?

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Arthritis ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Negative Impact ◽  
Sacroiliac Joints ◽  
Chronic Inflammatory Arthritis ◽  
The Past ◽  
Assessment And Treatment

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. AS has a major negative impact on patients’ quality of life. AS is part of a larger group of related spondyloarthritis (SpA) conditions and patients with AS often have extra-articular manifestations of these conditions. Over the past decade, there have been major advances in the understanding of the genetics and pathophysiology of the disease. Advances in imaging have allowed patients to be diagnosed without having to develop the radiographic structural damage that characterize AS, resulting in the concept of axial spondyloarthritis (axSpA). Together with the development of highly effective TNF inhibitors, these advances have transformed the management and outlook of patients with this condition. It is hoped that further advances in diagnosis, assessment and treatment of axSpA will lead to further progress in future.

scholarly journals Secukinumab in axial spondyloarthritis: a narrative review of clinical evidence

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110418
Author(s):  
Jürgen Braun ◽  
Uta Kiltz ◽  
Björn Bühring ◽  
Xenofon Baraliakos
Keyword(s):  
Ankylosing Spondylitis ◽  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Human Leukocyte ◽  
Signs And Symptoms ◽  
Axial Skeleton ◽  
Narrative Review ◽  
The European Union ◽  
New Bone Formation

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammation and new bone formation in the axial skeleton. AxSpA is considered a spectrum of disease that includes two subtypes identified by the Assessment in SpondyloArthritis International Society classification criteria, namely, radiographic (r-axSpA usually referred to as ankylosing spondylitis) and non-radiographic axSpA (nr-axSpA). Although the burden of disease appears similar between the two classified subtypes, the degree of inflammation, as assessed by magnetic resonance imaging and C-reactive protein, and the degree of new bone formation are significantly higher in r-axSpA than in nr-axSpA. Nevertheless, axSpA is considered one disease with different courses. International guidelines for the management of axSpA have outlined treatment goals focused on control of signs and symptoms, inflammation, prevention of progressive structural damage, preservation of physical function, normalization of social participation and improvement of quality of life. The pathogenesis of axSpA has not been completely elucidated to date. A strong link between human leukocyte antigen B27 and axSpA, however, has been identified, and the success of anti-tumour necrosis factor and anti-interleukin (IL)-17A therapy has highlighted some of the key pro-inflammatory cytokines involved. The anti-IL-17A monoclonal antibody secukinumab is approved for the treatment of ankylosing spondylitis and nr-axSpA in the European Union and United States. In this narrative review, we discuss data for secukinumab in axSpA from randomized controlled trials, including MEASURE trials in AS and PREVENT in nr-axSpA, and real-world evidence.

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