Ankylosing spondylitis

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.

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Axial spondyloarthropathies

10.1093/med/9780199642489.003.0113_update_003 ◽

2016 ◽

Author(s):

Joachim Sieper

Keyword(s):

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

Hla B27 ◽

Term Outcome ◽

Long Term Outcome ◽

Male Predominance ◽

Inflammatory Drugs ◽

Active Inflammation ◽

Necrosis Factor

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.

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Axial spondyloarthritis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0113_update_005 ◽

2013 ◽

pp. 879-889

Author(s):

Denis Poddubnyy ◽

Joachim Sieper

Keyword(s):

Kinase Inhibitors ◽

Axial Spondyloarthritis ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

Janus Kinase ◽

Hla B27 ◽

Term Outcome ◽

Male Predominance ◽

Phosphodiesterase 4 ◽

Active Inflammation

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. In 2009, new classification criteria for axSpA have been developed by the Assessment of SpondyloArthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) and interleukin (IL)-17 blockers have been proven to be effective in the drug treatment of axial SpA, while Janus kinase inhibitors showed the first promising results in phase II trials. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are usually not effective; IL-23 and phosphodiesterase-4 blockade showed also no clinical efficacy in placebo-controlled trials.

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Musculoskeletal system

Revision Notes for MCEM Part A ◽

10.1093/med/9780199583836.003.0045 ◽

2011 ◽

pp. 411-414

Author(s):

Dr Mark Harrison

Keyword(s):

Musculoskeletal System ◽

Early Mobilization ◽

Musculoskeletal Injuries ◽

Pharmacological Intervention ◽

Term Outcome ◽

Long Term Outcome ◽

System P ◽

Inflammatory Drugs ◽

Anti Inflammatory

8.1 Nonpharmacological measures, 412 8.2 Nonsteroidal anti-inflammatory drugs (NSAIDs), 412 8.3 Corticosteroids, 414 8.4 Drugs used in gout and hyperuricaemia, 414 • Management of musculoskeletal injuries and diseases involves more than just pharmacological intervention. • Consideration of splinting, physiotherapy, and early mobilization can be the most effective way to ease pain and improve long-term outcome....

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Subacute Thyroiditis: Clinical Presentation and Long Term Outcome

International Journal of Endocrinology ◽

10.1155/2014/794943 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Assim A. Alfadda ◽

Reem M. Sallam ◽

Ghadi E. Elawad ◽

Hisham AlDhukair ◽

Mossaed M. Alyahya

Keyword(s):

Clinical Presentation ◽

Thyroid Stimulating Hormone ◽

Subacute Thyroiditis ◽

University Hospital ◽

Term Outcome ◽

Long Term Outcome ◽

Thyroid Uptake ◽

Inflammatory Drugs ◽

And Gender

Few studies have been reported from the Kingdom of Saudi Arabia (SA) to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT). Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded.β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted.

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Long-term outcome of patients with active ankylosing spondylitis with etanercept-sustained efficacy and safety after seven years

Arthritis Research & Therapy ◽

10.1186/ar4244 ◽

2013 ◽

Vol 15 (3) ◽

pp. R67 ◽

Cited By ~ 31

Author(s):

Xenofon Baraliakos ◽

Hildrun Haibel ◽

Claudia Fritz ◽

Joachim Listing ◽

Frank Heldmann ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Efficacy And Safety ◽

Term Outcome ◽

Long Term Outcome ◽

Sustained Efficacy

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The role of secukinumab in the treatment of psoriatic arthritis and ankylosing spondylitis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x18787766 ◽

2018 ◽

Vol 10 (9) ◽

pp. 169-180 ◽

Cited By ~ 9

Author(s):

Leticia Garcia-Montoya ◽

Helena Marzo-Ortega

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Inflammatory Diseases ◽

Outcome Data ◽

Term Outcome ◽

Treatment Protocols ◽

Long Term Outcome ◽

Significant Disability

Psoriatic arthritis and ankylosing spondylitis are chronic inflammatory diseases that can cause significant disability. The commercialization of the first tumour necrosis factor (TNF) inhibitors led to a radical improvement of the quality of life of people affected by these conditions; however, response was not universal, highlighting the need for alternative therapeutic targets. Secukinumab is a monoclonal interleukin (IL)-17A inhibitor which has been proven efficacious for psoriatic arthritis and ankylosing spondylitis in recent clinical trials. Dactylitis, enthesitis, skin and nails are some of the domains in which the inhibition of IL-17 has shown significant improvements apart from the joints. Its safety profile and satisfactory medium- to long-term outcome data are some of the aspects suggesting its potential impact in treatment protocols in the short term.

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The pathogenesis of ankylosing spondylitis

Neurosurgical FOCUS ◽

10.3171/foc/2008/24/1/e3 ◽

2008 ◽

Vol 24 (1) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Mohammed F. Shamji ◽

Mohammed Bafaquh ◽

Eve Tsai

Keyword(s):

Ankylosing Spondylitis ◽

Molecular Mimicry ◽

Human Leukocyte ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

The Body ◽

Hla B27 ◽

Leukocyte Antigen ◽

Molecular Events ◽

Microbial Tolerance

✓ Ankylosing spondylitis (AS) is a chronic inflammatory disease that can cause significant functional complications by affecting the sacroiliac joints and axial skeleton. Despite a longstanding knowledge about the familial associations of this disease, particularly among patients positive for human leukocyte antigen (HLA)–B27, the fundamental pathogenetic mechanism by which this disease arises in genetically susceptible individuals remains ill defined. Furthermore, the molecular predilection for characteristic articular site involvement remains under ongoing investigation. Current theories about the HLA-B27 association range from the presentation of novel arthritogenic peptides, to abnormal autoimmune stimulation, to anomalous microbial tolerance. The immune effectors of this damage include CD4+, CD8+, and natural killer cells, with marked heterogeneity at different sites. Biomechanical stresses may trigger this disease by exposing the body to previously immune-sequestered autoantigens or by providing a route for bacterial seeding. Environmental triggers such as infection have not been definitively established but may represent a primary pathogenic step in a molecular-mimicry process. In this article, the authors review the current literature on the origin and pathophysiology of AS, focusing on genetic and molecular associations, consequent pathomechanisms, and associated triggers. An improved understanding of the sequence of molecular events that predispose and initiate the onset of this disease will allow for more specific and targeted therapy and better avoidance of the significant side effects of systemic immunomodulation.

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