Relevance of structural damage in the sacroiliac joints for the functional status and spinal mobility in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort

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.

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Progression of Structural Damage in the Sacroiliac Joints in Patients With Early Axial Spondyloarthritis During Long‐Term Anti–Tumor Necrosis Factor Treatment: Six‐Year Results of Continuous Treatment With Etanercept

Arthritis & Rheumatology ◽

10.1002/art.40786 ◽

2019 ◽

Vol 71 (5) ◽

pp. 722-728 ◽

Cited By ~ 5

Author(s):

Valeria Rios Rodriguez ◽

Kay‐Geert Hermann ◽

Anja Weiß ◽

Joachim Listing ◽

Hildrun Haibel ◽

...

Keyword(s):

Tumor Necrosis Factor ◽

Structural Damage ◽

Tumor Necrosis ◽

Axial Spondyloarthritis ◽

Continuous Treatment ◽

Sacroiliac Joints ◽

Necrosis Factor ◽

Tumor Necrosis Factor Treatment

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Determinants of the patient global assessment of well-being in early axial spondyloarthritis: 5-year longitudinal data from the DESIR cohort

Rheumatology ◽

10.1093/rheumatology/keaa353 ◽

2020 ◽

Vol 60 (1) ◽

pp. 316-321

Author(s):

Fumio Hirano ◽

Désirée van der Heijde ◽

Floris A van Gaalen ◽

Robert B M Landewé ◽

Cécile Gaujoux-Viala ◽

...

Keyword(s):

Back Pain ◽

Educational Level ◽

Joint Pain ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Morning Stiffness ◽

Well Being ◽

Spinal Mobility ◽

Explanatory Variables ◽

Over Time

Abstract Objectives To investigate the determinants of patient well-being over time, and the influence of age, gender and education in patients with early axial spondyloarthritis (axSpA). Methods Five-year data from DESIR, a cohort of early axSpA, were analysed. The outcome was the BAS-G over 5 years. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from five outcome domains (disease activity, physical function, spinal mobility, structural damage and axial inflammation) and BAS-G over time. Longitudinal relationships were analysed using an autoregressive GEE model. Age, gender and educational level were tested as effect modifiers or confounders. Results A total of 708 patients were included. Higher BASDAI questions on fatigue [β (95% CI): 0.17 (0.13, 0.22)], back pain [0.51 (0.46, 0.56)], peripheral joint pain [0.08 (0.04, 0.12)] and severity of morning stiffness [0.08 (0.03–0.13)], and higher BASFI [0.14 (0.08, 0.19)] were associated with a higher BAS-G. In the autoregressive model, the same variables except for morning stiffness were associated with a worsening in BAS-G. Age, gender and educational level were neither effect modifiers nor confounders. Conclusion A higher level of back pain is associated with a worsening of patient well-being, as are, though to a lesser extent, higher levels of fatigue, peripheral joint pain and physical disability. Age, gender and educational level do not have an impact on these relationships.

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Imaging in axial spondyloarthritis

10.1093/med/9780198755296.003.0011 ◽

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.

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What are axial spondyloarthritis and ankylosing spondylitis?

10.1093/med/9780198755296.003.0001 ◽

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.

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Top-Ten Tips for Effective Imaging of Axial Spondyloarthritis

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0039-1693661 ◽

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.

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