scholarly journals Ankylosing spondylitis: diagnostic challenges and efficacy of upadacitinib

2021 ◽  
Vol 31 (4) ◽  
pp. 62-70
Author(s):  
S. Moiseev ◽  
P. Novikov ◽  
S. Gulyaev ◽  
E. Kuznetsova ◽  
T. Shevtsova ◽  
...  
Keyword(s):  
Back Pain ◽  
Structural Damage ◽  
Inflammatory Back Pain ◽  
Common Disease ◽  
Interleukin 17 ◽  
Sacroiliac Joints ◽  
Young Males ◽  
Reactive Protein ◽  
Ankylosing Spondilitis ◽  
Inflammatory Bowel

Ankylosing spondilitis (AS) is a relatively common disease mainly affecting young males and presenting with chronic inflammation of the spine and the sacroiliac joints. AS is one of the forms of axial spondyloarthritis (SpA). Diagnosis of AS is usually delayed on average by 8-10 years from the first symptoms. SpA should be considered both in males and females who present with chronic low back pain starting before the age of 45 years and at least one additional factor (inflammatory back pain, HLA-B27, sacroileitis, peripheral arthritis, enthesitis, dactylitis, psoriasis, uveitis, inflammatory bowel disease, family history for SpA, elevated ESR and/or C-reactive protein, and good response to NSAIDs). Such patients should be referred to rheumatologist. MRI improves early diagnosis of AS since it detects inflammatory changes, which precede structural damage of the sacroiliac joints (nonradiographic SpA). Physical exercises and NSAIDs are the first-line treatment for AS, whereas TNF and interleukin-17 inhibitors are widely used as a second-line therapy. Upadacitinib is the first JAK-inhibitor that was approved for the treatment of active AS in adult patients who have responded inadequately to conventional therapy. The authors discuss clinical cases demonstrating efficacy of upadacinitib in patients with AS.

scholarly journals Comorbid pain in axial spondyloarthritis, including fibromyalgia

2020 ◽  
Vol 12 ◽  
pp. 1759720X2096612
Author(s):  
Clementina López-Medina ◽  
Anna Moltó
Keyword(s):  
Back Pain ◽  
Vertebral Fractures ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Inflammatory Diseases ◽  
Correct Diagnosis ◽  
Degenerative Changes ◽  
Inflammatory Back Pain ◽  
Management Options ◽  
Biomechanical Stress

The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response. In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

Reactive arthritis and enteropathic arthropathy

2016 ◽  
Author(s):  
J. S. Hill Gaston
Keyword(s):  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Immune Responses ◽  
Reactive Arthritis ◽  
Inflammatory Back Pain ◽  
Hla B27 ◽  
Genetic Studies ◽  
Inflammatory Bowel ◽  
Disease Modifying ◽  
Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort

2016 ◽  
Vol 76 (2) ◽  
pp. 392-398 ◽  
Author(s):  
Pauline A C Bakker ◽  
Rosaline van den Berg ◽  
Gregory Lenczner ◽  
Fabrice Thévenin ◽  
Monique Reijnierse ◽  
...  
Keyword(s):  
New York ◽  
Back Pain ◽  
Axial Spondyloarthritis ◽  
The Other ◽  
Inflammatory Back Pain ◽  
Symptom Duration ◽  
Sacroiliac Joints

ObjectivesInvestigating the utility of adding structural lesions seen on MRI of the sacroiliac joints to the imaging criterion of the Assessment of SpondyloArthritis (ASAS) axial SpondyloArthritis (axSpA) criteria and the utility of replacement of radiographic sacroiliitis by structural lesions on MRI.MethodsTwo well-calibrated readers scored MRI STIR (inflammation, MRI-SI), MRI T1-w images (structural lesions, MRI-SI-s) and radiographs of the sacroiliac joints (X-SI) of patients in the DEvenir des Spondyloarthrites Indifférenciées Récentes cohort (inflammatory back pain: ≥3 months, <3 years, age <50). A third reader adjudicated MRI-SI and X-SI discrepancies. Previously proposed cut-offs for a positive MRI-SI-s were used (based on <5% prevalence among no-SpA patients): erosions (E) ≥3, fatty lesions (FL) ≥3, E/FL ≥5. Patients were classified according to the ASAS axSpA criteria using the various definitions of MRI-SI-s.ResultsOf the 582 patients included in this analysis, 418 fulfilled the ASAS axSpA criteria, of which 127 patients were modified New York (mNY) positive and 134 and 75 were MRI-SI-s positive (E/FL≥5) for readers 1 and 2, respectively. Agreement between mNY and MRI-SI-s (E/FL≥5) was moderate (reader 1: κ: 0.39; reader 2: κ: 0.44). Using the E/FL≥5 cut-off instead of mNY classification did not change in 478 (82.1%) and 469 (80.6%) patients for readers 1 and 2, respectively. Twelve (reader 1) or ten (reader 2) patients would not be classified as axSpA if only MRI-SI-s was performed (in the scenario of replacement of mNY), while three (reader 1) or six (reader 2) patients would be additionally classified as axSpA in both scenarios (replacement of mNY and addition of MRI-SI-s). Similar results were seen for the other cut-offs (E≥3, FL≥3).ConclusionsStructural lesions on MRI can be used reliably either as an addition to or as a substitute for radiographs in the ASAS axSpA classification of patients in our cohort of patients with short symptom duration.

scholarly journals ASAS criteria for inflammatory back pain: diagnostic significance in patients with inflammatory bowel disease

2019 ◽  
Vol 57 (2) ◽  
pp. 175-179
Author(s):  
E. N. Belousova ◽  
A. Kh. Odintsova ◽  
M. S. Protopopov ◽  
D. I. Abdulganieva
Keyword(s):  
Back Pain ◽  
Likelihood Ratio ◽  
International Society ◽  
Predictive Value ◽  
Chronic Back Pain ◽  
Inflammatory Back Pain ◽  
Diagnostic Significance ◽  
Asas Criteria ◽  
Diagnostic Characteristics ◽  
Inflammatory Bowel

Damage of peripheral joints and spine is a frequent manifestation of spondyloarthritis associated with inflammatory bowel diseases (IBD). One of the most frequent and typical manifestations of axial spondyloarthritis (axSpA) is inflammatory back pain (IBP), which is determined according to the IBP criteria of the International society for the study of spondyloarthritis (The Assessment of SpondyloArthritis international Society – ASAS) 2009. The diagnosis of axSpA is based on the identification of combination of typical changes in the sacroiliac joints (presence of sacroiliitis according to MRI or radiography) with a characteristic clinical picture. However, the diagnostic significance of these criteria and the possibility of use in patients with IBD and chronic back pain have not been studied.Subjects and methods. The study included 84 patients with IBD and back pain. The mean age of patients was 40.5±11.9 years, the duration of IBD symptoms – 8.11±7.67 years.Results and discussion. In our study, the sensitivity of the ASAS criteria for IBD was 76.9% and specificity – 67.2%, positive predictive value was 0.51, a negative predictive value – 0.87. The likelihood ratio of a positive result is 2.3, the likelihood ratio of a negative result is 0.3.Conclusion. The main diagnostic characteristics of ASAS IBD criteria (2009) for patients with IBD were comparable with those in the population of patients with chronic back pain (sensitivity – 79.6% and specificity – 72.4%).

scholarly journals Examining spondyloarthritis in patients with inflammatory bowel disease

2020 ◽  
Vol 3 ◽  
Author(s):  
Catherine Burns ◽  
Reem Jan
Keyword(s):  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Bowel Disease ◽  
Axial Spondyloarthritis ◽  
Joint Disease ◽  
Inflammatory Back Pain ◽  
Gastrointestinal Manifestations ◽  
Inflammatory Bowel ◽  
Patient Responses ◽  
Peripheral Spondyloarthritis

Background/Objective: Axial spondyloarthritis refers to a syndrome of inflammatory back pain associated with radiographic or magnetic resonance imaging abnormalities. Peripheral spondyloarthritis can include dactylitis, enthesitis or oligo-arthritis. Together these encompass common extra-gastrointestinal manifestations of inflammatory bowel disease (IBD), with the prevalence of ankylosing spondylitis estimated to be about 3% in patients with IBD and unspecified sacroiliitis occurring in 10%. The goals of this study are to validate the accuracy of the Toronto Axial Spondyloarthritis Questionnaire in identifying patients with rheumatologic symptoms in the context of IBD, to re-evaluate the prevalence of spondyloarthritis in this population, and to identify any differences in referral rate between racial and ethnic groups.    Methods: Patients were selected based on the following criteria: diagnosis of IBD, upcoming appointment with their gastroenterologist, prior consent in the Genesys database and access to an operational MyChart account. Patients were sent a link and asked to complete a RedCap survey modified from the Toronto Axial Spondyloarthritis Questionnaire. Positive patient responses will be analyzed in a follow-up visit with a rheumatologist to investigate the patients’ symptoms.    Results: At present, the survey was sent to 86 patients with 26 respondents completing the survey. Of the respondents, 6 patients had experienced back pain for a duration of 3 months or longer. Eleven patients had pain and swelling of a joint unrelated to injury. Seven patients experienced pain and swelling of an entire finger or toe unrelated to injury. Seven patients experienced heel pain unrelated to injury. One patient is followed by rheumatology.    Conclusion/Potential Impact: Major extra gastrointestinal manifestations of IBD include axial or peripheral spondyloarthritis which can lead to disabling back pain and/ or joint disease. With the modified Toronto Axial Spondyloarthritis Questionnaire, gastroenterologists could have a better way to identify concerning symptoms, leading to increased referral to rheumatologists and potential changes in treatment plans.

scholarly journals What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

2019 ◽  
Vol 71 (12) ◽  
pp. 2027-2033 ◽  
Author(s):  
Bodil Arnbak ◽  
Tue S. Jensen ◽  
Berit Schiøttz‐Christensen ◽  
Susanne J. Pedersen ◽  
Mikkel Østergaard ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Structural Damage ◽  
Low Back ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Follow Up Study ◽  
Pain Patients

Reactive arthritis and enteropathic arthropathy

2013 ◽  
pp. 901-910
Author(s):  
J. S. Hill Gaston
Keyword(s):  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Bowel Disease ◽  
Reactive Arthritis ◽  
Inflammatory Back Pain ◽  
Hla B27 ◽  
Genetic Studies ◽  
Inflammatory Bowel ◽  
Disease Modifying ◽  
Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

Inflammatory Spinal Disease in Psoriatic Arthritis: A Report from the GRAPPA 2010 Annual Meeting

2012 ◽  
Vol 39 (2) ◽  
pp. 418-420 ◽  
Author(s):  
DAFNA D. GLADMAN
Keyword(s):  
Back Pain ◽  
Psoriatic Arthritis ◽  
Clinical Symptoms ◽  
Inflammatory Back Pain ◽  
Resonance Imaging ◽  
Spinal Disease ◽  
Sacroiliac Joints ◽  
Axial Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Ankylosing Spondyloarthritis

Diagnosing axial disease in patients with psoriatic arthritis (PsA) has been largely dependent on identifying inflammatory back pain (IBP), which itself has been difficult to define. We review the criteria used to identify IBP in patients with ankylosing spondylitis (AS) and other forms of spondyloarthritis. Recently, the Ankylosing SpondyloArthritis International Society (ASAS) developed a list of clinical and radiographic criteria for identifying IBP in patients with AS. However, it is more difficult to identify IBP in patients with PsA because generally they have less pain than patients with rheumatoid arthritis or AS. Further, PsA patients may have clinical symptoms of pain but negative radiographs. It may be more useful to identify sacroiliitis or syndesmophytes by magnetic resonance imaging (MRI), since MRI identifies lesions in the sacroiliac joints and the spine much earlier than can be detected on radiographs. In summary, all patients with PsA should be assessed for axial involvement with history, physical examination, and imaging. Patients with psoriasis whose history includes onset of back pain before age 40 years, the presence of night pain, and improvement with exercise but not with rest, or who have limited neck or back mobility, should be referred to a rheumatologist.

Reactive arthritis and enteropathic arthropathy

2013 ◽  
pp. 901-910
Author(s):  
J. S. Hill Gaston
Keyword(s):  
Inflammatory Bowel Disease ◽  
Back Pain ◽  
Bowel Disease ◽  
Reactive Arthritis ◽  
Inflammatory Back Pain ◽  
Hla B27 ◽  
Genetic Studies ◽  
Inflammatory Bowel ◽  
Disease Modifying ◽  
Crystal Induced Arthritis

Reactive arthritis (ReA), and enteropathic arthritis secondary to inflammatory bowel disease, are forms of spondyloarthritis, all of which share an association with HLA B27 and can involve both axial and peripheral joints. Genetic studies strongly implicate the cytokines IL-17 and IL-23 in their pathogenesis, and evidence for autoimmunity is lacking. ReA is triggered by particular bacteria, mainly affecting the gut and genitourinary tract, though infections are sometimes asymptomatic. Classically an acute oligo- or monoarthritis with enthesitis occurs, often with inflammatory back pain, though mild polyarthritis can also occur. Septic and crystal-induced arthritis are the principal differential diagnoses. Extra-articular features may aid diagnosis, which otherwise requires laboratory evidence of preceding infection. Bacterial components traffic to the joint (which is nevertheless sterile), and elicit local pro-inflammatory immune responses. Most ReA is self-limiting, but persistent cases may require disease-modifying anti-rheumatic drugs or even biologics.

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