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Axial Spondyloarthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Several putative biomarkers have been shown to associate with higher risk for radiographic progression in AxSpA, though none have, to date, entered wide clinical practice.104, 105 Serum calprotectin, anti-Saccharomyces cerevisiae antibodies, matrix metalloproteinase 3, citrullinated vimentin breakdown products, and visfatin have been associated with higher rates of radiographic progression. Low levels of sclerostin and elevations of DKK1 or leptin have been specifically associated with syndesmophyte formation.106
Clinical Spectrum of Spondyloarthritis
Published in Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi, Psoriasis and Psoriatic Arthritis, 2017
Inflammation of vertebrae (spondylos = vertebra, Greek) is typically seen at the edges of vertebral bodies but may also involve the posterior and lateral vertebral elements, that is, the facet joints, pedicles, transverse and spinous processes. Similar to sacroiliitis, spondylitis manifests as IBP. The earliest detectable lesions are inflammatory vertebral corner lesions on fluid-sensitive MRI sequences. These lesions are thought to progress to fatty corner lesions and ultimately bony syndesmophytes. The radiographic correlate of early inflammation at vertebral edges is the shiny corner or Romanus lesion. Syndesmophyte formation ultimately results in the bridging of vertebral bodies, giving rise to the radiographic finding of the bamboo spine.
Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
AS is characterised by the hallmark of bilateral and symmetrical sacroiliac joint involvement, though there may be unilateral involvement in the early stages of disease. Other common findings include periostitis with whiskering of the pelvic bones and the typical ‘bamboo’ spine appearance from syndesmophyte formation. Up to 10% of AS cases are associated with inflammatory bowel disease, and iritis is common in up to 40% of patients. Ninety-six percent of patients are HLA-B 27 positive, the antigen associated with the other seronegative spondyloarthropathies of psoriasis, Reiter’s syndrome and inflammatory bowel disease–associated spondyloarthritis.
Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis
Published in Modern Rheumatology, 2020
Keita Fujikawa, Shin-ya Kawashiri, Yushiro Endo, Akinari Mizokami, Toshiaki Tsukada, Masanobu Mine, Masataka Uetani, Atsushi Kawakami
The clinical manifestations assessed included past medical history, symptoms, and physical examination at baseline. Laboratory investigations at baseline included human leukocyte antigen (HLA)-typing and levels of C-reactive protein (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibody. X-ray of the sacroiliac joint (SIJ) and spine were examined. On X-ray, sacroiliitis was defined according to the modified New York criteria [14], whereas a syndesmophyte was defined as a score >2 (obvious syndesmophyte) on the modified Stoke Ankylosing Spondylitis Spinal Score [15]. In cases where radiographic sacroiliitis was doubtful or there IBP was persistent, magnetic resonance imaging (MRI) of the SIJs was performed. On MRI, sacroiliitis was defined according to the Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SpA [10,16]. The MRI of SIJs was assessed by MU, an expert radiologist. Whether patients fulfilled criteria including the Amor [17], the European Spondyloarthropathy Study Group (ESSG) [18], the ASAS criteria for axial and peripheral SpA [10,16,19], and the modified New York criteria were also assessed. These data were retrospectively extracted and verified by KF, YE, and AM.
A case of advanced ankylosing spondylitis complicated with cervical myelopathy due to ossification of yellow ligament in which bone histomorphometry demonstrated delayed calcification
Published in Modern Rheumatology Case Reports, 2020
Naoki Kondo, Tatsuki Mizouchi, Kai Kubota, Naoto Endo
His physical status included multiple enthesopathy and pain, especially in bilateral insertions of the Achilles tendon. The result of a Shorber test was 0 cm, and he also demonstrated bilateral hip flexion contracture. Plain X-ray imaging revealed marked ankylosis in his sacroiliac joints (Figure 1(a)) and Computed tomography also showed complete ankylosis in his sacroiliac joint (Figure 1(b)). In the lumbar spine, ankylosis so-called “bamboo spine” and syndesmophyte was detected (Figure 1(c,d)). In the thoracic spine, ankylosis and a syndesmophyte were detected and kyphosis of the spine was observed (Figure 1(e,f)). In the cervical spine, ossification of anterior longitudinal ligament and cross-linking between vertebral columns were observed. Lateral x-ray revealed enthesopathy in the insertions of both Achilles tendons and plantar fascia (Figure 2).
Inflammation on spinal magnetic resonance imaging is associated with poor bone quality in patients with ankylosing spondylitis
Published in Modern Rheumatology, 2019
Joon-Yong Jung, Seung Hee Han, Yeon Sik Hong, Sung-Hwan Park, Ji Hyeon Ju, Kwi Young Kang
There are a few studies that have examined the association between inflammation on spinal MRI and lumbar spine BMD in axSpA or AS. Our findings are inconsistent with one previous study, in that the BME on spinal MRI is not related to the BMD value at the lumbar spine. In the DESIR cohort study of young patients with early inflammatory back pain suggestive of axSpA, low spine BMD was associated with the presence of spine MRI inflammation and systemic inflammation (ESR). Among the 332 patients, only 94 (28%) had radiographical sacroiliitis and 63 (19%) had the presence of BME on spine MRI [31]. Another study in non-radiographic axSpA patients showed that low BMD is associated with inflammation on spine MRI [33]. A recent study in AS patients also reported that the BME on spine MRI is related to BMD values [13]. BMD at the lumbar spine was lower in patients with BME on spine MRI than in those without BME, but the comparison was calculated only in AS patients with syndesmophytes. The discrepancies between the present study and previous ones may be due to differences in the study populations. The AS patients in this study showed more syndesmophyte formation and had a higher rate of BME on MRI. This means that our patients had more severe symptoms and were advanced AS patients. This difference could lead to an artifactual increase in BMD, related to syndesmophytes or calcified ligaments. Therefore, a finding of no association between BME on spinal MRI and BMD of the spine should be interpreted with caution.