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Axial Spondyloarthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
While the Modified NY Classification Criteria were intended to identify a homogenous patient population for research, they have been commonly applied for diagnosis as well.2 As a result, radiographic findings played a central role in the diagnosis of ankylosing spondylitis. In the past several decades, however, the paradigm for both classifying and diagnosing this condition has shifted.
Medicine
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 22-year-old man presents with a 4-week history of progressively worsening lower back pain, radiating towards his buttocks and hips. He has associated stiffness in the lower back that appears to be worse when he wakes up, and he finds exercising helps to reduce this. You suspect ankylosing spondylitis. Give two other seronegative spondyloarthropathies. (2)Which antigen tends to be positive in the majority of patients with these conditions? (1)Describe the classical radiographic changes seen in ankylosing spondylitis? (2)Give two medical options for management of ankylosing spondylitis. (2)Four months later, the same patient visits his GP, with severe pain and photophobia in his right eye. On examination, his visual acuity is 6/6 in his left eye and 6/24 in his right eye.What diagnosis must be excluded? (1)As part of your assessment, you also listen to his heart and lungs. What added sounds may you hear? (2)
Case 29: Backache
Published in Iqbal Khan, Medical Histories for the MRCP and Final MB, 2018
When a definitive diagnosis of ankylosing spondylitis is made, a detailed explanation of the condition and its potential implications should be provided for the patient. He should be encouraged to maintain activity. Indeed, the regular exercise to maintain mobility is the mainstay of the treatment programme. Additionally, analgesia (usually NSAIDs) can help to alleviate the symptoms. In some patients, second line agents such as steroids, sulfasalazine, etanercept may be used under specialist supervision. Rarely, severe disease may require surgery, e.g. hip replacement, spinal surgery.
Findings in ancient Egyptian mummies from tomb KV64, Valley of the Kings, Luxor, with evidence of a rheumatic disease
Published in Scandinavian Journal of Rheumatology, 2023
LM Öhrström, R Seiler, S Bickel, F Rühli
The changes in the cervical spine could possibly be caused by a rheumatic disease. For RA, however, the typical erosive changes are absent and other, often radiologically detectable changes, such as an instability of the dens axis, cannot be assessed, since this part of the spine is not articulated in anatomical position. The involvement of the cervical spine is rather common in RA and according to Redlund-Johnell, severe TMJ RA is often associated with cervical affection (24). The subtle changes on both sides of the SIJs could possibly be caused by RA. Hereby, the SIJ affection appears rather late in the disease progression (25). However, typical erosive or proliferative changes of the hand skeleton are not seen, making RA a possible but rather unlikely diagnosis. Sclerosis of the SIJs could also suggest ankylosing spondylitis, but the changes are minimal, the thoracolumbar spine is not affected, and the typical calcifications in the vertebral ligaments are absent. This makes the diagnosis of ankylosing spondylitis very unlikely. Thus, the alterations in the TMJs are most likely to have been caused by an inflammatory rheumatic disease, and most likely by PsA, and the changes in the cervical spine and SIJs are probably of degenerative origin.
Patients with ankylosing spondylitis have high risk of irritable bowel syndrome: a long-term nationwide population-based cohort study
Published in Postgraduate Medicine, 2022
Hao-Yuan Feng, Chi-Ho Chan, Yu-Cheng Chu, Xin-Man Qu, Yu-Hsun Wang, James Cheng-Chung Wei
Ankylosing Spondylitis is a chronic inflammatory disease, which mainly invades the sacroiliac joints of the lower spine. There is seldom a direct connection between AS and IBS. However, previous studies on autoimmune diseases and gastrointestinal disorders like gut inflammation or dyspepsia have been published. A case-control study indicated that autoimmune patients except those with endocrine autoimmune disorders might have a higher prevalence to develop functional gastrointestinal disorders (FGIDs), i.e. functional dyspepsia (FD), chronic idiopathic constipation (CIC), and multiple FGIDs [20]. Most recently, atopic and autoimmune diseases are risk factors for FGIDs in a population-based study [18]. In a longitudinal observation study, autoimmunity had the potential to cause post-infectious gut dysmotility [21]. Besides, a 5-year follow-up study reports that fecal calprotectin(FCP) level which is a crucial marker of intestinal inflammation increased in AS patients. Although the sample size of this research are not large, this research shows a strong relationship between gut inflammation and AS [22].
Serum calprotectin correlates with risk and disease severity of ankylosing spondylitis and its change during first month might predict favorable response to treatment
Published in Modern Rheumatology, 2019
Hua Hu, Fei Du, Shizhan Zhang, Weiguo Zhang
262 AS patients at the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology between 2014/06/01 and 2016/07/30 were consecutively enrolled in this study. All the patients were diagnosed as AS through X-ray or magnetic resonance imaging (MRI) (for those who were suspected in an early stage) and assessed by more than one doctor according to Ankylosing Spondylitis International Society (ASAS) 2010 criteria, and all the patients also fulfilled the New York criteria [11]. Patients with the following conditions were excluded from this study: Complicated with or history of malignant tumors, severe infection; severe hepatic or renal dysfunction and previous joint operations. 260 health volunteers with age and gender matched to AS patients from Department of Physical Examination in the same duration were enrolled in this study as health controls (HCs). HCs with the following conditions were excluded: infection, inflammatory diseases, allergic disease, malignant tumors, hepatic or renal dysfunction.