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Axial Spondyloarthritis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Whole-body MRI (wbMRI), in contrast, allows imaging of the full body in a single examination, currently lasting less than one hour.83–86 This technique has particular appeal in the context of spondyloarthritis. Currently, data regarding the utility of this technique is limited, and it is not routinely available in clinical practice. Given the heterogeneous presentation of AxSpA, a single sequence capable of a screen for findings of enthesitis, or typical findings of spondylitis, holds appeal.
Reactive arthritis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
The classic syndrome is a triad of symptoms, involving the urethra, conjunctiva, and synovium; however, the majority of patients do not present with this classic triad [1]. It is considered as a form of spondyloarthritis, a group of diseases with inflammatory arthritis, negative rheumatoid factor, and genetic association with HLA-B27 [2].
Rheumatology
Published in Shahed Yousaf, Medical Examination Made Memorable (MEMM), 2018
Ankylosing spondylitis derives its name from the Greek ankylos (bent) spondylos (vertebrae). A seronegative spondyloarthritis, a chronic, progressive inflammatory arthritis affecting joints in the spine and the sacroilium causing fusion of the spine.
Tofacitinib for the treatment of active ankylosing spondylitis in adults
Published in Expert Review of Clinical Immunology, 2022
Raagav Mohanakrishnan, Secia Beier, Atul Deodhar
Spondyloarthritis (SpA) is a group of chronic immune-mediated inflammatory disorders that encompasses many diseases involving joints, entheses, skin, nails, as well as extra-musculoskeletal organs such as eyes and gastrointestinal tract. Axial spondyloarthritis (axSpA), a member of the SpA family of diseases, is an inflammatory arthritis that involves the spine including sacroiliac joints, and often manifests as chronic back pain [1,2]. AxSpA can further be differentiated into ankylosing spondylitis (AS), also known as radiographic axial spondyloarthritis, and non-radiographic axial spondyloarthritis (nr-axSpA) based on the presence or lack of definitive sacroiliitis on imaging, respectively [2]. There have been many treatment options developed for axial spondyloarthritis, focusing primarily on symptom management and the inflammatory cascade. These treatments include physical therapy, non-steroid anti-inflammatory drugs (NSAIDs), and biologics such as anti-tumor necrosis factor alpha (anti-TNF-alpha) inhibitors, and Interleukin 17 (IL-17) inhibitors [3]. Janus kinase inhibitors (JAKi) are the latest class of agents to have undergone successful clinical trials in the treatment of axSpA [4]. While this article specifically focuses on the use of tofacitinib in adults with active AS, we have included a brief review on the pathogenesis of AS, since it is germane to the discussion on why JAK inhibitors would be useful in the management of AS.
Diagnostic challenge of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome in pediatric age: A monocentric case series
Published in Modern Rheumatology, 2021
Ilaria Maccora, Edoardo Marrani, Valerio Maniscalco, Maria Vincenza Mastrolia, Ilaria Pagnini, Gabriele Simonini
As in patient #3, SAPHO syndrome can additionally share several clinical and radiological features with juvenile spondylarthritis such as sacroiliitis (usually unilateral), ankylosis, enthesitis, paravertebral ossification as well as the association with IBDs and psoriasis [18]. This feature can make challenging the diagnosis for the physicians and emphases the issue of the SAPHO syndrome classification. Indeed, several authors shared the thought that SAPHO syndrome should be included in the spectrum of the spondyloarthropathies rather than being considered as an autoinflammatory disease [19]. In our cohort all patients had clinical manifestations overlapping with spondylarthritis with a higher frequency than reported in other studies. [5,14,20]. Skrabl-Baumgartner et al evaluated overlapping features of enthesitis-related arthritis and CNO in only 6 over 24 paediatric patients (25%) [20]. In another large Chinese cohort of pediatric SAPHO syndrome, spine or sacroiliac involvement was documented by several imaging technique in 21% of patients [5]. In the systematic review by Naves et al., pediatric patients with SAPHO syndrome had a comparable frequency of such involvement (25%) that was lower than adults (39%). Moreover, the presence of HLA-B27 does not seem to be a hallmark of paediatric SAPHO disease, as in our cohort [5,14,20]. Furthermore, Anti-TNFa, in particular Adalimumab and Etanercept, in our cases series and other paediatric cohort seems to have a good efficacy and safety profile in the treatment of SAPHO paediatric patients [5,6,21].
Relationship between sleep quality and physical activity level in patients with ankylosing spondylitis
Published in Modern Rheumatology, 2020
Ankylosing spondylitis is a prototype of a group of rheumatic diseases defined as spondyloarthritis, mainly seen with involvement of the axial skeleton, but may also show peripheral joint involvement. It is a chronic, progressive and systemic inflammatory disease that has been shown to be associated with HLA-B27 antigen and its etiology is unknown [1]. Although sacroiliitis is the earliest finding in AS, peripheral joint involvement and extra-articular findings can be observed in the early or progressive period [2]. Although AS occurs most frequently in the second and third decades of life, it is present in a wide age range including children and elderly age groups [3]. Early onset of symptoms is associated with poor functional outcomes in patients. Clinical symptoms may differ in young patients with AS. Considering the effect of gender, it was found that male patients had more structural changes than female patients [4]. In ankylosing spondylitis, sleep disorders vary from 15.4% to 80% depending on the sleep test. Sleep disorders seen in ankylosing spondylitis may vary, such as insufficient resting sleep, morning stiffness, difficulty waking up, obstructive sleep apnea syndrome [5–7]. Patients with ankylosis, limited chest expansion and weight gain may lead to obstructive sleep apnea syndrome [8,9]. Axial pain and inflammatory back pain in the second half of the night is a major cause of sleep disorders [10]. Sleep disorders are common symptoms of ankylosing spondylitis due to back pain, chronic depression and accompanying anxiety [11].