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Overview of JAK-STAT Pathways in Spondyloarthritis
Published in Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi, Psoriasis and Psoriatic Arthritis, 2017
Smriti K. Raychaudhuri, Sanchita Raychaudhuri, Debasis Bagchi, Anand Swaroop, Siba P. Raychaudhuri
Inflammation at the tendons, or bone joints, is termed enthesitis. It is considered to be the central, characteristic feature of spondyloarthropathy. Traditionally, enthesitis has been considered an insertional disorder. Advanced imaging, along with molecular imaging, suggests that enthesitis is a diffuse process that affects the tendons, their adjacent adjacent bone, and soft tissue [3]. Continued biomechanical stress and chronic microinjury at the enthesis trigger an inflammatory response in the synovium and are also likely to be a contributing factor for synovitis. Magnetic resonance imaging (MRI) has demonstrated the ubiquitous nature of enthesitis in SpA. MRI demonstrated that enthesitis lesions may be extensive and could explain the diffuse nature of bone changes seen in some patients with spondyloarthropathies. These processes occur adjacent to synovial joints, and thus partially substantiate the mechanisms of synovitis in spondyloarthropathies [2,3]. However, the process is more complex, and how biomechanical stress interacts with the systemic immune response dysregulation in autoimmune conditions of SpA remains unclear.
Musculoskeletal cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
Ankylosing spondylitis is a seronegative spondyloarthropathy with a male predilection (male:female = 3:1), which usually manifests in the third decade; 90% of Caucasian patients are HLA-B27 positive. The disease commonly involves the spine and sacroiliac joints but may also affect other small and large joints. Sacroiliitis, symmetrical and bilateral, is the commonest first manifestation. Early spondylitis in the spine is associated with small erosions at the corners of vertebral bodies, with sclerosis as they heal (Romanus lesions). Progressive erosion leads to sclerosis, fusion, and ankylosis.What other imaging may be helpful?
Inflammatory rheumatic disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
These are generalized chronic inflammatory diseases, but their effects are seen mainly in the spine and sacroiliac joints. Definitions have changed in the last decade to reflect the fact that ankylosing spondylitis (AS) is the end stage of a disease process best described by the term axial spondyloarthropathy (axial SPA). AS is characterized by pain and stiffness of the back, with variable involvement of the hips and shoulders and (more rarely) the peripheral joints. Its reported prevalence is 0.1–0.2% in Western Europe and North America, but it is much lower in Japanese and African peoples. Males are affected more frequently than females (estimates vary from 2:1 to 10:1) and the usual age at onset is between 15 and 25 years. There is a strong tendency to familial aggregation and association with the genetic markers HLA-B27 and ERAP1.
Real-world effectiveness and safety of adalimumab for treatment of ankylosing spondylitis in Japan
Published in Modern Rheumatology, 2019
Shigeto Kobayashi, Tomoko Kashiwagi, Junko Kimura
Ankylosing spondylitis (AS) is a chronic, progressive, seronegative, inflammatory spondyloarthropathy mainly affecting the spine, sacroiliac joints, and major joints of the extremities. It occurs primarily in young individuals (aged <30 years) [1] and commonly presents as inflammatory pain arising in the lower back associated with stiffness, limitation of spinal mobility, and inhibited chest expansion. Extra-articular manifestations of AS include anterior uveitis, aortic valve insufficiency, restrictive lung disease, ulcerative colitis, and Crohn disease [2]. While the prevalence of AS is estimated between 0.1% and 1.4% globally [3], the estimated prevalence is much lower in Japan (0.0065%, using data from 1985 to 1996) [4]; ∼4500 individuals in Japan are estimated to have AS [5].
Correlation between body image perception and spinopelvic parameters in ankylosing spondylitis
Published in British Journal of Neurosurgery, 2018
Jung Sub Lee, Jong Ki Shin, Tae Sik Goh
Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease characterized by inflammatory back pain due to sacroiliitis and spondylitis, and the formation of syndesmophytes leading to ankylosis.1 AS is believed to be the most common and typical form of spondyloarthropathy.2 Advanced stages of the disease are characterized by progressive stiffening of the spine and thorax.3 Sagittal balance deteriorates during the course of the disease and produces rigid thoracolumbar kyphosis.3 Severe thoracolumbar kyphosis results in downward tilting of the head and face,3 and ability to see above the level of horizontal gaze progressively worsens.4 In addition, the center of gravity moves anteriorly to cause a stooped, downward-looking posture, which is characteristic of advanced AS,4 and contributes to poor body image and many disabilities, including social activity limitations.
Tumour necrosis factor inhibitors in enthesitis related arthritis and juvenile spondylarthropathies
Published in Expert Opinion on Orphan Drugs, 2018
Infliximab is a chimeric murine-human monoclonal anti-TNF antibody marketed first for treatment of rheumatoid arthritis in the late 1990s of the last century. It is still not approved for treatment of JIA. A controlled, randomized, double-blinded trial did not reach primary end point and therefore did not demonstrate superiority for treatment with infliximab over placebo [51]. Patients with active and so far treatment resistant juvenile spondyloarthropathy classified according to the European Spondyloarthropathy Study Group criteria but less than 16 years of age at disease onset and less than 18 years at start of treatment were included in a randomized, double-blind head-to-head study with infliximab or placebo for 12 weeks with an open-label extension study period until week 52. Twelve patients received infliximab 5 mg/kg and 14 patients placebo [44]. More patients on infliximab (73%/73%/45%) reached a BASDAI50/70/90 than patients on placebo (35%/12%/6%). However, infliximab is not approved for this indication.