Overview of JAK-STAT Pathways in Spondyloarthritis
Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi in Psoriasis and Psoriatic Arthritis, 2017
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.
The History of Ankylosing Spondylitis
Barend J. van Royen, Ben A. C. Dijkmans in Ankylosing Spondylitis Diagnosis and Management, 2006
Rothschild and Wood (3), analyzing an extensive search for spondylarthropathy in North American skeletal remains of 16 populations dated from 4700-years ago up to less than 500-years ago, found 35 cases with spondylarthropathies. Spondyloarthropathy was defined as zygapophyseal or sacroiliac joint erosion or fusion, asymmetrical pattern of arthritis, reactive new bone formation, enthesopathy, or peripheral joint fusion. Considering that erosion can be an artifact in skeletal remains, in 6 individuals out of 31, fusion of sacroiliac bones was present. One hundred sixty-five individual skeletons were examined. Six of them had definite sacroiliac fusion (0.3%), and 2.1% had skeletal signs of peripheral or axial arthritis. These prevalence of sacroiliac fusion (0.3%) and 2.1% for peripheral arthritis are in line with what one would expect in modern times.
Intra-articular and local soft-tissue injections
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
Plantar fasciitis26 is an enthesitis which causes pain under the heel when weight bearing in the overweight, middle-aged joggers, and those with flat feet. It also occurs in seronegative spondyloarthropathy. It is always worse in the morning or after nonweight bearing. There is local tenderness in front of the calcaneum. Approximately 30 percent have a plantar spur on a lateral x-ray – plantar spurs do not always cause pain. Inferior heel pain may also be due to subcalcaneal bursitis (policeman’s heel) and fat pad disruption. MRI is rarely indicated but demonstrates the specific pathology clearly. A heel cup, an arch support, and thick-soled shoes help. Systematic reviews show no significant long-term benefit from corticosteroid injection versus placebo in plantar fasciitis and symptoms often settle spontaneously.27 Local corticosteroid injections, with or without local anesthetic or tibial nerve blockade are painful.28 The evidence-base for injection is weak.29
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.
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].
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