Axial spondyloarthritis by Stefan Siebert, Raj Sengupta, Alexander Tsoukas

By Stefan Siebert, Raj Sengupta, Alexander Tsoukas

Axial spondyloarthritis is the most typical inflammatory arthritis affecting the backbone. normally first proposing to a number of fundamental and secondary care pros, the excessive international affliction burden of this situation has created a necessity for elevated wisdom of this throughout quite a number rheumatology specialties.

A pocketbook geared toward the non-specialist reader Axial Spondyloarthritis is the basic consultant to this universal . concentrating on the sensible implications of advancements in category, prognosis and therapy, this simply obtainable textual content totally covers the wider spectrum of the disease.

Concise and completely illustrated, this addition to the Oxford Rheumatology Library covers the heritage and pathophysiology of axial spondylitis, along distinctive sections on remedies, issues and manifestations of the . With each one part supported by way of a convenient key issues part, Axial Spondyloarthritis is an invaluable and positive source for any practitioner or trainee encountering this condition.

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HLA-​B27 is also associated with related spondyloarthritis (SpA) conditions such as reactive arthritis (70%), psoriatic arthritis with axial involvement (~60%), and acute anterior uveitis (50%). There are over 50 subtypes of HLA-​B27, whose evolution and geographical variation largely reflects the migration of humans from Africa. Not all subtypes are associated with AS and some even appear to be protective. It should be noted that as HLA-​B27 occurs in a significant percentage of the population, only a minority of these people will develop AS (less than 10%), although 20% of HLA-​B27-​positive relatives of patients with AS will develop the condition.

The concept of inflammatory back pain (IBP) therefore evolved in an effort to help distinguish those with a probable underlying inflammatory cause for their back pain from those with the far more prevalent non-​specific mechanical back pain. 1 Potential sources of chronic low back pain Potential sources of chronic back pain Non-​specific low back pain (no obvious cause) Degenerative disc disease Facet joint disease Muscle or ligament pain Herniated discs Spondylolisthesis Severe kyphosis or scoliosis Osteoporotic wedge fracture Spinal stenosis or radiculopathy Inflammation due to axial spondyloarthritis or related spondyloarthritis conditions Infections: septic discitis, osteomyelitis, epidural abscess Tumours: primary or metastases Abdominal aortic aneurysm Renal disorders Endometriosis Gastrointestinal disorders Fibromyalgia with features suggestive of IBP is an important first step in identifying potential patients who may have axSpA.

39 40 A x i al S p o n d y l o a r t h r i t i s authors reported sensitivity of 95% and specificity of 85% in their test population, although specificity was lower when applied to other populations. Berlin Criteria (2006) The Berlin criteria were developed as a result of a study designed to assess the components of IBP, individually and in various combinations, in patients younger than 50 years with low back pain for at least 3 months (Rudwaleit, 2006). Three sets of four variable combinations were defined and found to perform similarly.

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