ankylosing spondylitis, axial spondyloarthritis; Marie Strumpell disease; Bechterew's disease (AS)

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Etiology

Epidemiology

  • generally begins in 2nd or 3rd decade of life
  • onset after age 40 is unusual
  • male:female ratio 3:1
  • more common in white than black adults
  • affects 0.2% of white adults

Pathology

Genetics

  • HLA-B27 is positive in 90-95% of patients[3]
  • concordance rate in identical twins is 50%
  • frequently family history

Clinical manifestations

Diagnostic criteria

* >= 3 diagnostic criteria[25]

Laboratory

Diagnostic procedures

Radiology

Complications

Differential diagnosis

Management

More general terms

Additional terms

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1904-1906
  2. 2.0 2.1 Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 864-65, 789
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2022.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. 4.0 4.1 Song IH, Poddubnyy DA, Rudwaleit M, Sieper J. Benefits and risks of ankylosing spondylitis treatment with nonsteroidal antiinflammatory drugs. Arthritis Rheum. 2008 Apr;58(4):929-38 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18383378
  5. 5.0 5.1 Chary-Valckenaere I, d'Agostino MA, Loeuille D. Role for imaging studies in ankylosing spondylitis. Joint Bone Spine. 2011 Mar;78(2):138-43 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20851029
  6. Vosse D, Feldtkeller E, Erlendsson J et al Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheumatol. 2004 Oct;31(10):1981-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15468363
  7. 7.0 7.1 Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012 Aug;4(4):301-11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22859929
  8. 8.0 8.1 Braun J, van den Berg R, Baraliakos X et al 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011 Jun;70(6):896-904. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21540199
  9. van der Heijde D, Sieper J, Maksymowych WP et al 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis. 2011 Jun;70(6):905-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21540200
  10. de Vries MK, van Eijk IC, van der Horst-Bruinsma IE et al Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthritis Rheum. 2009 Nov 15;61(11):1484-90 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19877087
  11. Robinson PC, Brown MA. The genetics of ankylosing spondylitis and axial spondyloarthritis. Rheum Dis Clin North Am. 2012 Aug;38(3):539-53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23083754
  12. Rudwaleit M, Taylor WJ. Classification criteria for psoriatic arthritis and ankylosing spondylitis/axial spondyloarthritis. Best Pract Res Clin Rheumatol. 2010 Oct;24(5):589-604. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21035082
  13. 13.0 13.1 Haroon NN et al. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: A population- based study. Ann Intern Med 2015 Aug 11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258401
  14. 14.0 14.1 Wang R et al. Progression of nonradiographic axial spondyloarthritis to ankylosing spondylitis: A population-based cohort study. Arthritis Rheumatol 2016 Jun; 68:1415 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26663907
  15. 15.0 15.1 Baraliakos X, Heldmann F, van den Bosch F et al Long-term efficiency of infliximab in patients with ankylosing spondylitis: real life data confirm the potential for dose reduction. RMD Open. 2016 Jul 19;2(2):e000272. eCollection 2016. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27493791 Free PMC Article
  16. 16.0 16.1 Sieper J, Listing J, Poddubnyy D et al. Effect of continuous versus on-demand treatment of ankylosing spondylitis with diclofenac over 2 years on radiographic progression of the spine: results from a randomised multicentre trial (ENRADAS). Ann Rheum Dis 2016 Aug 75:1438 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26242443
  17. 17.0 17.1 Strand V, Singh JA. Patient Burden of Axial Spondyloarthritis. J Clin Rheumatol. 2017 Oct;23(7):383-391. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28937474 Free PMC Article
  18. 18.0 18.1 Pavelka K, Kivitz A, Dokoupilova E et al Efficacy, safety, and tolerability of secukinumab in patients with active ankylosing spondylitis: a randomized, double-blind phase 3 study, MEASURE 3. Arthritis Res Ther. 2017 Dec 22;19(1):285. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29273067 Free PMC Article
  19. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016 Jun 30;374(26):2563-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27355535
  20. Kirkner M Working Group Proposes MRI Definitions of Structural Lesions Indicative of Axial Spondyloarthritis. Medscape - Jun 08, 2020. https://www.medscape.com/viewarticle/931907
  21. 21.0 21.1 Yin Y, Wang M, Liu M et al Efficacy and Safety of IL-17 Inhibitors for the Treatment of Ankylosing Spondylitis. Arthritis Res Ther. 2020;22(111) via Medscape PMID: https://www.ncbi.nlm.nih.gov/pubmed/32398096 PMCID: PMC7216398 Free PMC article https://www.medscape.com/viewarticle/932033
    Franki L FDA Approves Cosentyx for Treatment ofActive nr-axSpA Medscape - Jun 18, 2020. https://www.medscape.com/viewarticle/932574
  22. 22.0 22.1 22.2 Harris S Mortality in Ankylosing Spondylitis and Psoriatic Arthritis. AS alone linked with greater all-cause mortality; CV deaths elevated with both diseases. MedPage Today April 15, 2022 https://www.medpagetoday.com/reading-room/acrr/psoriaticarthritis/98224
    Chaudhary H, Bohra N, Syed K et al All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2021 Nov 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34788902 https://onlinelibrary.wiley.com/doi/10.1002/acr.24820
  23. 23.0 23.1 23.2 NEJM Knowledge+ Hematology
  24. 24.0 24.1 Baraliakos X et al. A good response to nonsteroidal antiinflammatory drugs does not discriminate patients with longstanding axial spondyloarthritis from controls with chronic back pain. J Rheumatol 2024 Mar; 51:250. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38224987 https://www.jrheum.org/content/51/3/250
  25. 25.0 25.1 Marques ML, Ramiro S, van Lunteren M et al. Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort. Ann Rheum Dis 2024 Apr 11; 83:589. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38233104 https://ard.bmj.com/content/83/5/589
  26. National Institute of Arthritis and Muscluloskeletal and Skin Diseases (NIAMS) Ankylosing Spondylitis https://www.niams.nih.gov/health-topics/ankylosing-spondylitis

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