Sacroiliitis on imaging* and ≥ 1 SpA feature**.The ASAS criteria for axial SpA mandates patients have back pain for ≥ 3 months and be < 45 years of age while fulfilling 1 of the following 2 sets of criteria: These recent criteria may aid clinicians in the diagnosis of axial SpA well before patients fulfill AS criteria by the 1984 Modified New York criteria. Radiographic parameters include ≥ grade 2 sacroiliitis bilaterally or grade 3 or 4 sacroiliitis unilaterally.īecause many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA. It requires at least 1 clinical manifestation and at least 1 radiographic parameter. Clinical manifestations include ≥ 3 months of inflammatory back pain that improves with exercise and exacerbated by rest, limitation of lumbar motion in both frontal and sagittal planes, and limitation of chest expansion compared to the normative population. There is no consensus on the diagnosis of AS, but the 1984 Modified New York classification criteria has been generally accepted for both research and clinical purposes. Based on more recent data, the pattern of spinal fusion may actually occur in a saltatory manner rather than strictly in continuously ascending fashion. For many patients, ankylosis classically begins at the sacroiliac joints and progresses in an ascending manner, from the lumbar spine to eventually the cervical spine. This process tends to be slow, but when it progresses can ultimately lead to complete spinal fusion or ankylosis (i.e. These syndesmophytes frequently bridge adjacent vertebrae, resulting in impaired spinal mobility. The natural history of AS for some patients includes structural abnormalities of the spine from development of new bone formation. Inflammatory back pain will tend to improve with stretching and physical activity and worsen with prolonged inactivity. Symptoms tend to worsen in the early morning hours, causing sleep disturbance in many patients. Spinal inflammation results in symptoms of back stiffness, soreness, and pain. Cardiac involvement resulting in aortitis and arrhythmias occur less commonly. This will frequently be accompanied by peripheral arthritis, enthesitis, and/or acute anterior uveitis. Most patients with AS will experience symptoms of inflammatory back pain due to sacroiliitis and axial arthritis of the spine. Other MHC alleles that may play a minor role in AS heritability include HLA-B60 and HLA-DR1. Recent genome wide association studies (GWAS) of patients with AS have identified susceptibility loci, including IL23R, ERAP1, and IL1R2 among others. The precise etiology of AS remains mostly unknown, though heritability is frequently cited as a significant contributor. Major histocompatibility alleles, particularly HLA-B27, may account for up to one-third of the genetic effect. Approximately 80% of patients with AS experience symptoms at ≤ 30 years of age, while only 5% will present with symptoms at ≥ 45 years of age. Age of disease onset usually peaks in the second and third decades of life. AS occurs more frequently in men than women (2:1). Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. In addition to axial arthritis, AS can result in peripheral arthritis, enthesitis, and uveitis, all shared characteristics of the SpA. AS is the archetype of a heterogeneous group of arthritides within the rheumatic diseases known formerly as the seronegative spondyloarthropathies but now frequently referred to as spondyloarthritis (SpA). Ankylosing spondylitis (AS) is a chronic inflammatory disease causing axial arthritis, frequently resulting in inflammatory low back pain early in the disease course, with eventual severe impairment of spinal mobility due to structural changes ultimately leading to spinal fusion.
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