Spondyloarthritis

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Format: Buch
Sprache:English
Veröffentlicht: Philadelphia [u.a.] Saunders 2012
Schriftenreihe:Rheumatic disease clinics of North America 38,3
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adam_text Spondyloarthrìtis Contents Foreword xiii Michael H. Weisman Preface xvii Jürgen Braun and Joachim Sieper Epidemiology of Spondyloarthritis 441 Carmen Stolwijk, Annelies Boonen, Astrid van Tubergen, and John D. Reveille Spondyloarthritis (SpA) represents a group of interrelated diseases with common clinical features and a close association with HLA-B27. Reports of incidence and prevalence of diseases vary depending on methodolog¬ ical differences between studies, the case definition used to classify disease, and the prevalence of HLA-B27 in the population studied. Newly proposed criteria for axial SpA and peripheral SpA present a new approach to facilitate classification of the SpA into 2 main subtypes and the criteria allow earlier detection of patents with inflammatory back pain. These criteria were developed for use in a (specialized) clinical setting and not for large epidemiologie studies. Classification, Diagnosis, and Referral of Patients with Axial Spondyloarthritis 477 Jürgen Braun and Joachim Sieper The concepts for classification, diagnosis and referral of patients with axial spondyloarthitis differ, although they of course basically relate to the same disease. While classification criteria and referral strategies concentrate largely on patients with chronic back pain with an age at onset before 45 years, the rheumatologist can make a diagnosis of axial SpA in patients with late onset or in patients with back pain for only some weeks if other items are fulfilled. Early recognition of patients with axial SpA is important to establish the diagnosis, potentially start therapeutic interventions and avoid unnecessary health care procedures. Inflammatory Back Pain 487 Rubén Burgos-Vargas and Jürgen Braun Inflammatory back pain (IBP) is a concept, which elements characterize the spinal involvement of patients with ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA). The identification of patients with IBP depends on the clinical setting and the diagnostic value of several IBP criteria. IBP differentiation from non-inflammatory, mechanical chronic back might be sometimes difficult, but the role of IBP diagnosis in the early stage of axSpA and AS leads to a better treatment. Inflammatory Back Pain: The United States Perspective 501 Michael H. Weisman Inflammatory back pain (IBP) is a relatively recent and well-accepted con¬ cept whose precise definition remains elusive. The definition of IBP varies Contents by criteria set, as does its sensitivity and specificity regarding screening and case ascertainment in various clinical and epidemiologie settings. This article reviews the history of efforts to define IBP, particularly the cri¬ teria sets that have been built around its measurement, describes assess¬ ment of IBP in the clinical setting, and illustrates how IBP has been used in epidemiologie and clinical research. Imaging in Axial Spondyloarthritis: Diagnostic Problems and Pitfalls 513 Xenofon Baraliakos, Kay-Geert A. Hermann, and Jürgen Braun Structural changes in axial Spondyloarthritis (axSpA) are best identified by conventional radiographs, while magnetic resonance imaging (MRI) is considered the gold standard for assessment of inflammatory changes. Imaging of the axial skeleton is crucial for the diagnosis but also for classification to non-radiographic axSpA according to the 2009 ASAS classification criteria. Despite the existing definitions for a positive MRI for the sacroiliac joints and the spine, these predefined lesions can also be seen in other conditions, representing pitfalls and false-positive conclu¬ sions in patients with similar clinical symptoms who do not have SpA. Diagnosis of SpA should result from the combination of clinical, laboratory and imaging findings. Comorbidities in Patients with Spondyloarthritis 523 Irene E. van der Horst-Bruinsma, Michael T. Nurmohamed, and Robert B.M. Landewé Chronic inflammatory spondyloarthritis involves axial symptoms of the spine and sacroiliac joints, or peripheral arthritis. Many patients suffer from extra-articular manifestations. With acute anterior uveitis, rapid treatment prevents synechiae. Other organs can be involved. Treatment includes exercise, nonsteroidal antiinflammatory drugs (if insufficient response, tumor necrosis factor blockers), and (with peripheral arthritis) sulfasalazine. Patients with ankylosing spondylitis have comorbidities and increased cardiovascular risk. For uveitis or inflammatory bowel disease, patients should be referred to an ophthalmologist or gastroen- terologist. Cardiovascular risk may originate from atherosclerotic dis¬ ease and cardiac manifestations. Epidemiológica! studies should be conducted before echocardiogram screening and cardiovascular risk management. The Genetics of Ankylosing Spondylitis and Axial Spondyloarthritis 539 Philip C. Robinson and Matthew A. Brown Ankylosing spondylitis (AS) and spondyloarthritis are strongly genetically determined. The long-standing association with HLA-B27 is well de¬ scribed, although the mechanism by which that association induces AS remains uncertain. Recent developments include the description of HLA- B27 tag single nucleotide polymorphisms in European and Asian popula¬ tions. An increasing number of non-MHC genetic associations have been reported, which provided amongst other things the first evidence of the in¬ volvement of the IL-23 pathway in AS. The association with ERAP1 is now known to be restricted to HLA-B27 positive disease. Preliminary studies on Contents the genetics of axial spondyloarthritis demonstrate a lower HLA-B27 car¬ riage rate compared with AS. Studies with larger samples and including non-European ethnic groups are likely to further advance the understand¬ ing of the genetics of AS and spondyloarthritis. Pathophysiology of New Bone Formation and Ankylosis in Spondyloarthritis 555 Rik J.U. Lories and Georg Schett The outcome of patients suffering from spondyloarthritis is determined by chronic inflammation and new bone formation leading to ankylosis. The latter process manifests by new cartilage and bone formation leading to joint or spine fusion. This article discusses the main mechanisms of new bone formation in spondyloarthritis. It reviews the key molecules and con¬ cepts of new bone formation and ankyiosis in animal models of disease and translates these findings to human disease. In addition, proposed biomarkers of new bone formation are evaluated and the translational current and future challenges are discussed with regards to new bone formation in spondyloarthritis. Pathophysiology and Role of the Gastrointestinal System in Spondyloarthritides 569 Peggy Jacques, Liesbet Van Praet, Philippe Carrón, Filip Van den Bosch, and Dirk Elewaut Inflammatory bowel disease (IBD) is a well-known extra-articular manifes¬ tation in spondyloarthritis (SpA); about 6.5% of patients with ankylosing spondylitis develop IBD during the course of the disease. The pathogene- sis of both SpA and IBD is considered to be the result of a complex interplay between the host (genetic predisposition), the immune system and environmental factors, notably microorganisms, leading to a disturbed immune system and chronic inflammation. Over the past decade, the role of tumor necrosis factor inhibition (infliximab, etanercept, adalimumab, go- limumab) in improving signs and symptoms and overall quality of life has been well documented in various forms of SpA. Future research will clarify the role of other potential targets. Therapy for Spondyloarthritis: The Role of Extra-articular Manifestations (Eye. Skin) 583 Philippe Carrón, Liesbet Van Praet Peggy Jacques, Dirk Elewaut, and Filip Van den Bosch Spondyloarthritis can be considered one of the prototypes (besides rheu¬ matoid arthritis) of an inflammatory rheumatic disease. The locomotor sys¬ tem is prominently involved with arthritis, enthesitis, dactylitis, sacroiliitis, and/or axial disease; but besides the rheumatologic component, other body systems are frequently affected. Extra-articular manifestations are all the medical conditions and symptoms that are not directly related to the locomotor system. Besides inflammatory bowel diseases, the major concept-related extra-articular manifestations are located in the eye (acute anterior uveitis) and the skin (psoriasis). This review focuses on the possible implications of these nonrheumatologic manifestations re¬ garding the treatment of spondytoarthritis. Contents Therapeutic Controversies in Spondyloarthritis: Nonsteroidal Anti-Inflammatory Drugs 601 Denis Poddubnyy and Désirée van der Heijde Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a first-line therapy in patients with axial spondyloarthritis (axSpA), including ankylos- ing spondylitis. NSAIDs reduce pain and stiffness effectively in most pa¬ tients, are able to reduce systemic and local inflammation, and can inhibit progression of structural damage in the spine. However, effective control of symptoms and retardation of radiographie progression often re¬ quire continuous and long-term treatment, which raises safety concerns. This article discusses controversies related to the current role of NSAIDs in axSpA treatment, risks and benefits of this treatment, and current trends for individualized treatment. Therapeutic Controversies: Tumor Necrosis Factor α Inhibitors in Ankylosing Spondylitis 613 I.H. Song and W.P. Maksymowych Tumor necrosis factor α inhibitors (TNF blockers) have revolutionized the treatment of patients with ankylosing spondylitis. Despite clinical efficacy, there are questions and controversies treating rheumatologists face, which this review discusses: whether there are specific indications for spe¬ cific TNF blockers; whether the dose of TNF blockers can be decreased; whether immunogenicity plays a role; what the role of residual active in¬ flammation on MRI might be; and whether there is a window of opportunity to treat patients with ankyiosing spondylitis and prevent radiographie pro¬ gression. This article also summarizes evidence for switching between TNF blockers and addresses the question of malignancies. How Important is Early Therapy in Axial Spondyloarthritis? 635 Joachim Sieper and Jürgen Braun There are 2 groups of drugs that have been shown effective in the treatment of patients with axial spondyloarthritis: nonsteroidal anti-inflammatory drugs and tumor necrosis factor a, blockers. Conventional disease-modify¬ ing drugs and some other biologies have not been shown clinically effica¬ cious in this disease. This overview discusses the available data on whether early treatment strategies in patients with axial spondyloarthritis have an effect on (1) the percentage of patients reaching clinical remission, (2) achieving drug-free remission, and (3) the progress of radiographie pro¬ gression in the spine as a parameter for structural damage. Index 643
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spellingShingle Spondyloarthritis
Rheumatic disease clinics of North America
Bechterew-Krankheit (DE-588)4069213-9 gnd
subject_GND (DE-588)4069213-9
title Spondyloarthritis
title_auth Spondyloarthritis
title_exact_search Spondyloarthritis
title_full Spondyloarthritis guest ed.: Jürgen Braun ...
title_fullStr Spondyloarthritis guest ed.: Jürgen Braun ...
title_full_unstemmed Spondyloarthritis guest ed.: Jürgen Braun ...
title_short Spondyloarthritis
title_sort spondyloarthritis
topic Bechterew-Krankheit (DE-588)4069213-9 gnd
topic_facet Bechterew-Krankheit
url http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025420175&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA
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