This document provides an overview of ankylosing spondylitis and related spondyloarthropathies. It discusses the definition, epidemiology, etiology, pathological anatomy, clinical manifestations, diagnostic criteria and evaluation, and treatment of these conditions. Key points include that ankylosing spondylitis is a chronic inflammatory disease associated with the HLA-B27 gene, it predominantly affects the spine and sacroiliac joints, and diagnosis involves assessing symptoms of inflammatory back pain and structural damage visible on imaging studies according to criteria from ASAS.
2. Ankylosing spondylitis
Reiter's syndrome (reactive or arthritis)
Arthropathy of inflammatory bowel disease (Crohn's disease, ulcerative
colitis)
Psoriatic arthritis
Undifferentiated spondyloarthropathies
Juvenile chronic arthritis and ankylosing spondylitis of juvenile onset
Spondyloarthropathies
3. Angkylos and spondylos
Is a chronic inflammatory disease associated with the
human leukocyte antigen (HLA-B27)
Extra-articular Manifestations
DEFINITION
4. In 1666-1698 Bernard Corner
By Waters :
1693- 1824
1824 -1885
1897 -1931
1936 - 1950
In 1850, Brodie
In 1896, Roentgen had discovered the radiographic technique; but 1930
History
5. BEFORE Y AFTER 1950
LUMPERS SPLITTERS
1963 SAR
SA- ES-AP, SR
NOT KNOWN ETIOLOGY
History
6. 1968 BERNAR AMOR SPA- S. REITER , COMMON GENETIC BASIS
1970: spondyloarthropathy
Moll et al: seronegative spondyloarthropathy
History
7.
8. Servicio de Rhumatologie,
universitaire hopital Reina
Sofía, departamento de
Médecine, Université de
Cordoue, Córdoba, España.
Joint Bone Spine (factor de
impacto: 2,75). 02/2000; 67 (6):
516-20.Fuente: PubMed
Recomendación 12. No se recomiendan los criterios de ESSG ni los de
Amor para la clasificación de las EsA [2b, B, 74,3%].
10. Predisposition in certain population groups, such as American Indians or
tribes near the Arctic
Europe 0.3 or 1.8% of the population
In Japan 0.3 to 6.9 in Finland and 7.3 in USA per people 100,000 / year
Mexico is 0.9% among general
Caucasian 0.05%
prevalence of HLA-B27, around 2.5%
Epidemiology
11. Males (3 to 5 times more)
Onset after 50 years is exceptional
Epidemilogy
17. FOLDING INSUFFICIENT HLA B-27
Formation of a misfolded form of HLA-B27 within the endoplasmic reticulum
of an antigen-presenting cell and the elicitation of stress and
proinflammatory responses
ETIOLOGY
18. Homodimers on the cell surface and noncanonical recognition of HLA-B27
Generation of additional forms of HLA-B27, such as free heavy chains and
dimers on the cell surface, and their interactions with T cells, natural killer
cells and antigen-presenting cells.
ETIOLOGY
19. - L T CD8 AND PRESENTATION OF THE SURFACE ANTIGENS OF HLA B27
A DECREASEDTHE AMOUNT DUE EXPLANATION OF
PATHOPHYSIOLOGY A NEW KNOWLEDGE
- ANY OTHERTHEORY EXCLUDES AND CAN NOT EVEN
EXPLAINTHE PATHOGENESIS
Conclusions
27. Clinical history as a screening test for ankylosing spondylitis
A controlled study of 138 subjects demonstrated that the clinical history may be sensitive (95%)
and specific (85%) in the differential diagnosis of ankylosing spondylitis when reliance of five
specific historic features is made. Back pain that is insidious in onset, in a patient younger than
40 years, persisting for at least three months, associated with morning stiffness and improving
with exercise is characteristic of inflammatory spinal disease
INFLAMMATORY BACK PAIN
28. Inflammatory back pain in ankylosing spondylitis: a reassessment of the
clinical history for application as classification and diagnostic criteria
We assessed the clinical history of 213 patients (101 with AS and 112 with MLBP)
younger than 50 years who had chronic back pain. Single clinical parameters and
combinations of parameters were compared between the AS and MLBP patient
groups.
ASAS IBP criteria mnemonic for criteria “Ipain
S: 77% E 91.7%
CB: > E < S
CC: > S < E
Ozgocmen S, Akgul O, Khan MA. Mnemotécnico para la evaluación de los
criterios de la sociedad internacional espondiloartritis. J Rheumatol. 2010; 37 :.
1978
CRITERIA BERLIN
69. DIAGNOSIS . CRITERIA ASAS
M Rudwaleit1 D van der Heijde2 R Landewé3 N Akkoc4 J Brandt5 C T Chou6 M Dougados7 F Huang8 J Gu9 Y Kirazli10 F Van
den Bosch11 I Olivieri12 E Roussou13 S Scarpato14 I J Sørensen15 R Valle-Oñate16 U Weber17 J Wei18 J Sieper
70.
71. Area Domain Measurement / Instrument
ACTIVITY
(General and nightly)
spinal pain Horizontal
scale with numerical descriptors (1-10)
Patient global assessment Horizontal scale with numerical descriptors (1-10)
BASDAI
Overall rating of health Horizontal scale with numerical descriptors (1-10)
fatigue Horizontal scale with numerical descriptors (1-10)
joint count Count of 44, 78/76 or 68/66 or 28 joints
enthesitis Validated index (MASES, San Francisco, Berlin, etc)
dactylitis Present / absent and acute / chronic
Acute phase reactants ESR,CRP
spinal Stiffness Horizontal scale with numerical descriptors (1-10)
72. Area Domain Measurement / Instrument
Function
spinal mobility chest expansion
Test Schöber
Occiput-wall distance
cervical rotation
Lateral flexion of the spine
BASMI
General
function
BASFI
HAQ
structural Damage X-ray
Based on the criteria of NewYork Scale
(sacroiliac joints)
mSASSS (column) or BASRI (spine and hip)
ASspiMRI
79. ACTIVITY CRITERIA AND REFERRAL
ASDAS
Lukas et al. Ann RheumDis 2009;68:18-24
van derHeiijdeD et al. Ann Rheum Dis. 2008 Dec 5. [Epubahead of print]
80. ASDAS
Lukas et al. Ann RheumDis 2009;68:18-24
van derHeiijdeD et al. Ann Rheum Dis. 2008 Dec 5. [Epubahead of print]
97. 1. FRONTLINE
NSAIDS
COX-2 INHIBITORS
2. SECOND LINE
METHOTREXATE: NO EVIDENCE
STEROIDS
SULFASALAZINE
3. BIOLOGICAL:
TNF INHIBITORS
4. ALTERNATIVETHERAPIES
ABATACEPT INHIBITINGT CELL COSTIMULATION (CTLA-4Ig)
THE IL-1 RECEPTOR ANTAGONIST ANAKINRA HAS BEEN STUDIED IN PATIENTS
WITH AS
APREMILAST IS A PHOSPHODIESTERASE-4
TALIDOMIDA INHIBITING DE FNT
RITUXIMAB INHIBITING C20
TOCILIZUMAB MONOCLONAL ANTIBODY DESIGNEDTO INHIBIT BOTH SIGNALS
THROUGHTHE MEMBRANE AND SOLUBLE IL-6R
TREATMENT
98. EFFICIENCY SHORT
AND LONG TERM
INFLIXIMAB
5 mg/kg 0-2-6 y 8
RESPONSE VARIABLE
37-67%
ADALIMUMAB
40 mg c/ 2 s
ASAS 40
IMPROVEMENT
CRITERIA OF 54% VS
12.5 PLACEBO GROUP
ETANERCEP
25 MG SC 2 V X S
BASDAI 66.1%
IMPROVEMENT IN
RELATION TO
PLACEBO GROUP 50%
GOLIMUMAB
50-100 mg 1 v/ moth
IMPROVEMENT
CRITERIA ASAS 40% IN
RELATION TO 12% OF
PLACEBO
BIOLOGICAL: TNF INHIBITORS
99. A historical perspective of the spondyloarthritis
Henning Zeidlera, Andrei Calinb and Bernard Amorc
Current Opinion in Rheumatology 2011, 23:327–333
Hospital Clinicoquirúrgico Intermunicipal "Mártires del 9 de Abril
«www.ncbi.nlm.nih.gov/pubmed/21519270
PATOGENIA DE LAS ESPONDILOARTROPATÍAS SERONEGATIVAS
Dr. Modesto González Cortiñas
Rev Cubana Med 1998;37(1):28-35
Genetic aspects of susceptibility, severity, and clinical expression in ankylosing spondylitis
Matthew A. Brown, MB, BS, MD, FRACP, Alison M. Crane, PhD, and B. Paul Wordsworth, MRCP
Current Opinion in Rheumatology 2002, 14:354–360
Pathogenesis of ankylosing spondylitis and reactive arthritis
Tae-Hwan Kima, Wan-Sik Uhma and Robert D. Inman Curr Opin Rheumatol 17:400—405. ª 2005
Lippincott Williams & Wilkins.
Classification criteria for spondyloarthropathies Published online: December 18, 2012.
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KELLEY REUMATOLOGIA CLINICA VII EDICION
Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history
for application as classification and diagnostic criteria. Ozgocmen S, Akgul O, Khan
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