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Arthritis Care & Research Oct 2019To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). (Review)
Review
2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.
OBJECTIVE
To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
METHODS
We conducted updated systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat-to-target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel.
RESULTS
Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co-administration of low-dose methotrexate with TNFi is not recommended, nor is a strict treat-to-target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended.
CONCLUSION
These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.
Topics: Antirheumatic Agents; Biomedical Research; Clinical Trials as Topic; Humans; Rheumatology; Spondylarthritis; Spondylitis, Ankylosing; Treatment Outcome; United States
PubMed: 31436026
DOI: 10.1002/acr.24025 -
Frontiers in Immunology 2019
Topics: Disease Management; Disease Susceptibility; Humans; Immune System Diseases; Spondylitis, Ankylosing
PubMed: 31214188
DOI: 10.3389/fimmu.2019.01232 -
The Kurume Medical Journal Sep 2019Although pyogenic spondylitis is an infrequent infection, its incidence is increasing because of the growing number of elderly people and immunocompromised patients.... (Review)
Review
Although pyogenic spondylitis is an infrequent infection, its incidence is increasing because of the growing number of elderly people and immunocompromised patients. Diagnosis is often difficult and appropriate imaging, blood cultures and/or biopsy are essential in making an early diagnosis. Most of the cases can be treated non-operatively. Surgical treatment is indicated in patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients who have failed conservative treatment. Early and accurate diagnosis of pyogenic spondylitis is important for timely and effective management, in order to reduce the occurrence of spinal deformity and dysfunction.
Topics: Humans; Magnetic Resonance Imaging; Spondylitis
PubMed: 31406038
DOI: 10.2739/kurumemedj.MS653001 -
Journal of Clinical Rheumatology :... Dec 2021Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis... (Review)
Review
BACKGROUND
Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care-related costs, imposing a high burden on patients, their caregivers, and society.
SUMMARY OF WORK
Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA.
MAJOR CONCLUSIONS
A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA.
FUTURE RESEARCH DIRECTIONS
The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
Topics: Adult; Humans; Quality of Life; Rheumatologists; Sacroiliac Joint; Spine; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33105312
DOI: 10.1097/RHU.0000000000001575 -
Clinical and Experimental Rheumatology 2018Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The... (Review)
Review
Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The 2009 ASAS classification criteria differentiate between the classical ankylosing spondylitis or radiographic axSpA and non-radiographic axSpA based on the presence or absence of definite radiographic changes in the sacroiliac joints. Importantly, back pain in patients with axSpA may well have reasons other than axial inflammation or new bone formation. There are several important differential diagnoses such as diffuse idiopathic skeletal hyperostosis and osteitis condensans. This review summarises recent publications concerning the performance of imaging modalities in the field, such as conventional radiography, magnetic resonance imaging, computed tomography and dual energy x-ray absorptiometry including the trabecular bone score.
Topics: Back Pain; Diagnosis, Differential; Diagnostic Imaging; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results; Rheumatology; Sacroiliac Joint; Severity of Illness Index; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 30296971
DOI: No ID Found -
Rheumatology (Oxford, England) Oct 2020In recent years, significant progress has been made in improving the early diagnosis of spondyloarthritides (SpA), including axial SpA. Nonetheless, there are still... (Review)
Review
In recent years, significant progress has been made in improving the early diagnosis of spondyloarthritides (SpA), including axial SpA. Nonetheless, there are still issues related to the application of classification criteria for making the primary diagnosis of SpA in the daily practice. There are substantial conceptional and operational differences between the diagnostic vs classification approach. Although it is not possible to develop true diagnostic criteria for natural reasons as discussed in this review, the main principles of the diagnostic approach can be clearly defined: consider the pre-test probability of the disease, evaluate positive and negative results of the diagnostic test, exclude other entities, and estimate the probability of the disease at the end. Classification criteria should only be applied to patients with an established diagnosis and aimed at the identification of a rather homogeneous group of patients for the conduction of clinical research.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Spondylarthritis; Spondylitis, Ankylosing; Tomography, X-Ray Computed
PubMed: 33053191
DOI: 10.1093/rheumatology/keaa250 -
Deutsches Arzteblatt International Dec 2017A recent population-based study from Denmark showed that the incidence of spondylodiscitis rose from 2.2 to 5.8 per 100 000 persons per year over the period 1995-2008;...
BACKGROUND
A recent population-based study from Denmark showed that the incidence of spondylodiscitis rose from 2.2 to 5.8 per 100 000 persons per year over the period 1995-2008; the age-standardized incidence in Germany has been estimated at 30 per 250 000 per year on the basis of data from the Federal Statistical Office (2015). The early diagnosis and treatment of this condition are essential to give the patient the best chance of a good outcome, but these are often delayed because it tends to present with nonspecific manifestations, and fever is often absent.
METHODS
This article is based on a systematic search of Medline and the Cochrane Library for the period January 2009 to March 2017. Of the 788 articles identified, 30 publications were considered.
RESULTS
The goals of treatment for spondylodiscitis are to eliminate infection, restore functionality of the spine, and relieve pain. Magnetic resonance imaging (MRI) remains the gold standard for the radiological demonstration of this condition, with 92% sensitivity and 96% specificity. It also enables visualization of the spatial extent of the infection and of abscess formation (if present). The most common bacterial cause of spondylodiscitis in Europe is Staphylococcus aureus, but tuberculous spondylodiscitis is the most common type worldwide. Antibiotic therapy is a pillar of treatment for spondylodiscitis and should be a part of the treatment in all cases. Neurologic deficits, sepsis, an intraspinal empyema, the failure of conservative treatment, and spinal instability are all indications for surgical treatment.
CONCLUSION
The quality of life of patients who have been appropriately treated for spondylodiscitis has been found to be highly satisfactory in general, although back pain often persists. The risk of recurrence increases in the presence of accompanying illnesses such as diabetes mellitus, renal failure, or undrained epidural abscesses.
Topics: Aged; Delayed Diagnosis; Discitis; Europe; Germany; Humans; Magnetic Resonance Imaging; Methicillin-Resistant Staphylococcus aureus; Positron Emission Tomography Computed Tomography; Quality of Life; Spondylitis; Treatment Outcome
PubMed: 29321098
DOI: 10.3238/arztebl.2017.0875 -
Clinical and Experimental Rheumatology Nov 2023Axial spondyloarthritides (axSpA) are a group of systemic autoimmune diseases, characterised by an inflammatory involvement of the axial skeleton, which, in the earlier... (Review)
Review
Axial spondyloarthritides (axSpA) are a group of systemic autoimmune diseases, characterised by an inflammatory involvement of the axial skeleton, which, in the earlier phases, cannot be detected by conventional radiology, but only by magnetic resonance imaging, thus defining the so-called non-radiographic axSpA (nr-axSpA). The initial osteitis then tends to complicate into bone reabsorption and aberrant bone deposition, which then determines the ankylosis of the axial skeleton in the latest phases of the disease.Peripheral joints may also be affected, enthesitis being its more characteristic manifestation. The radiographic form corresponds to ankylosing spondylitis which, with psoriatic arthritis, is the best-known subtype of SpA. AxSpA are rarely associated to laboratory abnormalities and are usually complicated by the presence of both extra-articular manifestations (particularly acute anterior uveitis, psoriasis and inflamatory bowel disease) and comorbidities, with a subsequent higher risk for patients of an impaired quality of life.In this paper we reviewed the literature on axSpA of 2021 and 2022 (Medline search of articles published from 1st January 2021 to 31st December 2022).
Topics: Humans; Spondylarthritis; Quality of Life; Spondylitis, Ankylosing; Arthritis, Psoriatic; Psoriasis
PubMed: 37965699
DOI: 10.55563/clinexprheumatol/9fhz98 -
Rheumatology (Oxford, England) Mar 2019In ankylosing spondylitis (AS), structural damage that occurs as a result of syndesmophyte formation and ankylosis of the vertebral column is irreversible. Structural... (Review)
Review
In ankylosing spondylitis (AS), structural damage that occurs as a result of syndesmophyte formation and ankylosis of the vertebral column is irreversible. Structural damage is currently assessed by conventional radiography and scoring systems that reliably assess radiographic structural damage are needed to capture the differential effects of drugs on structural damage progression. The validity of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) as a primary outcome measure in evaluating the effect of AS treatments on radiographic progression rates was assessed in this review. The mSASSS has not been used, to date, as a primary outcome measure in a prospective randomized controlled clinical trial of biologic therapy in AS. This review of the medical literature confirmed that the mSASSS is the most validated and widely used method for assessing radiographic progression in AS, correlating with worsening measures of disease signs and symptoms, spinal mobility and physical function, with a 2-year interval being required to ensure sufficient sensitivity to change.
Topics: Anti-Inflammatory Agents; Disease Progression; Humans; Radiography; Severity of Illness Index; Spondylitis, Ankylosing
PubMed: 29860356
DOI: 10.1093/rheumatology/key128 -
Journal of Korean Medical Science Aug 2022
Topics: Humans; Psoriasis; Spondylitis; Spondylitis, Ankylosing
PubMed: 35996935
DOI: 10.3346/jkms.2022.37.e259