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Axial spondyloarthritis

Last reviewed: 4 Oct 2024
Last updated: 02 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • HLA-B27 positive
  • inflammatory back pain
  • iritis/uveitis
  • enthesitis
  • presentation in late teens and early 20s
  • male sex
  • positive family history of ankylosing spondylitis (AS)
Full details

Other diagnostic factors

  • fatigue
  • sleep disturbance
  • tenderness at sacroiliac joint
  • dyspnea
  • loss of lumbar lordosis
  • peripheral joint involvement
  • kyphosis
  • psoriasis
  • symptoms of inflammatory bowel disease
Full details

Risk factors

  • HLA-B27
  • endoplasmic reticulum aminopeptidase 1 (ERAP1) and interleukin-23 receptor (IL23R) gene polymorphisms
  • positive family history of ankylosing spondylitis (AS)
  • male sex
Full details

Diagnostic tests

1st tests to order

  • pelvic x-ray
Full details

Tests to consider

  • HLA-B27
  • MRI
  • cervical spine x-ray (lateral)
  • lumbar spine x-ray (lateral)
  • thoracic spine x-ray (lateral)
  • ultrasound
Full details

Treatment algorithm

ACUTE

adults with pain and/or stiffness

adults without pain and/or stiffness

children

ONGOING

adults with pain and/or stiffness refractory to 2 NSAIDs and nonpharmacologic measures

Contributors

Authors

Antoni Chan, MBChB, FRCP, PhD

Consultant

Rheumatology Department

Royal Berkshire NHS Foundation Trust

Reading

UK

Disclosures

AC has served on the advisory boards for MSD, Novartis, and Sanofi; contributed to educational events for Janssen, MSD, Novartis, Sanofi, and Celgene; been on the speaker bureau for Janssen, Pfizer, and Novartis; and received travel grants from AbbVie, UCB, Lilly, and Pfizer to attend educational conferences.

Sarah Sacks, MBBS, BSc

Specialist Registrar in Rheumatology

Stoke Mandeville Hospital

Aylesbury

UK

Disclosures

SS declares that she has no competing interests.

Acknowledgements

Dr Antoni Chan and Dr Sarah Sacks would like to gratefully acknowledge Dr Jessica Gunn, Dr Sarah Keidel, Dr Millicent Stone, Dr Raj Sengupta, Dr Athimalaipet V. Ramanan, and Dr Emma Pomeroy, the previous contributors to this topic. We would like to gratefully acknowledge the late Dr Andrew Keat, Consultant Physician and Rheumatologist at Northwick Park Hospital for his contribution to this topic as a peer reviewer.

Disclosures

JG, SK, RS, and AVR declare that they have no competing interests. MS is an author of several references cited in this topic. EP is an author of a reference cited in this topic.

Peer reviewers

Roger Sturrock, MD, FRCP

Professor of Rheumatology

Centre for Rheumatic Diseases

University Department of Medicine

Glasgow Royal Infirmary University Trust

Glasgow

UK

Disclosures

RS is an author of a reference cited in this topic.

Karl Gaffney, BCh, BAO (Hons), FRCPI, FRCP

Consultant

Norfolk and Norwich University Hospital

Norwich and the Cromer & District Hospital

Cromer

UK

Disclosures

KG is an author of a reference cited in this topic.

Alexios G. Carayannopoulos, DO, MPH

Interventional Spine Physiatrist

Pain Medicine Specialist

Medical Director

Spine Center

Lahey Clinic

Burlington

MA

Disclosures

AGC declares that he has no competing interests.

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