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Axial spondyloarthritis

Última revisión: 10 Sep 2025
Última actualización: 02 Apr 2024

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • 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)
Todos los datos

Otros factores de diagnóstico

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

Factores de riesgo

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

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • pelvic x-ray
Todos los datos

Pruebas diagnósticas que deben considerarse

  • HLA-B27
  • MRI
  • cervical spine x-ray (lateral)
  • lumbar spine x-ray (lateral)
  • thoracic spine x-ray (lateral)
  • ultrasound
Todos los datos

Algoritmo de tratamiento

Agudo

adults with pain and/or stiffness

adults without pain and/or stiffness

children

En curso

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

Colaboradores

Autores

Antoni Chan, MBChB, FRCP, PhD

Consultant

Rheumatology Department

Royal Berkshire NHS Foundation Trust

Reading

UK

Divulgaciones

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

Divulgaciones

SS declares that she has no competing interests.

Agradecimientos

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.

Divulgaciones

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.

Revisores por pares

Roger Sturrock, MD, FRCP

Professor of Rheumatology

Centre for Rheumatic Diseases

University Department of Medicine

Glasgow Royal Infirmary University Trust

Glasgow

UK

Divulgaciones

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

Divulgaciones

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

Divulgaciones

AGC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):19-34.Texto completo  Resumen

Ward MM, Deodhar A, Gensler LS, et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis andnonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2019 Oct;71(10):1599-613.Texto completo  Resumen

National Institute for Health and Care Excellence (UK). Spondyloarthritis in over 16s: diagnosis and management. Jun 2017 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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