Ankylosing spondylitis

Axial spondyloarthritis is classified as a seronegative spondyloarthropathy. The seronegative spondyloarthropathies (including psoriatic arthritis, enteropathic arthritis, and reactive arthritis) are a heterogenous group of conditions with overlapping clinical manifestations and association with the gene HLA-B27.

Axial spondyloarthritis is a chronic progressive inflammatory arthropathy, which ultimately may lead to radiographic changes in the spine and sacroiliac joints. This radiographic stage is known as ankylosing spondylitis (AS).

Inflammatory back pain is the hallmark clinical feature. This is defined as back pain that is of insidious onset, is worse in the morning, and improves with exercise.

A positive response to nonsteroidal anti-inflammatory drugs (NSAIDs) is characteristic of most patients.

Physical therapy and NSAIDs are the cornerstone of treatment. In people whose symptoms are refractory to these approaches, tumor necrosis factor-alpha inhibitors and interleukin-17 inhibitors play a key role.

Axial spondyloarthritis (axSpA) is a chronic progressive inflammatory arthropathy. Patients present with severe pain and spinal stiffness, which ultimately may lead to radiographic changes in the spine and sacroiliac joints. This radiographic stage is known as ankylosing spondylitis (AS). Progression of disease may lead to spinal fusion. Patients with complete spinal fusion suffer extreme disability.

AS mainly affects the axial skeleton, although peripheral joints, entheses (tendon or ligament attachments to bone), and extra-articular sites such as the eye and bowel are frequently affected.[1]Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in spondylarthropathies: a systematic literature review. Ann Rheum Dis. 2008 Jul;67(7):955-9. http://www.ncbi.nlm.nih.gov/pubmed/17962239?tool=bestpractice.com [2]Rudwaleit M, Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol. 2006 Jun;20(3):451-71. http://www.ncbi.nlm.nih.gov/pubmed/16777576?tool=bestpractice.com

Nonradiographic axial spondyloarthritis (nr-axSpA) describes axial inflammation visible on magnetic resonance imaging (MRI) that has not caused substantial erosive damage to the sacroiliac joints. Patients can be classified as nr-axSpA on the basis of a positive MRI of the sacroiliac joint.[Figure caption and citation for the preceding image starts]: Bamboo spineStudent BMJ 2002;10:303-52. © BMJ Publishing Group Ltd 2008 [Citation ends].