Summary
Definition
A espondiloartrite axial (axSpA) é uma artropatia inflamatória progressiva crônica. Os pacientes se apresentam com dor intensa e rigidez na coluna, que podem acabar causando alterações radiográficas na coluna e nas articulações sacroilíacas. Este estágio radiográfico é conhecido como espondilite anquilosante (EA). A evolução da doença pode levar a fusão espinhal. Pacientes com fusão espinhal total sofrem de incapacidade extrema.
A EA afeta principalmente o esqueleto axial, embora articulações periféricas, ênteses (conexões de tendões ou ligamentos ao osso) e locais extra-articulares, como o olho e intestino, sejam frequentemente afetados.[1][2]
A espondiloartrite axial não radiográfica (axSpA-nr) descreve uma inflamação axial visível na ressonância nuclear magnética (RNM) que não tenha causado danos erosivos substanciais às articulações sacroilíacas.[Figure caption and citation for the preceding image starts]: Coluna em bambuStudent BMJ 2002;10:303-52. © BMJ Publishing Group Ltd 2008 [Citation ends].
History and exam
Key diagnostic factors
- presença de fatores de risco
- dorsalgia inflamatória
- irite/uveíte
- entesite
- apresentação no final da adolescência e logo após os 20 anos
- sexo masculino
- história familiar positiva de espondilite anquilosante (EA)
Other diagnostic factors
- fadiga
- perturbação do sono
- sensibilidade na articulação sacroilíaca
- dispneia
- perda de lordose lombar
- comprometimento das articulações periféricas
- cifose
- psoríase
- sintomas de doença inflamatória intestinal
Risk factors
- HLA (antígeno leucocitário) B27
- polimorfismos nos genes aminopeptidase 1 do retículo endoplasmático (ERAP1) e receptor de interleucina 23 (IL23R)
- história familiar positiva de espondilite anquilosante (EA)
- sexo masculino
Diagnostic investigations
1st investigations to order
- radiografia pélvica
Investigations to consider
- HLA (antígeno leucocitário) B27
- RNM
- radiografia da coluna cervical (lateral)
- radiografia da coluna lombar (lateral)
- radiografia da coluna torácica (lateral)
- ultrassonografia
Treatment algorithm
adultos com dor e/ou rigidez
adultos sem dor e/ou rigidez
crianças
adultos com dor e/ou rigidez refratária a 2 anti-inflamatórios não esteroidais (AINEs) e medidas não farmacológicas
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
利益声明
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
利益声明
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.
参考文献
关键文献
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.全文 摘要
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.全文 摘要
National Institute for Health and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management. Jun 2017 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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