axial spondylitis: the best management - parkside … axial spondyloarthritis with erosive...
TRANSCRIPT
Professor John Axford DSc MD FRCP FRCPCH
St George’s University of London
London Rheumatology Clinic
Axial Spondylitis:
The Best Management
Mr KH 49yo Professional
footballer/coach
R THR 4.13
Pain Shoulders + Sternum
Sleep <2hr
60min EMS
Unwell, tired, bed @8pm
O/E: Fit
tender shoulder & pelvic
girdles
Significant OA
Inx:ESR 43, CRP 21,
XR Normal
Diagnosis?
Mr KH
Polymyalgia Rheumatica
Mr JC 55yo Businessman
>10 y LBP >last 2y
Pain Shoulders + Sternum
Sleep <2hr
60min EMS
Unwell, tired, bed @8pm
O/E: OW, facial rosacea,
Psoriasis scalp & elbow,
tender shoulders, axial,
sternum
Inx:ESR normal, CRP 21, Vit
D 27.
XR normal
Diagnosis?
Mr JC Diagnosis
Psoriatic axial spondyloarthritis with erosive
sternoclavicular arthritis.
Sternoclavicular hyperostosis syndrome (SAPHO)
synovitis; acne; pustulosis; hyperostosis; and
osteomyelitis
Treatment
MTX + Corticosteroids
Will probably need anti-TNF
Axial Spondyloarthritis
Axial Spondyloarthritis
Axial Spondylitis:
The best management
FIRST of all:
Refer back pain to a rheumatologist
We may not be dextrous
…but our job is to talk to
patients……….endlessly
1.
der Greek
ankylos = bent or crooked
spondylos = a spinal vertebra
Inflammation
Spine and sacroiliac joints
Hip and shoulder
Costovertebral, manubriosternal,
sternoclavicular, and costochondral joints
extraspinal entheses
Peripheral arthritis
extraarticular organ involvement
eye, lungs, heart
Axial Spondyloarthritis
Age of onset <40 years
Insidious onset
Improvement with exercise
No improvement with rest
Pain at night
inflammatory back pain
qualitatively different from mechanical
spinal pain
Axial Spondyloarthritis
Overlapping disorders
Ankylosing spondylitis (AS)
Non-radiographic axial SpA (nr-axSpA)
Undifferentiated spondyloarthritis (UspA)
Reactive arthritis
SpA associated with
Psoriasis,Crohn’s disease and ulcerative
colitis
Juvenile onset spondyloarthritis
Axial Spondyloarthritis
Axial Spondyloarthritis
Diagnosis
History
Examination
Imaging
Acute phase reactants
HLA-B27
Testing for HLA B27
diagnosis of SpA unlikely
Negative HLA-B27 and imaging for
sacroiliitis
testing for HLA-B27
back pain for more than three months
and with onset before age 45 years.
HLA-B27 +ve 95 % AS
8 % of the general population
prevalence of AS in the HLA-B27 5 %
positive HLA-B27 is not diagnostic.
Axial Spondyloarthritis
Axial Spondyloarthritis
Treatment
Goals:
Relief of symptoms
Maintenance of function
Prevention of complications of spinal disease
Minimization of extraspinal and extraarticular
manifestations and comorbidities
Treatment
Education
Exercise
Analgesia
NSAIDs
Corticosteroid
Sulphasalazine
Anti-TNF
Axial Spondyloarthritis
Axial Spondyloarthritis: Cure!
Cervical myelopathy
www.londonrheumatology.co.uk
The London Rheumatology Clinic Parkside Hospital
Thank you for your attention…