Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside

Rudwaleit, Martín; Feldtkeller, Ernst; Sieper, Joachim

doi:10.1136/ard.2005.051045

Cited by 50 publications

(44 citation statements)

References 6 publications

(4 reference statements)

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“…Dabei handelt es typischerweise um ein subchondrales Knochenmarködem (Osteitis), das nur in der Short-tau-inversion-recovery(STIR)-oder T2-Sequenz mit Fettsuppression nachweisbar ist [17]. In einer reinen T2-Sequenz kann nicht unterschieden werden, ob ein hyperintenses Signal durch Entzündung oder aber durch In der täglichen Praxis wird in der Regel ein diagnostischer Algorithmus angewendet, bei dem das Abfragen klinischer Parameter und das Durchführen einer Röntgenuntersuchung der Sakroiliakralgelenke am Anfang stehen [15,20]. Je nach Wahrscheinlichkeit der Diagnose folgt eine Bestimmung des HLA-B27; die Anordnung einer MRT-Untersuchung ergibt sich bei diesem stufenweisen Vorgehen zuletzt, da eine MRT-Untersuchung nicht immer einfach zu organisieren und relativ teuer ist.…”

Section: Diagnose Und Klassifikationunclassified

Diagnose und Therapie der axialen Spondyloarthritis einschließlich des Morbus Bechterew

Poddubnyy

Sieper

2012

Orthopäde

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The term axial spondyloarthritis covers patients with established structural changes visible on x-ray in sacroiliac joints and/or in the spine (classical ankylosing spondylitis) but also patients with non-radiographic axial spondyloarthritis in whom early inflammatory signs of the disease can only be visualized with magnetic resonance imaging (MRI). The MRI technique plays an important role in the diagnosis of this disease and an early diagnosis is normally based on a combination of clinical, laboratory and imaging parameters. Only non-steroidal anti-inflammatory drugs and TNF-α blockers are effective in the treatment of axial spondyloarthritis. Patients with short disease duration and elevated acute phase reactant levels demonstrate best therapy response and, therefore, should be closely followed-up and consistently treated.

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Section: Diagnose Und Klassifikationunclassified

Diagnose und Therapie der axialen Spondyloarthritis einschließlich des Morbus Bechterew

Poddubnyy

Sieper

2012

Orthopäde

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“…Multiples of LRs from clinical, radiological and genetic features combined with pre-test odds based on background prevalence [23] result in a post-test probability of disease, in this case axial-SpA being present. Therefore, according to the previously proposed theoretical scheme, a patient with IBP (LR = 3.1) who is HLA-B27 positive (LR = 9.0) and has MRI evidence of sacroiliitis (LR = 9.0) has a post-test probability of 93% [5,21,22]. A post-test probability of 590% is regarded as definite, between 80 and 90% is probable and 410-20% unlikely [21].…”

Section: Mri In Diagnosis Of Si Joint Disease In Spamentioning

confidence: 99%

“…Therefore, according to the previously proposed theoretical scheme, a patient with IBP (LR = 3.1) who is HLA-B27 positive (LR = 9.0) and has MRI evidence of sacroiliitis (LR = 9.0) has a post-test probability of 93% [5,21,22]. A post-test probability of 590% is regarded as definite, between 80 and 90% is probable and 410-20% unlikely [21].…”

Section: Mri In Diagnosis Of Si Joint Disease In Spamentioning

confidence: 99%

“…The new ASAS criteria, as proposed by Rudwaleit and colleagues [5,21,22], are based on an easy bedside assessment of early disease in SpA with statistical analysis on clinical, radiological, serological and genetic features and their singular or combined effect on the probability of disease. With knowledge of the background prevalence of axial-SpA in chronic back pain in the general population (5%) [23], likelihood ratios (LRs) of other common features of disease in axial-SpA were combined to estimate an overall probability of disease.…”

Section: Mri In Diagnosis Of Si Joint Disease In Spamentioning

confidence: 99%

“…To illustrate this: if a subject under the age of 50 years assessed in the rheumatology clinic who meets IBP criteria (LR = 3.1) [5,22], is HLA-B27 positive (LR = 9.0) [5,22] and has at least one mild to moderate posterior element lesion (LR = 14.5) or 53 inflammatory RLs (LR = 12.4) on spinal MRI, then that patient has definite axial-SpA (post-test probability = 95%) [21]. This emphasizes the substantial diagnostic utility that the addition of whole-spine fat-suppressed MRI has in the diagnosis of axial-SpA rather than scanning the SI joints alone.…”

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confidence: 99%

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The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Bennett¹,

Marzo‐Ortega²,

Rehman³

et al. 2010

Rheumatology

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, on behalf of the Leeds Spondyloarthropathy Group AbstractIn the past decade, fat-suppression MRI techniques have been increasingly used for the assessment of axial-SpA. Indeed, newly proposed classification criteria have suggested the inclusion of fat-suppression MRI for the evaluation of the SI joint in inflammatory back pain (IBP) of suspected axial-SpA. However, recent data on the whole spine have identified certain MRI spinal lesions to be highly diagnostic of axial-SpA; that the SI joint can be spared in axial-SpA; and that IBP may originate in the lumbar spine rather than SI joint. Therefore, it is proposed that MRI of the whole spine and not just the SI joint should now become a routine part of the assessment of axial-SpA. Not only is spinal MRI of great diagnostic utility in axial-SpA but there is also increasing evidence to suggest that it can play a significant role in the management, in particular directing anti-TNF therapy in AS, and also it may be prognostically useful in axial-SpA. With the wider availability, improving technology and falling cost of MRI, and the difficulty that clinical assessment of axial-SpA poses, especially in early disease, there is now a strong case for the use of whole-spine MRI in the diagnosis and management of axial-SpA.

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Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis: Results of a twelve‐week randomized, double‐blind, placebo‐controlled trial followed by an open‐label extension up to week fifty‐two

Haibel¹,

Rudwaleit²,

Listing³

et al. 2008

Arthritis & Rheumatism

298

185

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Objective. To evaluate the efficacy and safety of the tumor necrosis factor (TNF) antagonist adalimumab in patients with axial spondylarthritis (SpA) without radiographically defined sacroiliitis refractory to conventional treatment.Methods. Patients with active axial SpA (n ‫؍‬ 46) were randomized to receive placebo or adalimumab at a dosage of 40 mg subcutaneously every other week for 12 weeks, followed by an open-label extension that continued up to week 52. The diagnosis of axial SpA required the presence of 3 of 6 diagnostic criteria, including 2 of the following 3 criteria: inflammatory back pain, HLA-B27 positivity, or acute inflammation of the spine or sacroiliac joints on magnetic resonance imaging, in the absence of radiographic evidence of sacroiliitis. The primary end point was a 40% response according to the improvement criteria of the Assessment of SpondyloArthritis international Society (ASAS40).Results. All 46 patients (22 receiving adalimumab and 24 receiving placebo) completed the 12-week trial; 38 patients completed the extension period to week 52. At week 12, an ASAS40 response was achieved by 54.5% of the adalimumab-treated patients, as compared with 12.5% of the placebo-treated patients (P ‫؍‬ 0.004). After switching to adalimumab, a similar degree of efficacy was also achieved by the patients who were initially treated with placebo. Efficacy was maintained in all patients until week 52. Young age at study entry and an elevated C-reactive protein concentration were the best predictors of achieving an ASAS40 response. Serious adverse events occurred in 5 patients, none of which was related to the study drug.Conclusion. Adalimumab is the first TNF antagonist to demonstrate good clinical efficacy and safety in patients with axial SpA without radiographically defined sacroiliitis.The tumor necrosis factor (TNF) antagonists adalimumab, etanercept, and infliximab have all been proven to be highly effective in the treatment of patients with ankylosing spondylitis (AS) that continued to be active despite treatment with nonsteroidal antiinflammatory drugs (NSAIDs) (1-4). In all of these studies, an ClinicalTrials.gov identifier: NCT00235105.

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Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside

Cited by 50 publications

References 6 publications

Diagnose und Therapie der axialen Spondyloarthritis einschließlich des Morbus Bechterew

Diagnose und Therapie der axialen Spondyloarthritis einschließlich des Morbus Bechterew

The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis: Results of a twelve‐week randomized, double‐blind, placebo‐controlled trial followed by an open‐label extension up to week fifty‐two

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