Spondyloarthritides: Current Perspective on Diagnosis and Classification

Czech version

Authors: L. Procházková; P. Němec; M. Souček
Authors‘ workplace: Revmatologická ambulance II. interní kliniky Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Miroslav Souček, CSc.
Published in: Vnitř Lék 2013; 59(5): 383-390
Category: Review

Overview

Spondyloarthritides (SpA) are a heterogeneous group of chronic inflammatory diseases with common clinical features and genetic basis. They primarily affect the axial skeleton, especially the sacroiliac joint, other localizations of the affection being peripheral joints and entheses – typical of the group of spondyloarthritides. On the basis of the predominant affection of the axial or peripheral skeleton, they can be divided, according to the current classification criteria, into axial SpA and peripheral SpA. Apart from axial and peripheral articular manifestations, many patients also display extra‑ articular manifestations, which can thus become an important diagnostic clue and also the first symptom of the disease. The most frequent of them are anterior uveitis, inflammatory bowel diseases, and psoriasis. Also the strong binding of spondyloarthritides to the positivity of HLA B27 antigen or a family history of the disease is important information which helps in the diagnosis. Comorbidities, the most common and important of which are cardiovascular diseases or osteoporosis and its consequences in the form of fractures, are an integral part of the issue of spondyloarthritides.

Key words:
spondyloarthritides – ASAS criteria – sacroiliitis – MRI – extra‑ articular manifestation – entezitis

Sources

1. Feldtkeller E, Erlendsson J. Definition of disease duration in ankylosing spondylitis. Rheumatol Int 2008; 28: 693– 696.

2. Mau W, Zeidler H, Mau R et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10‑year followup. J Rheumatol 1988; 15: 1109– 1114.

3. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361– 368.

4. van Tubergen A, Heuft‑ Dorenbosch L, Schulpen G et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis 2003; 62: 519– 525.

5. Rudwaleit M, van der Heijde D, Landewe R et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777– 783.

6. Huerta‑ Sil G, Casasola‑ Vargas JC, Londono JD et al. Low grade radiographic sacroiliitis as prognostic factor in patients with undifferentiated spondyloarthritis fulfilling diagnostic criteria for ankylosing spondylitis throughout follow up. Ann Rheum Dis 2006; 65: 642– 646.

7. Jurik AG, Hansen J, Puhakka KB. Effective radiation dose from semicoronal CT of the sacroiliac joints in comparison with axial CT and conventional radiography. Eur Radiol 2002; 12: 2820– 2825.

8. Fazel R, Krumholz HM, Wang Y et al. Exposure to Low‑ Dose Ionizing Radiation from Medical Imaging Procedures. N Engl J Med 2009; 361: 849– 857.

9. Berrington de Gonzalez A, Mahesh M, Kim KP et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169: 2071– 2077.

10. Smith‑ Bindman R, Lipson J, Marcus R et al. Radiation Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Arch Intern Med 2009; 169: 2078– 2086.

11. Song IH, Carrasco‑ Fernández J, Rudwaleit M et al. The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research. Ann Rheum Dis 2008; 67: 1535– 1540.

12. Baraliakos X, Hermann KG, Landewe R et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging (MRI): a comparison between contrast enhanced T1 and short‑ tau inversion recovery (STIR) sequences. Ann Rheum Dis 2005; 64: 1141– 1144.

13. Madsen KB, Egund N, Jurik AG. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short‑ tau inversion recovery and gadolinium contrast‑ enhanced sequences. J Rheumatol 2010; 37: 393– 400.

14. Sieper J, Rudwaleit M, Baraliakos X et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to asses spondyloarthritis. Ann Rheum Dis 2009; 68: (Suppl. II): ii1– ii 44.

15. Maksymowych WP, Crowther SM, Dhillon SS et al. Systematic assessment of inflammation by magnetic resonance imaging in the posterior elements of the spine in ankylosing spondylitis. Arthritis Care Res 2010; 62: 4– 10.

16. Braun J, Listing J, Sieper J. Reply. Arthritis Rheum 2005; 52: 4049– 4050.

17. Reveille J. Clinical features of ankylosing spondylitis. In: Rheumatology. 4th edition, Mosby, Elservier 2007, 1109– 1114.

18. Brown MA, Kennedy LG, MacGregor AJ et al. Susceptibility to AS in twins. Arthritis Rheum 1997; 40: 1823– 1828.

19. Rudwaleit M, van der Heijde D, Khan MA et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004; 63: 535– 543.

20. Sieper J, van der Heide D, Landewe R et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis Society (ASAS). Ann Rheum Dis 2009; 68: 784– 788.

21. van den Berg R, de Hooge M, Rudwaleit M et al. ASAS modification of the Berlin algorithm for diagnosing axial spondyloarthritis: results from the SPondyloArthritis Caught Early (SPACE)- cohort and from the Assessment of SpondyloArthritis international Society (ASAS)- cohort. Ann Rheum Dis doi:10.1136/ annrheumdis‑ 2012– 201884.

22. Rudwaleit M, van der Heijde D, Landewe R et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777– 783.

23. D’Agostino MA, Palazzi C, Olivieri I. Entheseal involvement. Clinical and Experimental Rheumatology 2009; 27: (4, supplement 55): S50– S55.

24. Oliveri H et al. Editorial: Dactylitis or “Sausage‑ Shaped” Digit. J Rheumatol 2007; 34: 1217– 1220.

25. Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology 2007; 133: 1670– 1689.

26. Cooper C, Carbone I, Michet CJ et al. Fracture risk in patients with AS: a population based study. J Rheumatol 1994; 10: 1887– 1882.

27. Vosse D, Landewé R, Heijde D et al. AS and the risk of fracture: results from a large primary care based nested case‑ control study. Ann Rheum Dis 2009; 68: 1839– 1842.

28. Franck H, Meurer T, Hofbauer LC et al. Evaluation of BMD, hormones, biochemical markers of bone metabolism, and OPG serum levels in patients with AS. Rheumatol 2004; 31: 2236– 2241.

29. Arends SA, Spoorenberg A, Bruyn GA et al. The relationship between BMD, vitamin D levels and bone markers in AS patients. Osteoporos Int 2011; 22: 1431– 1439.

30. Weijden MA, Denderen JC, Lems WF et al. Low BMD is related to male gender and decreased functional capacity in early AS. Clin Rheumatol 2011; 30: 497– 503.

31. van der Weijden MA, van der Horst‑ Bruinsma IE, van Denderen JC et al. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int 2012; 23: 1683– 1690.

32. Allali F, Breban M, Porcher R et al. Increase in BMD of patients with AS treated with anti‑TNF. Ann Rheum Dis 2003; 62: 347– 349.

33. Bijlsma J EULAR compendium on rheumatic diseases. London: BMJ Publishing Group; 2009.

34. Peters MJ, Visman I, Nielen MM et al. Ankylosing spondylitis: a risk factor for myocardial infarction? Ann Rheum Dis 2010; 69: 579– 581.

35. McCarey D, Sturrock RD. Comparison of cardiovascular risk in ankylosing spondylitis and rheumatoid arthritis. Clin Exp Rheumatol 2009; 27: (Suppl.): S124– S126.

36. Farkouh ME, Kirshner H, Harrington RA et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomised controlled trial. Lancet 2004; 364: 675– 684.

37. Han C, Robinson jr. DW, Hackett MV et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006; 33: 2167– 2172.

38. Kang JH, Chen YH, Lin HC. Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population‑based study. Ann Rheum Dis 2010; 69: 1165– 1168.

39. Poddubnyy D, Rudwaleit M, Haibel H et al. Effect of non‑steroidal anti‑inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German spondyloarthritis Inception Cohort. Ann Rheum Dis 2012; 71: 1616– 1622.

40. Kroon F, Landewe R, Dougados M et al. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis 2012; 71: 1623– 1629.