Hip Pelvis.
2024 Dec;36(4):234-249. 10.5371/hp.2024.36.4.234.
Current Concepts and Medical Management for Patients with Radiographic Axial Spondyloarthritis
- Affiliations
-
- 1Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, Korea
- 2Department of Orthopedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 3Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Kyungpook National University College of Medicine, Daegu, Korea
- 4Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 5Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- 6Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- 7Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
- KMID: 2562314
- DOI: http://doi.org/10.5371/hp.2024.36.4.234
Abstract
- Radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease, can cause significant radiographic damage to the axial skeleton. Regarding the pathogenic mechanism, association of r-axSpA with tumor necrosis factor (TNF) and the interleukin-23/17 (IL23/IL17) pathway has been reported. Development of extraarticular manifestations, including uveitis, inflammatory bowel disease, and psoriasis, has been reported in some patients. The pivotal role of human leukocyte antigenB27 in the pathogenesis of r-axSpA remains to be clarified. Symptoms usually start in late adolescence or early adulthood, and disease progression can vary in each patient, with clinical manifestations ranging from mild joint stiffness without radiographic changes to advanced manifestations including complete fusion of the spine, and severe arthritis of the hip, and could include peripheral arthritis and extraarticular manifestations. The modified New York criteria was used previously in diagnosis of r-axSpA. However, early diagnosis of the disease prior to development of bone deformity was required due to development of biological agents. As a result of Assessment of SpondyloArthritis international Society (ASAS), the classification was improved in part for diagnosis of spondyloarthritis prior to development of bone deformity. The diagnosis is based on comprehensive laboratory findings, physical examinations, and radiologic findings. Medical treatment for r-axSpA involves the use of a stepwise strategy, starting with administration of nonsteroidal anti-inflammatory drugs and physiotherapy, and progressing to sulfasalazine or methotrexate and biologics including TNF-α inhibitors or IL-17 inhibitors as needed. Use of Janus kinase inhibitors has been recently reported.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Reconstruction of Anterior Chest Wall Defect Induced by Sterile Costochondritis: A Case Report of Non-radiographic Axial Spondyloarthritis
- MRI Features of Axial Spondyloarthritis and Differential Diagnosis: Focusing on the Spine and Sacroiliac Joint
- Piriformis syndrome as an overlooked cause of pain in a patient with axial spondyloarthritis: a case report
- Association of Uveitis with Radiographic Progression in Patients with Axial Spondyloarthritis: A Propensity Score Matching Analysis
- Simultaneous Presentation of Ocular Sarcoidosis and Early Axial Spondyloarthritis in a Young Woman
