Current Concepts and Medical Management for Patients with Radiographic Axial Spondyloarthritis.

Seung-Hoon Baek, Seungbae Oh, Bum-Jin Shim, Jeong Joon Yoo, Jung-Mo Hwang, Tae-Young Kim, Seung-Cheol Shim
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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 antigen-B27 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.

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影像学诊断中轴性脊柱炎的当前观念与医疗管理。
影像学中轴性脊柱炎(r-axSpA)是一种慢性炎症性疾病,可对中轴骨骼造成严重的影像学损伤。关于其致病机制,已有报道r-axSpA与肿瘤坏死因子(TNF)和白细胞介素-23/17 (IL23/ IL17)通路相关。一些患者出现关节外表现,包括葡萄膜炎、炎症性肠病和牛皮癣。人白细胞抗原b27在r-axSpA发病机制中的关键作用尚不清楚。症状通常始于青春期晚期或成年早期,每个患者的病情进展各不相同,临床表现从无影像学改变的轻度关节僵硬到晚期表现,包括脊柱完全融合和严重的髋关节关节炎,并可能包括外周关节炎和关节外表现。修订后的纽约标准以前用于r-axSpA的诊断。然而,由于生物制剂的发展,需要在骨骼畸形发展之前对疾病进行早期诊断。由于国际脊椎关节炎评估协会(ASAS)的结果,该分类得到了改进,部分是为了在骨骼畸形发展之前诊断脊椎关节炎。诊断是基于综合实验室结果、体格检查和放射学结果。r-axSpA的医学治疗包括使用循序渐进的策略,从非甾体抗炎药和物理治疗开始,根据需要进展到磺胺氮嗪或甲氨蝶呤和包括TNF-α抑制剂或IL-17抑制剂的生物制剂。最近报道了Janus激酶抑制剂的使用。
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