By Stefan Siebert, Raj Sengupta, Alexander Tsoukas
Axial spondyloarthritis is the most typical inflammatory arthritis affecting the backbone. more often than not first proposing to quite a few basic and secondary care pros, the excessive worldwide sickness burden of this situation has created a necessity for elevated expertise of this situation throughout a number rheumatology specialties.
A pocketbook aimed toward the non-specialist reader Axial Spondyloarthritis is the fundamental consultant to this universal situation. targeting the sensible implications of advancements in category, prognosis and remedy, this simply available textual content absolutely covers the wider spectrum of the disease.
Concise and entirely illustrated, this addition to the Oxford Rheumatology Library covers the heritage and pathophysiology of axial spondylitis, along special sections on remedies, problems and manifestations of the . With each one part supported by way of a convenient key issues part, Axial Spondyloarthritis is an invaluable and positive source for any practitioner or trainee encountering this condition.
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Additional resources for Axial spondyloarthritis
181. Wang R, Gabriel SE, Ward MM. Progression of patients with non-radiographic axial spondyloarthritis to ankylosing spondylitis: a population-based cohort study. 39542. Chapter 4 The genetics of axial spondyloarthritis Key points • Family and twin studies have long suggested a large genetic component in ankylosing spondylitis (AS). • The genetic association with HLA-B27 remains one of the strongest single gene variant associations reported in any complex polygenic disease. • The exact mechanism by which HLA-B27 contributes to AS remains unknown, with three main theories proposed: the arthritogenic peptide, endoplasmic reticulum stress with unfolded protein response, and homodimerization theories.
The mechanisms that determine which of these processes dominate at a particular site are not understood, but are likely to relate to local conditions and cytokine levels. Dysregulation of the IL-23/IL-17 axis in patients with AS has been reported in an increasing number of studies, further supporting the importance of this pathway in AS. A full review of these studies is beyond the scope of this publication, so only key factors are covered here. Patients with active AS and psoriatic arthritis have increased levels of IL-17 and IL-23 in serum and synovial fluid.
On occasion, further imaging may be required to detect enthesitis or subtle joint inflammation in order to inform treatment decisions. In addition to the axial diseases that characterizes axial spondyloarthritis (axSpA), many patients also develop peripheral musculoskeletal involvement. This can include peripheral joint synovitis, enthesitis, and dactylitis. Peripheral arthritis Patients with axSpA may develop an asymmetric, oligoarticular inflammatory arthritis. g. family history, inflammatory bowel disease), should be specifically asked about axial symptoms suggestive of inflammatory back pain (see Chapter 6).