Early diagnostics of ankylosing spondylitis

Czech version

Authors: K. Pavelka
Authors‘ workplace: Revmatologický ústav, Praha, ředitel prof. MUDr. Karel Pavelka, DrSc.
Published in: Vnitř Lék 2006; 52(7-8): 726-729
Category: 130th Internal Medicine Day - Rheumatology in clinical practice

Overview

The present study surveys the problems of diagnostics of early ankylosing spondylitis (AS) and axial spondylarthritis (SpA). Epidemiologic studies repeatedly identified seven- to nine-year delay of diagnosis of AS from its development to its first manifestations. Delayed diagnostics is caused both by unfamiliarity of rheumatologists with the disease and the inappropriateness of New York classification criteria for early stages of AS. In this study, we suggest diagnostic algorithms allowing high probability diagnosis of AS/axial in X-ray silent stage (the so-called pre X-ray stage). Spondylarthritis represents approximately 5 % of a total number of chronic low back pain (CLBP) cases. The probability grows up to 15% with the presence of inflammatory character of back pain. The presence of HLA B 27 increases the probability to 59 % and the occurrence of other 1 or 2 clinical signs raises the probability up to 90 %. Probability reaches 95% with positive MRI. The overall concept requires verification of new samples in a prospective study. After certification of such study, it will be possible to use biological medications for much more efficient therapy of patients in early AS stages.

Key words:
ankylosing spondylitis – spondylarthritis – biological therapy

Sources

1. Braun J, Bollow M, Remlinger G et al. Prevalence of spondylarthropathies in HLA B 27 positive and negative blood donors. Arthritis Rheum 1998; 41: 58-67.

2. Saraux A, Gaudes G, Allain J et al. Prevalence of rheumatoid arthritis and spondylarthropathy in Britany, France. J Rheumatol 1999; 26: 2622-2627.

3. Hánová P, Pavelka K, Dostál C et al. Epidemiology of rheumatoid arthritis, and gout in two regions of the Czech Republic in population-based survey in 2002-2003. V tisku{JEŠTĚ NEBYLO PUBLIKOVÁNO? POKUD NE, NUTNO DOPLNIT PERIODIKUM, KTERÉ PŘIJALO K OTIŠTĚNÍ}.

4. Sieper J, Braun J, Rudwalent M et al. Ankylosing spondylitis an overview. Ann Rheum Dis 2002; 61(Suppl 3): ii 8-ii18.

5. Pavelka K, Štolfa J, Forejtová Š et al. Which factors influence quality of life of patients with ankylosing spondylitis. Abstract, Bled 2006{LZE, PROSÍM, CITAČNĚ UPŘESNIT – NÁZEV KONFERENCE A DATUM KONÁNÍ}.

6. Rudwailet M, Khan MA, Sieper J The challenge of diagnosis and classification in early ankylosing spondylitis. Do we need new criteria? Arthritis Rheum 2005; 52: 1000-1008.

7. Kellgren JH, Jeffrey MR, Ball J. The epidemiology of chronic rheumatism. Oxford: Blackwell Scientific Publications 1963: vol. 1, 326-327.

8. Gofton JP, Lawrence JS, Bennett PH et al. Sacroiliitis in eight populations. Ann Rheum Dis 1966; 25: 528-533.

9. Bennett PH, Wood PH.Population studies of the rheumatic diseases. Amsterdam: Excerpta Medica Foundation 1968: 456-457.

10. Van der Linden SM, Valkenburg HA, Cats A. Evaluation of the diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-368.

11. 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: 11069-11074.

12. Oostveen J, Prevo R, den Boer J et al. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography: a prospective, longitudinal study. J Rheumatol 1999; 26: 1953-1958.

13. Braun J, Bollow M, Eggens U et al. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 1994; 37: 1039-1045.

14. Rudwaleit M, van der Heide D, Khan MA et al. How to diagnose axial spondylarthropathies early. Ann Rheum Dis 2004; 63: 535-543.

15. Underwood MR, Dawes P Inflammatory back pain in primary care. Br J Rheumatol 1995; 34: 1074-1077.

16. Zochling J, van der Heijde D, Burgos-Vargas R et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006; 65(4): 442-52.

17. Brandt J, Khariouzov A, Listing J et al. Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. Arthritis Rheum 2003; 48: 1667-1675.

18. Rudwaleit M, Listing J, Brandt J et al. Prediction of a major clinical response (BA