The Nonradiographic Axial Spondyloarthritis, the Radiographic Axial Spondyloarthritis, and Ankylosing Spondylitis: The Tangled Skein of Rheumatology
Autor: | Nilesh Sahebrao Patil, Roopa Rawat, Neha Agrawal, Anand N. Malaviya |
---|---|
Rok vydání: | 2017 |
Předmět: |
030203 arthritis & rheumatology
medicine.medical_specialty Ankylosing spondylitis lcsh:Diseases of the musculoskeletal system business.industry Radiography Immunology Sacroiliitis Review Article medicine.disease Rheumatology 03 medical and health sciences 0302 clinical medicine Internal medicine Physical therapy Medicine Effective treatment In patient 030212 general & internal medicine Radiology lcsh:RC925-935 Axial spondyloarthritis Stage (cooking) business |
Zdroj: | International Journal of Rheumatology, Vol 2017 (2017) International Journal of Rheumatology |
ISSN: | 1687-9279 1687-9260 |
Popis: | Since 1984 the diagnosis of ankylosing spondylitis (AS) has been based upon the modified New York (mNY) criteria with mandatory presence of radiographic sacroiliitis, without which the diagnosis is not tenable. However, it may take years or decades for radiographic sacroiliitis to develop delaying the diagnosis for long periods. It did not matter in the past because no effective treatment was available. However, with the availability of a highly effective treatment, namely, tumour necrosis factor-α inhibitors (TNFi), the issue of early diagnosis of AS acquired an urgency. The Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009 was a significant step towards this goal. These criteria described an early stage of the disease where sacroiliitis was demonstrable only on MRI but not on standard radiograph. Therefore, this stage of the disease was labelled “nonradiographic axial SpA” (nr-axSpA). But questions have been raised if, in search of early diagnosis, specificity was compromised. The Federal Drug Administration (FDA, USA) withheld approval for the use of TNFi in patients with nr-axSpA because of issues related to the specificity of these criteria. This review attempts to clarify some of these aspects of the nr-axSpA-AS relationship and also tries to answer the question whether ASAS classifiable radiographic axial spondyloarthritis (r-axSpA) term can be interchangeably used with the term AS. |
Databáze: | OpenAIRE |
Externí odkaz: |