Ankylosing Spondylitis

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Presentation transcript:

Ankylosing Spondylitis Introduction & Epidemiology Iraj Salehi-Abari MD., Internist Rheumatologist salehiabari@sina.tums.ac.ir

Iraj Salehi-Abari Definition: Ankylosing Spondylitis (AS) is a chronic inflammatory disease of the axial skeleton manifested by inflammatory LBP and progressive stiffness of the spine accompanied by enthesitis and/or arthritis Amir Alam Hosp.

Iraj Salehi-Abari Amir Alam Hosp.

Iraj Salehi-Abari Amir Alam Hosp.

Previous names: Marrie Strumble disease Bechtereve disease Iraj Salehi-Abari Previous names: Marrie Strumble disease Bechtereve disease Amir Alam Hosp.

Name in nowadays: Ankylosing Spondylitis Ankylos: Bony bridging Iraj Salehi-Abari Name in nowadays: Ankylosing Spondylitis Ankylos: Bony bridging Spondylos: Vertebra Amir Alam Hosp.

Names in future: Spondylo-sacroiliitis Rheumatoid Spondylitis Iraj Salehi-Abari Names in future: Spondylo-sacroiliitis Rheumatoid Spondylitis Amir Alam Hosp.

Iraj Salehi-Abari Introduction: AS is the prototype member of the Spondyloarthritis (SpA) family of disorders SpA are characterized by: Spondylitis Sacroiliitis Enthesitis Arthritis HLA-B27 positivity Usually RF negativity Amir Alam Hosp.

Historic names of SpA: Seronegative Rheumatism Spondyloarthropathies Iraj Salehi-Abari Historic names of SpA: Seronegative Rheumatism Spondyloarthropathies SEA syndrome: Spondylitis, Enthesitis, Arthritis BASE syndrome: B27, Arthritis, Sacroiliitis, Enthesitis SpondyloArthritis Amir Alam Hosp.

Iraj Salehi-Abari Amir Alam Hosp.

SpA family members: Ankylosing Spondylitis (AS) Iraj Salehi-Abari SpA family members: Ankylosing Spondylitis (AS) Reactive arthritis (ReA): Reiter’s Synd.) Psoriatic Arthritis (PsA) Enteropathic Arthritis (IBDrA) Juvenile Spodyloarthropathy (JSpA) Undifferentiated SpA (USpA) Amir Alam Hosp.

Sacroiliitis: History: Buttock pain Iraj Salehi-Abari Sacroiliitis: History: Buttock pain Ph. Exam: Positive Sacral push test Pelvic X-Ray: Sclerosis Erosion Narrowing Ankylosis Bilateral: AS Unilateral: other SpA Amir Alam Hosp.

Iraj Salehi-Abari Enthesitis: The Enthesis is the region of attachment of tendons and ligaments to bone Enthesitis: Inflammation of Enthesis Achille tendinitis, Plantar fasciitis, Costochondritis, … Amir Alam Hosp.

SpA-Iraj Salehi-Abari

SpA-Iraj Salehi-Abari

SpA-Iraj Salehi-Abari

Epidemiology-I: Chronic LBP is a common symptom Iraj Salehi-Abari Epidemiology-I: Chronic LBP is a common symptom 5% of chronic LBP is inflammatory Prevalence of Axial SpA: 1% Amir Alam Hosp.

Epidemiology-II: Young adults Peak age of onset: 20-30 years Iraj Salehi-Abari Epidemiology-II: Young adults Peak age of onset: 20-30 years Prevalence of AS: 0.2-1.4% AS in (+)HLA-B27 population: 5-6% Amir Alam Hosp.

Epidemiology-III: M/F ratio: (+)FH of AS  5.6–16 fold increases AS Iraj Salehi-Abari Epidemiology-III: M/F ratio: Many years ago: > 3/1 A few years ago; 3/1 t0 2/1 Nowadays: #1/1 (+)FH of AS  5.6–16 fold increases AS FH and HLA-B27 both positivity: AS rate of 10-30% Amir Alam Hosp.

Epidemiology in Iran*: Iraj Salehi-Abari Epidemiology in Iran*: Mean age at diagnosis: 35+10 years Male; 75%, Female: 25% Definite inflammatory LBP: #65% Probable inflammatory LBP: 25% Positive family history of AS: First-degree relatives: 8.5% Second-degree relatives: 1% HLA-B27 positivity in Iranian AS: 45% *Iraj Salehi-Abari, Early diagnosis of AS, Rheumatol Int. 2012, table 3 Amir Alam Hosp.

Attention please: Rate of AS is increased by: Hx of chronic LBP: X 10 Iraj Salehi-Abari Attention please: Rate of AS is increased by: Hx of chronic LBP: X 10 Positive FH of AS: X 10 Positive HLA-B27: X 10 Amir Alam Hosp.