Diagnosis And Treatment In Rheumatology


Author(s): Małgorzata Wisłowska

Pp: 27-49 (23)

DOI: 10.2174/9781681086552118010005

* (Excluding Mailing and Handling)


Spondyloarthropathies (SpA) are a group of chronic inflammatory arthropathies affecting the spine, sacroiliac joints, entheses and extra-articular sites. Clinical characteristics of spondyloarthritis are: peripheral arthritis, mainly in the lower limbs, asymmetrical, tendency for radiographic sacroilitis, no rheumatoid factor and presence of subcutaneous nodules. Significant familiar occurrence and association with HLA-B27 are characteristics for SpA. Diseases belonging to the group of spondyloarthritis are: ankylosing spondylitis, reactive arthritis (ReA), enteropathic arthritis (Crohn’s disease, ulcerative colitis), psoriatic arthritis (PsA), undifferentiated spondyloarthritis and juvenile chronic arthritis (juvenile onset ankylosing spondylitis). SpA occurs due to genetic predisposition especially in patients with positive test for major histocompatibility complex (MHC) class I molecule HLA-B27. Environmental factors are also involved in the pathogenesis. Extra-articular features include skin lesions in PsA, gut involvement in inflammatory bowel disease-related arthritis and the oculo-urethrosynovial triangle in ReA. NSAIDs and anti TNFα drugs are effective in the treatment of axial manifestations of AS. Acute episodes of ReA are treated using NSAIDs and is used as the first line treatment. In more severe cases including NSAIDs resistance, systemic or prolonged disease, systemic GCS may be used. Management of peripheral arthritis in PsA: NSAIDs, GCS, DMARDS: MTX, or Sulfasalazine or Ciclosporin or Leflunomide, anti –TNFα, new options for treatment includes inhibitor IL-17 (ixekizumab or secukinumab), ustekinumab – a fully human IgG 1k monoclonal antibody that binds to the common p40 subunit shared by interleukins 12 and 23, and apremilast – a phosphodiesterase inhibitor.

Keywords: Ankylosing spondylitis (AS), Anterior uveitis, antiTNFα drugs, Apremilast, Asymmetrical, Crohn’s disease, Entheses, HLA-B27, Ixekizumab, Lower limb, NSAIDs, Oculo-urethrosynovial triangle, Peripheral arthritis, Psoriatic arthritis (PsA), Reactive arthritis (ReA), Sacroiliac joints, Secukinumab, Spine, Spondyloarthropathies (SpA), Ulcerative colitis, Undifferentiated spondyloarthritis, Ustekinumab.

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