Management of Ankylosing Spondylitis by Rheuma Tv 12 Management of Ankylosing Spondylitis 1 / 5 What is the primary imaging recommendation made, according to EULAR, to diagnose the sacroiliac joint in axial spondylarthritis? Conventional radiography MRI Ultrasound CT scan As per EULAR recommends conventional radiography is the primary imaging method used to diagnose sacroiliitis in axial SpA1. Radiography is the gold standard method for the assessment of structural damage in the spine and sacroiliac joints. To learn more refer to Management of Ankylosing Spondylitis:- Recommendations & Practical Tips by Dr. Subramanian. 2 / 5 The following is the strongest predictor of structural changes in Ankylosing spondylitis Inflammatory parameters Genetic factors Receptor protein biomarkers Syndesmophytes Syndesmophytes are the most relevant structural changes in AS, and in the mSASSS. The growth of just one syndesmophyte in two years shows the progression of structural changes in AS. The strongest radiographic progression predictors are syndesmophytes.2 3 / 5 The first-line therapy of early axial spondyloarthropathy is TNF inhibitors Corticosteroids NSAIDs Biological DMARDs As per ACR 2019 guidelines and recommendations for the treatment of spondylarthritis, NSAIDs are the first line of therapy for symptom improvement in active axial spondylarthropathy.3 To learn more refer to Management of Ankylosing Spondylitis:- Recommendations & Practical Tips by Dr. Subramanian. R 4 / 5 The following statements are true except For long-term monitoring of structural damage, particularly new bone formation, in axial SpA, conventional radiography of the SI joints and/or spine may be used. MRI alone is the gold standard method for determining the presence of early axial spondyloarthritis (SpA) Scintigraphy and Ultrasound are not recommended for diagnosis of sacroiliitis as part of axial SpA. Conventional radiography can detect development of Syndesmophytes in axial SpA According to the guidelines of imaging in axial SpA, MRI is not the first recommended imaging method used for diagnosing early axial SpA. MRI of the SI joints is an alternate first imaging approach only in some circumstances, such as those involving young patients and those with brief symptom duration and where radiological changes are not obvious or inconclusive. 5 / 5 NSAIDs has following advantages in treatment of axial spondylarthropathy Symptom control Functional improvement Delay radiographic progression of axial spondyloarthropathy Both a and b NSAIDs are the first-line treatment of axial SpA. In axial SpA patients with NSAIDs treatment, symptoms are controlled and improvement in the function but there was no effect on the radiographic progression of the disease. Zhang JR et.al in their systematic review concluded that even in patients with elevated CRP levels, NSAIDs are incapable of restrict the radiographic progression of Axial SpA.4 References- Mandl P, Navarro-Compán V, Terslev L, Aegerter P, van der Heijde D, D’Agostino MA, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015 Jul;74(7):1327–39. Baraliakos X, Listing J, Rudwaleit M, Haibel H, Brandt J, Sieper J, et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis. 2007 Jul;66(7):910–5. Ward MM, Deodhar A, Gensler LS, Dubreuil M, Yu D, Khan MA, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019 Oct;71(10):1599–613. Zhang JR, Pang DD, Dai SM. Non-steroidal Anti-inflammatory Drugs Are Unlikely to Inhibit Radiographic Progression of Ankylosing Spondylitis: A Systematic Review. Frontiers in Medicine [Internet]. 2019 [cited 2022 Nov 9];6. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2019.00214 Your score is LinkedIn Facebook Twitter VKontakte Share this:TwitterFacebookLinkedInPinterestWhatsAppMorePrint Similar Posts
