Spondyloarthropathy--AS: Difference between revisions
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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | <div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | ||
'''Original Editors '''- Adam Bockey [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | '''Original Editors '''- Adam Bockey [[Pathophysiology of Complex Patient Problems|from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
</div> | </div> | ||
Definition/Description | Definition/Description | ||
'''Spondyloarthropathy''' represents a group of noninfectious, inflammatory, rheumatic diseases that primarily includes ankylosing spondylitis, Reiter’s syndrome, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the sacroiliac joints, the bony insertions of the annulus fibrosi of the intervertebral discs, and the apophyseal joints of the spine.<ref name="Differential Diagnosis">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, MO: Saunders Elsevier: 2007. 539</ref> <br>'''Ankylosing Spondylitis (AS)''' also known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.<ref name="Pathology">Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.</ref> AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.<ref name="Spondylitis">http://www.spondylitis.org/about/as.aspx</ref> <br> | '''Spondyloarthropathy''' represents a group of noninfectious, inflammatory, rheumatic diseases that primarily includes ankylosing spondylitis, Reiter’s syndrome, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the sacroiliac joints, the bony insertions of the annulus fibrosi of the intervertebral discs, and the apophyseal joints of the spine.<ref name="Differential Diagnosis">Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, MO: Saunders Elsevier: 2007. 539</ref> <br>'''Ankylosing Spondylitis (AS)''' also known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.<ref name="Pathology">Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.</ref> AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.<ref name="Spondylitis">http://www.spondylitis.org/about/as.aspx</ref> <br> | ||
Prevalence | Prevalence | ||
Ankylosing Spondylitis is 3 times more common in men than in women and most often begins between the ages of 20-40.<ref name="The Merck Manual">Beers MH, et. al. eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.</ref> Recent studies have shown that AS may be just as prevalent in women, but diagnosed less often because of a milder disease course with fewer spinal problems and more involvement of joints such as the knees and ankles. Prevalance of AS is nearly 2 million people or 0.1% to 0.2% of the general population in the United States. It occurs more often in Caucasions and some Native American than in African Americans, Asians, or other nonwhite groups.<ref name="Differential Diagnosis" /> AS is 10 to 20 times more common with first degree relatives of AS patients than in the general population. The risk of AS in first degree relatives with the HLA-B27 allele is about 20% occurrence.<ref name="The Merck Manual" /> | |||
The initial presenting complaints of AS is non-traumatic, insidious onset of low back, buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.<ref name="Differential Diagnosis" /> It is usually worse in the morning lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.<ref name="Pathology" /> Paravertebral muscle spasm, aching, and stiffness are common making sacrioliac areas and spinous process very tender upon palpation.<ref name="Differntial Diagnosis" /> A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.<ref name="The Merck Manual" /> Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.<ref name="Pathology" /> A positive Schober test is used to confirm reduction in spinal motion which is associated with AS. Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.<ref name="Differential Diagnosis" /> In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.<ref name="Pathology" /> | Characteristics/Clinical Presentation | ||
The initial presenting complaints of AS is non-traumatic, insidious onset of low back, buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.<ref name="Differential Diagnosis" /> It is usually worse in the morning lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.<ref name="Pathology" /> Paravertebral muscle spasm, aching, and stiffness are common making sacrioliac areas and spinous process very tender upon palpation.<ref name="Differntial Diagnosis" /> A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.<ref name="The Merck Manual" /> Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.<ref name="Pathology" /> A positive Schober test is used to confirm reduction in spinal motion which is associated with AS. Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.<ref name="Differential Diagnosis" /> In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.<ref name="Pathology" /> | |||
== Associated Co-morbidities == | == Associated Co-morbidities == | ||
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Uveitis, conjunctivitis, or iritis occurs in nearly 25% of the people with AS.<ref name="Differential Diagnosis" /> Signs of iritis or uveitis are: eye(s) becoming painful, watery, red, and sometimes blurred vision or sensitivity to bright light.<ref name="spondylitis" /> Pulmonary changes such as chronic infiltrative or fibrotic bullous changes of the upper lobe occur in 1% to 3% of the people with AS.<ref name="Differntial Diagnosis" /> Cardiomegaly, conduction defects, and pericarditis are all common complications of AS.<ref name="The Merck Manual" /> Also many people with AS experience bowel inflammation, which can be associated with Crohn’s Disease or ulcerative colitis.<ref name="spondylitis" /> <br> | Uveitis, conjunctivitis, or iritis occurs in nearly 25% of the people with AS.<ref name="Differential Diagnosis" /> Signs of iritis or uveitis are: eye(s) becoming painful, watery, red, and sometimes blurred vision or sensitivity to bright light.<ref name="spondylitis" /> Pulmonary changes such as chronic infiltrative or fibrotic bullous changes of the upper lobe occur in 1% to 3% of the people with AS.<ref name="Differntial Diagnosis" /> Cardiomegaly, conduction defects, and pericarditis are all common complications of AS.<ref name="The Merck Manual" /> Also many people with AS experience bowel inflammation, which can be associated with Crohn’s Disease or ulcerative colitis.<ref name="spondylitis" /> <br> | ||
Medications | Medications | ||
NSAIDs (nonsteroidal anti-inflammatory drugs) reduce pain and suppress joint inflammation and muscle spasm, in return increasing range of motion.<ref name="The Merck Manual" /> NSAIDs can cause significant side effects, in particular, damage to the gastrointestinal tract.<ref name="spondyilsis" /> In some cases disease modifying anti-rheumatic drugs (DMARDS) such as methotrexate (MTX) or sulfasalazine (SSZ) may be used for peripheral disease.<ref name="Pathology" /> Corticosteroid injections into the sacroiliac joints may help severe sacroiliitis. Topical corticosteroids can also be used for acute uveitis or iritis.<ref name="The Merck Manual" /> The most recent medication for AS are the biologics or TNF Blockers. These agents have been shown effective in preventing the progression of AS by reducing disease activity, decreasing inflammation, and improving spinal mobility.<ref name="Pathology" /><br>Examples of TNF blockers include: <ref name="5">Mayo clinic AS</ref><br> Adalimumab (Humira)<br> Etanercept (Enbrel)<br> Infliximab (Remicade)<br> Golimumab (Simponi)<br> | NSAIDs (nonsteroidal anti-inflammatory drugs) reduce pain and suppress joint inflammation and muscle spasm, in return increasing range of motion.<ref name="The Merck Manual" /> NSAIDs can cause significant side effects, in particular, damage to the gastrointestinal tract.<ref name="spondyilsis" /> In some cases disease modifying anti-rheumatic drugs (DMARDS) such as methotrexate (MTX) or sulfasalazine (SSZ) may be used for peripheral disease.<ref name="Pathology" /> Corticosteroid injections into the sacroiliac joints may help severe sacroiliitis. Topical corticosteroids can also be used for acute uveitis or iritis.<ref name="The Merck Manual" /> The most recent medication for AS are the biologics or TNF Blockers. These agents have been shown effective in preventing the progression of AS by reducing disease activity, decreasing inflammation, and improving spinal mobility.<ref name="Pathology" /><br>Examples of TNF blockers include: <ref name="5">Mayo clinic AS</ref><br> Adalimumab (Humira)<br> Etanercept (Enbrel)<br> Infliximab (Remicade)<br> Golimumab (Simponi)<br> | ||
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== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
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== Etiology/Causes == | == Etiology/Causes == | ||
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== Systemic Involvement == | == Systemic Involvement == | ||
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== Case Reports/ Case Studies == | == Case Reports/ Case Studies == | ||
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== Resources <br> | == Resources <br> == | ||
add appropriate resources here | add appropriate resources here | ||
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see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] | see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] | ||
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== References == | == References == | ||
see [[Adding References|adding references tutorial]]. | see [[Adding References|adding references tutorial]]. | ||
<references /> | <references /> | ||
[[Category:Bellarmine_Student_Project]] | [[Category:Bellarmine_Student_Project]] | ||
Revision as of 03:14, 17 March 2011
Original Editors - Adam Bockey from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description
Spondyloarthropathy represents a group of noninfectious, inflammatory, rheumatic diseases that primarily includes ankylosing spondylitis, Reiter’s syndrome, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the sacroiliac joints, the bony insertions of the annulus fibrosi of the intervertebral discs, and the apophyseal joints of the spine.[1]
Ankylosing Spondylitis (AS) also known as Marie- Strumpell disease or bamboo spine, is an inflammatory arthropathy of the axial skeleton, usually involving the sacroiliac joints, apophyseal joints, costovertebral joints, and intervertebral disc articulations.[2] AS is a chronic progressing inflammatory disease that causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In advanced stages, the inflammation can lead to new bone formation of the spine, causing the spine to fuse in a fixed position often creating a forward stooped posture.[3]
Prevalence
Ankylosing Spondylitis is 3 times more common in men than in women and most often begins between the ages of 20-40.[4] Recent studies have shown that AS may be just as prevalent in women, but diagnosed less often because of a milder disease course with fewer spinal problems and more involvement of joints such as the knees and ankles. Prevalance of AS is nearly 2 million people or 0.1% to 0.2% of the general population in the United States. It occurs more often in Caucasions and some Native American than in African Americans, Asians, or other nonwhite groups.[1] AS is 10 to 20 times more common with first degree relatives of AS patients than in the general population. The risk of AS in first degree relatives with the HLA-B27 allele is about 20% occurrence.[4]
Characteristics/Clinical Presentation
The initial presenting complaints of AS is non-traumatic, insidious onset of low back, buttock, or hip pain and stiffness for more than 3 months in a person, usually male under 40 years of age.[1] It is usually worse in the morning lasting more than 1 hour and is described as a dull ache that is poorly localized, but it can be intermittently sharp or jolting. Overtime pain can become severe and constant and coughing, sneezing, and twisting motions may worsen the pain. Pain may radiate to the thighs, but does not typically go below the knee. Buttock pain is often unilateral, but may alternate from side to side.[2] Paravertebral muscle spasm, aching, and stiffness are common making sacrioliac areas and spinous process very tender upon palpation.[5] A flexed posture eases the back pain and paraspinal muscle spasm; therefore, kyphosis is common in untreated patients.[4] Enthesitis (inflammation of tendons, ligaments, and capsular attachments to bone) may cause pain or stiffness and restriction of mobility in the axial skeleton.[2] A positive Schober test is used to confirm reduction in spinal motion which is associated with AS. Since AS is a systemic disease an intermittent low grade fever, fatigue, or weight loss can occur.[1] In advanced stages the spine can become fused and a loss of normal lordosis with accompanying increased kyphosis of the thoracic spine, painful limitations of cervical joint motion, and loss of spine flexibility in all planes of motion. A decrease in chest wall excursion less than 2 cm could be an indicator of AS because chest wall excursion is an indicator of decreased axial skeleton mobility.[2]
Associated Co-morbidities[edit | edit source]
Uveitis, conjunctivitis, or iritis occurs in nearly 25% of the people with AS.[1] Signs of iritis or uveitis are: eye(s) becoming painful, watery, red, and sometimes blurred vision or sensitivity to bright light.[6] Pulmonary changes such as chronic infiltrative or fibrotic bullous changes of the upper lobe occur in 1% to 3% of the people with AS.[5] Cardiomegaly, conduction defects, and pericarditis are all common complications of AS.[4] Also many people with AS experience bowel inflammation, which can be associated with Crohn’s Disease or ulcerative colitis.[6]
Medications
NSAIDs (nonsteroidal anti-inflammatory drugs) reduce pain and suppress joint inflammation and muscle spasm, in return increasing range of motion.[4] NSAIDs can cause significant side effects, in particular, damage to the gastrointestinal tract.[7] In some cases disease modifying anti-rheumatic drugs (DMARDS) such as methotrexate (MTX) or sulfasalazine (SSZ) may be used for peripheral disease.[2] Corticosteroid injections into the sacroiliac joints may help severe sacroiliitis. Topical corticosteroids can also be used for acute uveitis or iritis.[4] The most recent medication for AS are the biologics or TNF Blockers. These agents have been shown effective in preventing the progression of AS by reducing disease activity, decreasing inflammation, and improving spinal mobility.[2]
Examples of TNF blockers include: Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Adalimumab (Humira)
Etanercept (Enbrel)
Infliximab (Remicade)
Golimumab (Simponi)
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
add text here
Etiology/Causes[edit | edit source]
add text here
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
add text here
Physical Therapy Management (current best evidence)[edit | edit source]
add text here
Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
add text here
Case Reports/ Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 1.4 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, MO: Saunders Elsevier: 2007. 539
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.
- ↑ http://www.spondylitis.org/about/as.aspx
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Beers MH, et. al. eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.
- ↑ 5.0 5.1 Cite error: Invalid
<ref>tag; no text was provided for refs namedDifferntial Diagnosis - ↑ 6.0 6.1 Cite error: Invalid
<ref>tag; no text was provided for refs namedspondylitis - ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedspondyilsis
