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1
H, Mielants, and Veys E. M, eds. Spondyloarthropathies, involvement of the gut: Proceedings of the First Conference on Spondyloarthropathies, Involvement of the Gut, Ghent, 10-13 September 1986. Amsterdam: Excerpta Medica, 1987.
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2
Sieper, Joachim. Ankylosing spondylitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0113.
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Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2 and 0.8% and is strongly dependent on the prevalence of HLA B27 in a given population. For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axial spondyloarthritis (SpA) have been developed by the Assessement of Spondylo-Arthritis international Society (ASAS) which cover AS but also the earlier form of non-radiographic axial SpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.
3
Siebert, Stefan, Sengupta Raj, and Alexander Tsoukas. What are axial spondyloarthritis and ankylosing spondylitis? Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198755296.003.0001.
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Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. AS has a major negative impact on patients’ quality of life. AS is part of a larger group of related spondyloarthritis (SpA) conditions and patients with AS often have extra-articular manifestations of these conditions. Over the past decade, there have been major advances in the understanding of the genetics and pathophysiology of the disease. Advances in imaging have allowed patients to be diagnosed without having to develop the radiographic structural damage that characterize AS, resulting in the concept of axial spondyloarthritis (axSpA). Together with the development of highly effective TNF inhibitors, these advances have transformed the management and outlook of patients with this condition. It is hoped that further advances in diagnosis, assessment and treatment of axSpA will lead to further progress in future.
4
Wiffen, Philip, Marc Mitchell, Melanie Snelling, and Nicola Stoner. Therapy-related issues: musculoskeletal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198735823.003.0024.
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This chapter outlines information relevant to clinical pharmacists related to musculoskeletal diseases and is loosely based on the British National Formulary, Chapter 10. In particular, this chapter covers rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, osteoarthritis, osteoporosis, and gout.
5
A, Ebringer, and Shipley Michael, eds. Pathogenesis of ankylosing spondylitis and rheumatoid arthritis: Proceedings of the second international symposium held at the Middlesex Hospital, 14-15 April 1987. London: Baillière Tindall, 1988.
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6
Berry, Colin. Bone, joint, and connective tissue disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719410.003.0009.
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This chapter describes the anaesthetic management of the patient with those musculoskeletal disorders which are relevant to anaesthetic practice. Topics covered include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic sclerosis, scoliosis, and achondroplasia. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described.
7
Berry, Colin. Bone, joint, and connective tissue disorders. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0009_update_001.
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This chapter describes the anaesthetic management of the patient with those musculoskeletal disorders which are relevant to anaesthetic practice. Topics covered include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic sclerosis, scoliosis, and achondroplasia. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described.
8
Khan, Muhammad Asim. Clinical features. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0011.
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The leading chronic progressive inflammatory disease of the sacroiliac joints and the spinal column, traditionally known as ankylosing spondylitis (AS), is a relatively common but insidious rheumatic disease that can cause progressive limitation of physical function. It is a prototype of related forms of arthritis, grouped under the term spondyloarthritis that is subdivided into predominantly axial and predominantly peripheral forms. This chapter details the clinical features of axial spondyloarthritis, a term that encompasses ankylosing spondylitis. There is a predilection for the inflammation to affect sites where the tendons and ligaments attach to the bones (entheses) and can result in gradual and progressive spinal ankylosis, with resultant physical deformity. The disease may present with a wide spectrum of clinical features, both articular and extra-articular, and can be difficult to diagnose in early stages.
9
Kulkarni, Kunal, James Harrison, Mohamed Baguneid, and Bernard Prendergast, eds. Rheumatology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198729426.003.0018.
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This chapter focuses on some of the most influential clinical trials in rheumatology, with special focus on rheumatoid arthritis, ankylosing spondylitis, and gout. Today, there are clear criteria established for the clinical manifestations of rheumatic diseases, but there is still a long way to go in terms of establishing a clear understanding of their pathogenesis.
10
Tillett, William, and Neil McHugh. Plain radiography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0016.
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Psoriatic arthritis is a destructive inflammatory arthritis that can affect the peripheral and axial skeleton of patients with psoriasis. Plain radiography has formed an important part in defining psoriatic arthritis as a distinct clinical entity, from early work reporting on distinguishing features to more recent inclusion of osteoproliferation in the CASPAR classification criteria. Plain radiography is accessible, inexpensive and remains the standard measure of assessing damage in inflammatory arthritis. Originally considered a benign disease psoriatic arthritis is now recognised to be destructive and progressive, though not as aggressive as rheumatoid arthritis. Peripheral joint damage is characterised by erosions, joint space narrowing, osteoproliferation, osteolysis and ankylosis. Approximately twenty percent of patients have erosive disease at diagnosis progressing to approximately half of all patients by three years disease duration. In its most severe form, psoriatic arthritis mutilans, digits become shortened from gross bone resorption (osteolyisis) leading to severe functional impairment and disability. Spondyloarthritis may affect between 25-70% of patients with PsA. The radiographic features of Psoriatic Spondyloarthritis differ from Ankylosing Spondylitis, in that sacroiliitis is often asymmetrical and less severe, the cervical spine is frequently involved and syndesmophytes are asymmetrical and para-marginal. Overall radiographic features are less severe than ankylosing spondylitis. The natural history of both peripheral and axial radiographic damage in psoriatic arthritis in the modern era of early diagnosis, tight disease control and biologic drugs has yet to be established.
11
R, Cook Allan, ed. Arthritis sourcebook: Basic information about specific forms of arthritis and related disorders including rheumatoid arthritis, osteoarthritis, gout, polymyalgia rheumatica, psoriatic arthritis, spondyloarthropathies, juvenile rheumatoid arthritis, and juvenile ankylosing spondylitis along with treatment options from over-the-counter and prescription drugs to surgery and alternative measures and coping strategies to ease pain, fatigue, and stress. Detroit, MI: Omnigraphics, 1998.
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12
R, Cook Allan, ed. Arthritis sourcebook: Basic consumer health information about specific forms of arthritis and related disorders including rheumatoid arthritis, osteoarthritis, gout, polymyalgia rheumatica, psoriatic arthritis, spondyloarthropathies, juvenile rheumatoid arthritis, and juvenile ankylosing spondylitis, along with information about medical, surgical, and alternative treatment options, and including strategies for coping with pain, fatigue, and stress. Detroit, MI: Omnigraphics, 1999.
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13
Bawa, Sandeep, Paul Wordsworth, and Inoshi Atukorala. Spondyloarthropathies. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.010004.
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♦ Spondyloarthropathies are related conditions typically associated with axial skeletal involvement, absence of rheumatoid factor, familial clustering, and a variable positive association with HLA-B27♦ Ankylosing spondylitis is the prototype with sacroiliac joint involvement being a prerequisite for diagnosis♦ Diagnosis is frequently delayed for several years but the use of magnetic resonance imaging to detect sacroiliitis greatly facilitates the establishment of an early diagnosis♦ Psoriatic arthritis, reactive arthritis, and enteropathic arthritis have prominent peripheral joint involvement with variable degrees of spinal involvement♦ Non-steroidal anti-inflammatory drugs and physical therapy are the cornerstones of management but slow-acting disease-modifying antirheumatic drugs only have a role in peripheral arthritis♦ Anti-tumour necrosis factor biologic agents have revolutionized the treatment of the spondyloarthropathies.
14
Leirisalo-Repo, Marjatta, and John D. Carter. Infection and spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0009.
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Spondyloarthritis (SpA) is the designation encompassing a group of inflammatory diseases with several features in common. The patients have mono- or oligoarthritis with or without inflammatory back symptoms. Distinctive extra-articular inflammatory symptoms also characterize the diseases. The diagnostic subgroups in the SpA family include reactive arthritis (ReA), ankylosing spondylitis (AS), arthritis associated with inflammatory bowel disease (IBD), psoriasis arthritis (PsA), and some forms of juvenile-onset arthritis. These diseases share a strong association with a genetic marker, HLA-B27, absence of rheumatoid factor, tendency to family aggregation, and frequently occurring extra-articular manifestations. This chapter discusses the role of infections, either as triggering of the disease, most evident in the case of ReA, or as possibly contributing factors in the development of chronic forms of SpA and AS.
15
Brown, Matthew A., and John Reveille. Genetics of spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0005.
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In addition to sharing clinical, histopathological, and immunological features, spondyloarthritis (SpA) encompasses a group of diseases that are genetically linked through shared associations with HLA-B27, as well as other genes of the IL-23R and aminopeptidase groups. Great progress has been made since the development of the genome-wide association study approach, with better dissection of the HLA associations of this group of diseases, as well as the discovery of multiple genetic loci found outside of the major histocompatibility complex, in ankylosing spondylitis (AS) in particular. These genetic data shed light on the related pathogenesis of AS and psoriatic arthritis (PsA), inflammatory bowel disease (IBD)-related arthritis, and reactive arthritis (ReA). Genetic associations also strengthen the suggestive data that Behçet’s disease (BD) and Familial Mediterranean Fever (FMF) are related to the more classical forms of SpA.
16
Hughes, Edward, Miles Stanford, and Dania Qatarneh. Uveitis and medical ophthalmology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199672516.003.0007.
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This chapter focuses on uveitis and medical ophthalmology. It details uveal anatomy, before discussing anterior uveitis, intermediate uveitis, and posterior uveitis. Next, it discusses posterior uveitis and then specific non-infectious posterior uveitides before moving on to infectious uveitis (viral, parasitic, fungal, and bacterial) and HIV-related disease. It continues by examining systemic associations with uveitis, including sarcoidosis, Behcets disease, multiple sclerosis, and the seronegative arthritides ankylosing spondylitis, Reiter syndrome, psoriatic arthritis, and inflammatory bowel disease. In addition, it discusses scleritis and episcleritis, ocular inflammatory disorders (systemic treatment, biological agents and periocular treatments, intraocular treatments), rheumatological disease, vasculitis, cardiovascular disease and the eye, and endocrine, respiratory, and skin diseases in ophthalmology.
17
Brown, James P. R., and M. Joanne Douglas. Musculoskeletal disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0046.
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This chapter describes the major musculoskeletal diseases stating manifestations, associations, and their implications for pregnancy, delivery, and obstetric anaesthesia. It reviews and summarizes the literature, presenting the available evidence for methods of mitigating risks to the parturient. The chapter starts by discussing the pathophysiology, presentation, diagnosis, and management of malignant hyperthermia. The following conditions are then introduced in turn: backache, scoliosis, myopathies (including myotonic dystrophy), Ehlers–Danlos syndrome, rheumatoid arthritis, ankylosing spondylitis, achondroplasia, and osteogenesis imperfecta. The chapter aims to provide a pragmatic resource to allow obstetric anaesthetists to make informed decisions and management plans when faced with caring for a parturient with an uncommon musculoskeletal condition.
18
Gensler, Lianne, Michael Weisman, and Liron Caplan. Epidemiology of axial spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0002.
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Axial spondyloarthritis (axSpA) is an inflammatory arthritis of the sacroiliac joints and spine. The prototype is ankylosing spondylitis, the radiographic form of the disease; however, more recently, an earlier or less-differentiated presentation has been described termed non-radiographic axial spondyloarthritis (nr-axSpA). Extra-articular manifestations commonly include anterior uveitis, inflammatory bowel disease, and psoriasis. There is a strong association with the human leukocyte antigen B27 (HLA-B27) allele, and the prevalence of the disease tends to follow the frequency of the allele. Epidemiological studies in axSpA are relevant in the population studied and therefore have limited external validity. This chapter describes the epidemiology of axSpA.
19
Simon, Lee S., and Marc C. Hochberg. Non-steroidal anti-inflammatory drugs. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0030.
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Non-steroidal anti-inflammatory drugs (NSAIDs) are a chemically diverse group of compounds that share three cardinal characteristics: they are anti-inflammatory, analgesic, and antipyretic. They are approved by regulatory authorities for the treatment of patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gout, and some forms of juvenile idiopathic arthritis. There are at least 20 chemically different NSAIDs currently available in Europe and the United States. These include not only the ‘traditional’ non-selective cyclooxygenase (COX) inhibitors that inhibit both the COX-1 and COX-2 enzymes but also the COX-2 selective inhibitors. This chapter gives a background of NSAIDs, including the mechanism of action, pharmacology and adverse effects (including hypersensitivity and gastrointestinal, cardiovascular thrombotic, and renal adverse effects), before summarizing the use of NSAIDs in patients with osteoarthritis.
20
Brown, Matthew. Genetics of spondyloarthropathies. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0041.
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Spondyloarthropathies are a diverse group of conditions, of which ankylosing spondylitis is the prototypic disease, with shared clinical features, genetic risk factors, and histopathological characteristics. These conditions are highly familial and heritable. Several genes have been associated with spondyloarthropathies, with genes in the IL-23 signalling pathway being shared by the major types of spondyloarthritis. These discoveries have already led to the development and successful clinical introduction of novel treatments for psoriasis and psoriatic arthritis, and major advances in our understanding of the pathogenesis of the conditions. Many more genes remain to be identified which are involved in these common conditions; identifying these genes is likely to be highly informative as to their causes.
21
Brown, Matthew. Genetics of spondyloarthropathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0041_update_003.
Full textAbstract:
Spondyloarthropathies are a diverse group of conditions, of which ankylosing spondylitis is the prototypic disease, with shared clinical features, genetic risk factors, and histopathological characteristics. These conditions are highly familial and heritable. Several genes have been associated with spondyloarthropathies, with genes in the IL-23 signalling pathway being shared by the major types of spondyloarthritis. These discoveries have already led to the development and successful clinical introduction of novel treatments for psoriasis and psoriatic arthritis, and major advances in our understanding of the pathogenesis of the conditions. Many more genes remain to be identified which are involved in these common conditions; identifying these genes is likely to be highly informative as to their causes.
22
Rudwaleit, Martin. Enthesitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0054.
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Enthesitis is one of the key manifestations of spondyloarthritides (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term 'enthesis organ' has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.
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Rudwaleit, Martin. Enthesitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0054_update_002.
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Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.
24
Strand, Vibeke, Jeremy Sokolove, and Alvina D. Chu. Design of clinical trials in rheumatology. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0030.
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Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, 'first-in-human' to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 15 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis, ankylosing spondylitis, gout, and osteoarthritis have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic.
25
Strand, Vibeke, Jeremy Sokolove, and Alvina D. Chu. Design of clinical trials in rheumatology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0030_update_001.
Full textAbstract:
Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, ’first-in-human’ to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 15 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis, ankylosing spondylitis, gout, and osteoarthritis have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic.
26
Strand, Vibeke, Jeremy Sokolove, and Alvina D. Chu. Design of clinical trials in rheumatology. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199642489.003.0030_update_002.
Full textAbstract:
Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, ’first-in-human’ to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 15 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis, ankylosing spondylitis, gout, and osteoarthritis have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic.
27
Lubrano, Ennio. Axial disease. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0013.
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This chapter summarizes the state of the art for axial involvement in psoriatic arthritis (axial PsA). The definition and measurement of axial PsA still remain problematic and this, in turn, could affect the best approach of recognition and treatment of this intriguing subset of the psoriatic disease. Axial PsA has been studied over the last few years looking at the difference in function and radiological findings compared mainly to Ankylosing Spondylitis (AS), trying to differentiate it from a coincidental AS with psoriasis. Moreover, an assessment on a possible Diffuse Idiopathic Skeletal Hyperostosis (DISH) in PsA patients and clinical-radiological differences to axial PsA has been evaluated. The role of potential new imaging techniques, such as MRI, in the assessment of axial PsA has been considered in this chapter. The diagnosis and treatment of axial PsA has been reported by using the data obtained from the literature.
28
Poddubnyy, Denis, and Hildrun Haibel. Treatment: DMARDs. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0021.
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In axial spondyloarthritis (axSpA) there is little evidence to support use of classical synthetic disease-modifying antirheumatic drugs (DMARDs), with the majority of studies performed in advanced ankylosing spondylitis. Sulfasalazine is the best investigated DMARD in axSpA. Its positive clinical effect, if any, seems to be more prominent in the presence of peripheral arthritis, although a certain proportion of patients with axial disease might benefit from sulfasalazine therapy. Available data indicate that there is no evidence that methotrexate might be effective in axial disease, and only marginal evidence exists in support of methotrexate use in case of peripheral involvement. No true disease-modifying properties (e.g. retardation of structural damage progression in the spine) have been demonstrated for DMARDs in axSpA to date. Efficacy of a combination therapy (e.g. methotrexate plus sulfasalazine) as well as benefits of methotrexate (or other DMARDs) in addition to tumour necrosis factor α inhibitors in axSpA remain uncertain.
29
Braun, Juergen, and Irene E. van der Horst-Bruinsma. Treatment: biologics. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0022.
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According to classification criteria, the spectrum of spondyloarthritis (SpA) covers axial SpA (axSpA), which includes non-radiographic axSpA and ankylosing spondylitis, and peripheral SpA, which overlaps with psoriatic arthritis. Management recommendations for many forms of SpA have been recently published. Treatment of patients with axSpA with active disease starts with a sufficient dose of non-steroidal anti-inflammatory drugs (NSAIDs) for at least 4 weeks and preferably longer, in combination with exercise. In case of peripheral SpA, several disease-modifying antirheumatic drugs can be given, but these are not efficacious in axial disease. In case of insufficient response to NSAIDs for axSpA, biologic treatment can be added. The biologics most commonly used are TNF-blocking agents, but some other biologic agents seem to be beneficial in axial diseases as well, such as secukinumab (an IL-17 blocker). However, these new drugs have not yet been approved for axSpA at the time of writing this chapter.
30
Boonen, Annelies. Cost-of-illness and economic evaluations in axial spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0025.
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Consideration of costs and budgets plays an increasingly important role in decisions on access to innovative technologies. When clinicians want to influence such decisions, it is essential to understand the information on the burden of the disease and the evidence on cost-effectiveness of technologies. This chapter provides guidance to understanding the key methodological principles of economic evaluations, and describes available evidence on these issues in axial spondyloarthritis (axSpA). In the prebiologics era, the cost-of-illness for society of ankylosing spondylitis was slightly lower than for rheumatoid arthritis, and substantially lower than chronic low back pain. Cost of sick leave and work disability accounted for up to 75% of total cost-of-illness. Treatment with biologics increased cost-of-illness substantially, but the important gain in quality-adjusted life years resulted in acceptable cost-effectiveness in patients with active disease. There remains a gap in knowledge about the cost-effectiveness of diagnosing and treating axSpA earlier.
31
McGonagle, Dennis, and Iris Eshed. MRI. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0018.
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The features of psoriatic arthritis (PsA) are disparate—from peripheral synovitis to axial inflammation, from bone destruction to bone formation or both, and nail disease. Fat suppression magnetic resonance imaging (MRI) has had a major impact on understanding PsA. MRI suggests a unifying anatomical basis for PsA with the common denominator of disease localization to entheses and adjacent bone and other sites of high biomechanical stress. MRI has also shown that entheseal changes are not uncommon in generalized osteoarthritis and occasionally in normals, making careful clinical correlation essential for imaging interpretation. MRI is useful in predicting the course of axial spondyloarthritis but there are no specific studies in axial PsA; most data comes from ankylosing spondylitis. Additionally MRI has been used for monitoring therapeutic response in PsA where good resolution of enthesitis/osteitis has been reported. Further studies are needed to define the role of MRI in measuring biological remission of PsA.
32
Hla-B27 in the Development of Spondyloarthropathies. R G Landes Co, 1996.
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33
1953-, López-Larrea Carlos, ed. HLA-B27 in the development of spondyloarthropathies. New York: Springer, 1997.
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34
Siebert, Stefan, Raj Sengupta, and Alexander Tsoukas, eds. Axial Spondyloarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198755296.001.0001.
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Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. Over the past decade there have been major advances in many aspects of the disease, including a broadening of the disease description to axial spondyloarthritis (axSpA). While the many advances have transformed the lives of patients with axSpA, they have also increased complexity for non-specialists in this area. This handbook contains a timely update of the key developments and current state of play in axSpA. It is intended primarily for the many healthcare professionals who encounter patients with this condition, in both primary and secondary care settings. It will also be of interest to the wider medical and research community.The handbook is written by rheumatologists with active research programmes and clinical expertise in these conditions. The topics covered include: • the clinical features • extra-articular manifestations and complications • the impact on patients’ lives • the major advances in genetics and pathogenesis • imaging advances • classification criteria and diagnosis (and the important differences between these) • treatment advances (particularly TNF inhibitors and upcoming biologics)
35
Hoyles, Rachel K., and Athol U. Wells. Respiratory system. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0020.
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Pulmonary involvement is common in the connective tissue diseases (CTDs) and is associated with significant morbidity and mortality. Improved management of systemic disease has led to increasing numbers of surviving patients with clinically significant pulmonary disease. Screening for pulmonary complications highlights the frequency of subclinical involvement. In this chapter, the pulmonary manifestations of the more common CTDs are detailed, including rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM), Sjögren's syndrome (SS), and, more briefly, ankylosing spondylitis (AS). A broad spectrum of pulmonary disorders are seen in association with the CTDs or the drugs used to treat the underlying disorder, including interstitial lung disease, pulmonary infections, airways disease, pulmonary nodules, pleural disease, chest wall pathology and pulmonary vascular disease; the discussion is stratified by pulmonary complication. In many cases, two or more pulmonary manifestations of CTD coexist or there are other concurrent diseases such as asthma and lung cancer, resulting in potentially confusing mixed imaging and pulmonary function abnormalities. This chapter presents a comprehensive approach to the investigation, screening, prognostic evaluation, and treatment decisions in pulmonary disease associated with the CTDs.
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Merkesdal, Sonja, and Wilfried Mau. Health economics. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0031.
Full textAbstract:
The economic burden of rheumatic diseases for society, various payers, and last but not least the individual patient has been increasingly recognized. In addition to the well-known impact of back pain and osteoarthritis, the upcoming new and expensive therapies have made this issue especially intriguing in the treatment of rheumatoid arthritis (RA). A mean international estimate of the total annual costs of RA, mainly consisting of direct resource consumption and indirect costs due to productivity losses relating to paid work, comes to about €5600. Other inflammatory rheumatologic diseases (ankylosing spondylitis, psoriatic arthritis, lupus erythematosus) generate similar costs. The implementation of expensive biological drugs in rheumatic care has also led to the pressing need to determine the relation of their costs and clinical outcome (e.g. quality-adjusted life-years, QALYs) in order to compare different treatment strategies in defined patient groups. In RA the health-economic evidence for the cost-effectiveness of biologicals is already quite substantial in terms of treatment of early and advanced RA, as last option treatment of patients refractory to TNF inhibitors. Their cost-effectiveness as first line treatment is less clear. All biologicals have proved their cost-effectiveness in various settings depending on patient selection. It has been clearly demonstrated that adherence to the current guidelines, including monitoring of their effectiveness. leads to cost-effective scenarios. In TNF-refractory RA, abatacept and rituximab have proved to be economically favourable strategies. Economic data on other inflammatory rheumatic entities is relatively sparse. Incomplete long-term and observational data are still the most prominent gaps in health-economic evidence relating to rheumatic disorders.
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Sieper, Joachim. Axial spondyloarthropathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0113_update_003.
Full textAbstract:
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.