Ankylosing Spondylitis: Review of Clinical Features, Diagnosis, and Treatment
DOI:
https://doi.org/10.12775/JEHS.2024.51.006Keywords
Ankylosing Spondylitis, Bechterew Disease, Rheumatoid Spondylitis, bamboo spineAbstract
Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory disorder affecting the spine and joints, leading to significant physical impairment. With a prevalence of 0.1-1.4%, AS holds significance in healthcare and socioeconomic contexts, therefore a thorough understanding is crucial for diagnosis and effective management. This article provides a current state of knowledge of the subject for clinicians and patients.
Review methods
English-language scientific literature found in PubMed, Web of Science, Google Scholar and Wiley databases (2015-2023) was used for the review. Articles were searched based on keywords. Each article was analysed for knowledge currency and relevance for use in the review.
Description of the State of Knowledge
After searching the articles, 20 articles were selected for final analysis. The data collected provides the latest information on ankylosing spondylitis.
The etiology of AS has a strong association with the HLA-B27 antigen and research is being conducted on the association with HLA-15, IL-1, IL-23R, ERAP-1 and ERAP-2. Clinical manifestations include a broad spectrum of symptoms involving the musculoskeletal, ocular, respiratory, cardiovascular, gastrointestinal and psychiatric systems. Specific diagnostic guidelines have been published by ASAS and EULAR. Treatment includes NSAID, GCS and biologic drug therapy.
Summary
AS, with its complex etiology and diverse clinical manifestations, presents a diagnostic challenge to clinicians. The variable prognosis and complex treatment in AS requires physicians to continually update their knowledge.
Early diagnosis and treatment initiation can improve the patient's prognosis.
References
Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res. 2018 Sep 21;7:F1000 Faculty Rev-1512. https://doi.org/10.12688/f1000research.14956.1
Mei J, Hu H, Ding H, et al. Investigating the causal relationship between ankylosing spondylitis and osteoporosis in the European population: a bidirectional Mendelian randomization study. Front Immunol. 2023 Jun 8;14:1163258. https://doi.org/10.3389/fimmu.2023.1163258
Hwang MC, Ridley L, Reveille JD. Ankylosing spondylitis risk factors: a systematic literature review. Clin Rheumatol. 2021 Aug;40(8):3079-3093. https://doi.org/10.1007/s10067-021-05679-7
Hanson A, Brown MA. Genetics and the Causes of Ankylosing Spondylitis. Rheum Dis Clin North Am. 2017 Aug;43(3):401-414. https://doi.org/10.1016/j.rdc.2017.04.006
Chen B, Li J, He C, et al. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis (Review). Mol Med Rep. 2017 Apr;15(4):1943-1951. https://doi.org/10.3892/mmr.2017.6248
Wilbrink R, Spoorenberg A, Verstappen GMPJ, et al. B Cell Involvement in the Pathogenesis of Ankylosing Spondylitis. Int J Mol Sci. 2021 Dec 11;22(24):13325. https://doi.org/10.3390/ijms222413325
Watad A, Bridgewood C, Russell T, et al. The Early Phases of Ankylosing Spondylitis: Emerging Insights From Clinical and Basic Science. Front Immunol. 2018 Nov 16;9:2668. https://doi.org/10.3389/fimmu.2018.02668
Karoli Y, Avasthi S, Mahapatra S, et al. Clinical profile of ankylosing spondylitis at a teaching hospital. Ann Afr Med. 2022 Jul-Sep;21(3):204-207. https://doi.org/10.4103/aam.aam_103_20
Poddubnyy D. Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis. Rheumatology (Oxford). 2020 Oct 1;59(Suppl4):iv6-iv17. https://doi.org/10.1093/rheumatology/keaa250
Tan S, Wang R, Ward MM. Syndesmophyte growth in ankylosing spondylitis. Curr Opin Rheumatol. 2015 Jul;27(4):326-32. https://doi.org/10.1097/bor.0000000000000179
Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford). 2018 Aug 1;57(suppl_6):vi29-vi34. https://doi.org/10.1093/rheumatology/key200
Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: An evidence-based consensus statement. Semin Arthritis Rheum. 2016 Feb;45(4):411-27. https://doi.org/10.1016/j.semarthrit.2015.08.003
van der Heijde D, Baraliakos X, Sieper J, et al. Efficacy and safety of upadacitinib for active ankylosing spondylitis refractory to biological therapy: a double-blind, randomised, placebo-controlled phase 3 trial. Ann Rheum Dis. 2022 Nov;81(11):1515-1523. https://doi.org/10.1136/ard-2022-222608
Benucci M, Damiani A, Bandinelli F, et al. Ankylosing Spondylitis Treatment after First Anti-TNF Drug Failure. Isr Med Assoc J. 2018 Feb;20(2):119-122.
Braun J, Baraliakos X, Deodhar A, et al. Secukinumab shows sustained efficacy and low structural progression in ankylosing spondylitis: 4-year results from the MEASURE 1 study. Rheumatology (Oxford). 2019 May 1;58(5):859-868. https://doi.org/10.1093/rheumatology/key375
Lee YH. Comparative Efficacy and Safety of Janus Kinase Inhibitors and Secukinumab in Patients with Active Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Pharmacology. 2022;107(11-12):537-544. https://doi.org/10.1159/000525627
Xi Y, Jiang T, Chaurasiya B, et al. Advances in nanomedicine for the treatment of ankylosing spondylitis. Int J Nanomedicine. 2019 Oct 29;14:8521-8542. https://doi.org/10.2147/ijn.s216199
Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update; Annals of the Rheumatic Diseases 2023;82:19-34.
Chen Z, Zheng X, Wu X, et al. Adalimumab Therapy Restores the Gut Microbiota in Patients With Ankylosing Spondylitis. Front Immunol. 2021 Sep 1;12:700570. doi: 10.3389/fimmu.2021.700570.
Mahendradas P, Jain VK, Thomas S, et al. Role of secukinumab in ankylosing spondylitis with tubercular uveitis. Indian J Ophthalmol. 2020 Nov;68(11):2569-2572. doi: 10.4103/ijo.IJO_1081_20.
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Copyright (c) 2024 Szymon Markowiak, Marta Wardęszkiewicz, Wiktoria Jabłońska, Amelia Kasprzak, Maciej Świercz, Monika Truchta, Aleksandra Mańkowska, Agata Kolano, Anna Pejas
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