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What is Ankylosing Spondylitis and Axial Spondyloarthritis?

An overview of Ankylosing Spondylitis and Axial Spondyloarthritis, their diagnosis, symptoms, causes, and treatment options.

Ask about this video. Answers come from its transcript only — with the timestamp, so you can check them.

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Key Takeaways

  • AS and AxSpA are closely related conditions differentiated mainly by imaging findings.
  • Early diagnosis and intervention are crucial to managing disease progression effectively.
  • Genetics, especially HLA-B27, play a major role but the exact cause remains under research.
  • Symptoms are diverse and include inflammatory back pain and systemic features like psoriasis and uveitis.
  • Osteoporosis can coexist with AS despite new bone formation, complicating management.

What the video covers

  • Ankylosing Spondylitis (AS) and Axial Spondyloarthritis (AxSpA) are part of a group of conditions called spondyloarthritis, affecting the spine and trunk.
  • AS is a subgroup of AxSpA known as radiographic AxSpA, characterized by visible changes in imaging such as MRI or X-rays, including spinal fusion.
  • Non-radiographic AxSpA shows no visible changes on scans but shares similar symptoms and can progress to radiographic AxSpA.
  • Key affected joints include the sacroiliac joints between the sacrum and pelvic bones, where inflammation and structural changes begin.
  • Diagnosis involves criteria such as age under 45, chronic back pain over three months, imaging evidence, genetic markers like HLA-B27, and other spondyloarthritis features.
  • Symptoms include inflammatory back pain, peripheral arthritis, enthesitis, dactylitis, good response to NSAIDs, family history, psoriasis, inflammatory bowel disease, and uveitis.
  • The HLA-B27 gene plays a significant role in susceptibility, though the exact mechanism is unclear; autoimmune theories like the arthritogenic peptide theory are proposed.
  • AS patients may paradoxically experience both new bone formation and osteoporosis, possibly due to disrupted bone turnover or reduced physical activity.
  • Diagnosis is complex and often missed early; it relies on history, blood tests, imaging, and tools like the SpADE tool to fast-track referrals to rheumatologists.
  • Treatment typically begins conservatively, focusing on symptom management and early intervention to prevent progression.

Chapters

  1. 00:00Introduction to Ankylosing Spondylitis and Axial Spondyloarthritis
  2. 00:46Understanding Radiographic vs Non-Radiographic AxSpA
  3. 02:20Signs and Symptoms of Axial Spondyloarthritis
  4. 04:48Diagnosis Criteria and Role of HLA-B27
  5. 06:03Bone Changes and Disease Mechanisms
  6. 08:17Diagnosis Challenges and Patient Referral
  7. 09:28Treatment Options and Medication Overview
  8. 11:18Inflammation and Immune Response

Answers

Questions about this video

What is the difference between radiographic and non-radiographic axial spondyloarthritis?

Radiographic axial spondyloarthritis shows visible changes on imaging like MRI or X-rays, such as spinal fusion, while non-radiographic axial spondyloarthritis does not show such changes but shares similar symptoms and can progress to the radiographic form.

What are the common symptoms of axial spondyloarthritis?

Common symptoms include chronic inflammatory back pain lasting more than three months, morning stiffness lasting over an hour, arthritis in peripheral joints, enthesitis, dactylitis, good response to NSAIDs, and associated conditions like psoriasis and uveitis.

How is Ankylosing Spondylitis diagnosed?

Diagnosis is based on a combination of patient history, blood tests including HLA-B27, imaging studies showing inflammation or structural changes, and clinical criteria such as age under 45 and chronic back pain, often supported by tools like the SpADE tool.

Full Transcript — Download SRT & Markdown

00:00
Speaker A
[Music] foreign [Music] Spondylitis and axial spondyloarthritis these names can definitely be quite daunting and confusing especially when the conditions are recently getting renamed as researchers find out more about them to date axial spondyloarthritis axspa and Ankylosing Spondylitis as both fall under a group
00:27
Speaker A
of conditions known as spondyloarthritis let's break this down the axial and the spondylo refers to the spine and trunk and kelosing means stiffening or fusing and the itis means inflammation of the joints there are many conditions under spondyloarthritis such as psoriatic
00:46
Speaker A
arthritis or reactive arthritis but we'll focus more on Ax spa and as in this video to clear things up and kelosing Spondylitis as is actually the same as axial spondyloarthritis axspa but only one of the two subgroups of
01:02
Speaker A
axspa as is known as radiographic axspa whereas the other subgroup is known as non-radiographic there is growing acceptance that both subgroups of axspa are one disease and that term alone is a sufficient diagnosis this is because non-radiographic axspa
01:22
Speaker A
can progress into radiographic axspa or as so what does radiographic versus non-radiographic mean well radiographic means there are visible changes in the scans you have done like an MRI or x-ray radiographic axspa IE and kilosing Spondylitis can show your spinal joints
01:44
Speaker A
start to fuse this can have a bamboo-like appearance or maybe even a dagger-like appearance is essentially more bone as being laid down at areas they're not supposed to this tends to be more at later stages so early intervention is key for Effective
02:00
Speaker A
management the joints mainly associated with axspa are the sacroiliac joints which are the joints between your sacrum that triangle bone where your tailbone attaches to and your large pelvic bones this is where Ankylosing Spondylitis normally starts and if there is evidence
02:18
Speaker A
of active inflammation of these sacroiliac joints and or structural changes to the spine-like Bony outgrowths at later stages if untreated it then that would be diagnosed as radiographic ax bar AKA and kilosing Spondylitis on the other hand if there
02:35
Speaker A
are no visible changes to your scans then it would be non-radiographic axspa provided you have fulfilled the other criteria of spondyloarthritis outlined under signs and symptoms what are the signs and symptoms of axial spondyloarthritis there's a lot to look
02:52
Speaker A
out for but there are new classification criteria to help diagnose axspa both as a non-radiographic developed by the assessment of spondyloarthritis ASAS International Society it is highly likely you have as if you satisfy the following criteria under 45 years old
03:12
Speaker A
chronic long-term of at least three months back pain scans show inflammation of the sacroiliac joints and at least one of the following known as spondyloarthritis features inflammatory type back pain I.E morning stiffness longer than one hour gradual onset improvement with exercise or pain
03:35
Speaker A
that doesn't get relieved with rest arthritis in the peripheral joints I.E those not part of the spine such as knees fingers toes and hips emphasitis inflammation at the tendon and ligament attachments to Bone EG most commonly in the heel so heel pain
03:56
Speaker A
dactylitis inflammation of the fingers also known as sausage digits good response to NSAIDs EG ibuprofen and Diclofenac family history of spondyloarthritis EG is psoriatic arthritis Etc inflammatory bowel disease Crohn's disease ulcerative colitis blood tests show the Gene hlab27 and
04:26
Speaker A
elevated CRP an inflammatory marker psoriasis a skin condition characterized by red and crusty patches of skin covered with silvery scales buvaritis inflammation of the eye which includes redness pain and blurred vision however if you didn't have a scan done
04:48
Speaker A
you might have non-radiographic axial spondyloarthritis if you satisfy these criteria under 45 years old chronic long-term of at least three months back pain blood test shows you are hlab 27 positive at least two other spondyloarthritis features see above
05:11
Speaker A
so what causes axial spondyloarthritis there is a huge genetic component in developing axspa remember that includes Ankylosing Spondylitis which is with the gene hlab27 this Gene is present in about eight percent of the UK population and it belongs to a family of molecules
05:32
Speaker A
that play a huge role in making sure your immune system is working properly no one still actually knows how having hlab27 increases the risk of developing is but there are several theories one of the more popular theories is that
05:46
Speaker A
arthritogenic peptide Theory which describes how proteins from your own tissues get mistakenly interpreted as being foreign and so your body starts to attack itself we refer to these types of conditions as an autoimmune disorder the research is still ongoing and the
06:03
Speaker A
uncertainty around this area has reflected on The Limited treatments available to reverse or slow down the progression of symptoms one of the puzzling things about Ankylosing Spondylitis is that in many cases between 19 to 62 percent depending on a
06:18
Speaker A
study patients can also have osteoporosis a condition where your bone density is low consequently this also increases the risk of fractures too the reason why this is so puzzling is because Ankylosing Spondylitis also has the ability to lay down new bone yet
06:36
Speaker A
experience decreased bone density it can be hypothesized that the new bone being laid is not as organized which can explain its fragility your bones are normally very well structured and that is reflected by how strong they are another theory as to why people with
06:53
Speaker A
Ankylosing Spondylitis can have their natural bone turnover disrupted is because this new bone formation is now potentially thought to be unrelated to inflammation normally where there's inflammation as there would be an axial spondyloarthritis remember the itis stands for inflammation bone formation
07:11
Speaker A
is increased but there have been some cases where despite treatment with tnf Alpha Inhibitors this reduces inflammation still had persistent bone formation this suggests that this new bone formation may also be a result from another mechanism in your body that may
07:27
Speaker A
be a new Target for treatment a third potential explanation is to why people with as get osteoporosis is simply because they move less when they're in pain as we know loading the bones in our body is important in supporting bone health
07:42
Speaker A
if people don't move the Natural Health of your bone begins to deteriorate as they say use it or lose it how is Ankylosing Spondylitis diagnosed there is no Sure Fire way to diagnose ankylosing spondylitis like how you would diagnose a broken bone with an
08:01
Speaker A
x-ray or how you would diagnose high blood pressure with a sphygmomanometer however we can use a combination of case history taking blood tests and imaging to make an informed decision quite confidently if anything it is actually often missed particularly at the early
08:17
Speaker A
stages so what do we look for well the signs and symptoms outlined above essentially there have been tools developed to fast-track patients with potential axial spondyloarthritis to see a rheumatologist a doctor that deals with inflammatory autoimmune problems such as
08:35
Speaker A
the Spade tool which is mainly used by first Contact Healthcare practitioners like osteopaths GPS or physiotherapists looking for Clues during the case history physical examination and blood tests are the key to reaching a diagnosis one of the known patterns of
08:52
Speaker A
Ankylosing Spondylitis is that it tends to develop in men more often than women around 2.5 times more likely however do you remember there's another subgroup called non-radiographic axial spondyloarthritis well for those who don't have late stage Imaging changes such as the bamboo spine
09:11
Speaker A
or dagger spine the prevalence of non-axial spondyloarthritis is actually about the same between men and women this can suggest there's a lot of females with non-radiographic axial spondyloarthritis who may not be aware of it how is Ankylosing Spondylitis
09:28
Speaker A
treated the first line of action is either conservative treatment or with gentler anti-inflammatory medication conservative treatment is treatment that relies on nothing else other than your own body to see if it can adapt better with either Physical Therapy better
09:44
Speaker A
education exercise and other related Allied Health professional fields this is essential as it promotes your own body's natural capacity to improve symptoms and therefore minimizing the need for medication with side effects one of the Hallmark signs of having
10:00
Speaker A
inflammatory back pain such as Ankylosing Spondylitis or non-radiographic axial spondyloarthritis is that it responds effectively to non-steroidal anti-inflammatory drugs NSAIDs anti-inflammatory drugs do exactly what it says on the tin they suppress inflammation common NSAIDs include ibuprofen naproxen and diclofenac
10:24
Speaker A
over-the-counter NSAIDs from pharmacies or prescribed NSAIDs from your GP can help take the edge off the discomfort however stronger treatment may be needed if the progress from a combination of conservative treatment and NSAIDs has plateaued stronger treatment involves
10:42
Speaker A
biologic disease modifying anti-rheumatic drugs dmards which aim to inhibit inflammation even more dmard medication can include injections called tnf Alpha Inhibitors or anti-tnf tumor necrosis factor or tnf plays a fundamental role in your immune system and is involved with the inflammatory
11:04
Speaker A
process of Ankylosing Spondylitis with these injections you really have to weigh up the pros and cons as even though it can be very effective in suppressing the symptoms inhibiting inflammation to this extent lowers the strength of your immune system
11:18
Speaker A
dramatically inflammation isn't always bad and is very important in your body to fight against infections [Music] thank you
Topics:Ankylosing SpondylitisAxial SpondyloarthritisSpondyloarthritisRadiographic AxSpANon-radiographic AxSpAHLA-B27Inflammatory Back PainSacroiliac JointAutoimmune DiseaseBone Formation

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