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Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
Microsoft power poin t   µo™¢© ≠iµh§ß∂e¬-∑s∂iæi
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Microsoft power poin t µo™¢© ≠iµh§ß∂e¬-∑s∂iæi


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  • 1. Outlines  發炎性背痛(inflammatory back pain, 發炎性背痛之診斷新進展 IBP)  脊椎關節炎(spondyloarthritis, SpA)  Diagnostic clues 魏 正 宗 MD., PhD.  Classification criteria for AS and SpA 中山醫學大學附設醫院過敏免疫風濕科主任 中藥臨床試驗中心主任 醫學研究所副教授 Diagnosis of AS / SpA 下背痛  1960: seronegative arthritis •80% 一生至少痛一次  1970: Seronegative spondyloarthropathy  1984: Modified New York Criteria for AS •50% 在一週內痊癒  1991: ESSG criteria for Spondyloarthritis •90% 在二個月內痊癒  2009: ASAS criteria for axial SpA 下背痛的臨床診斷• Mechanical disorders • Metabolic disorders Strain Osteoporosis Disk herniation Osteomalacia Spinal stenosis/ Osteoarthritis stenosis/ PTH, GH Spondylolithesis • Infection Fracture Vertebral osteomyelitis Transitional segment Disc infection Scoliosis Pyogenic sacroiliitis• Inflammatory disorders Herpes zoster Spondyloarthropathy • Visceral referred pain Myofascial pain/ Fibromyalgia Aneurysm Diffuse idiopathic skeletal GI/ GU/ Gyn conditions hyperostosis • Neoplasm Osteitis condensans ilii Primary or metastatic Polymyalgia rheumatica • Psychogenic 1
  • 2. 指導教授Andrei Calin是僵直性脊椎炎臨床研究的權威,Royal National Hospital for Rheumatic Diseases, Bath, UK. 已出版兩百多篇論文及數本教科書。 Inflammatory back pain is key feature of axial SpA AS SpA IBP Back pain 2
  • 3. 脊椎關節炎Spondyloarthritis Diagnostic clues for SpA1. 僵直性脊椎炎(Ankylosing Spondylitis) 1. 發炎性下背痛:薦腸關節炎(sacroiliitis)2. 反應性關節炎(Reactive arthritis, 過去 及脊椎炎(spondylitis) 。 稱為萊特氏症候群Reiter syndrome) 2. 接骨點炎 (enthesitis) 。3. 乾癬性關節炎(Psoriatic arthritis) 3. 不對稱性的下肢關節炎。4. 發炎性大腸疾病(Enteropathic 4. 與HLA-B27基因有關聯。 arthropathy)5. 未分化型脊椎關節炎 5. 有關節外的表徵:如乾癬、腸炎、尿道 (Undifferentiated spondyloarthritis) 炎、葡萄膜炎。 Finger to floor test Enthesopathy, dactylitis Enthesopathy, Posterior SI compression test Patrick test 3
  • 4. European Spondyloarthropathy Study Group Classification Criteria for Spondyloarthropathy Extra-articular Extra- (ESSG, 1991) manifestations of SpA Inflammatory spinal pain OR Peripheral synovitis (asymmetrical or lower limb) PLUS any one of the following: • alternate buttock pain • psoriasis • sacroiliitis • inflammatory bowel disease • enthesopathy • urethritis or cervicitis or acute diarrhea Psoriasis Uveitis • positive family history Dougadous, 1991International Congress on Spondyloarthropathy Gent, Belgium X ray finding of spondylitis Anterior Squaring of vetebral bodies Corner enthesitis Lt: AS with bamboo spine Rt: Diffuse idiopathic skeletal Syndesmophyte Hyperostosis(DISH) 4
  • 5. Three Problems of the MNY criteria1. Ignore the other features associated with SpA, e.g. SpA, enthesitis, psoriasis and uveitis enthesitis,2. Ignore the role of HLA-B27 in HLA- diagnosis3. Too much reliance on plain X-ray X- changes of sacroiliiac joints HLA-B27, when to test? HLA- When you are not so sure about the diagnosis of SpA. SpA. Genetic counseling薦腸關節炎sacroiliitis薦腸關節炎sacroiliitis Rt side grade 3 sacroiliitis Lt side grade 2 sacroiliitis 5
  • 6. Sacroiliitis Osteiitis condensans ilii A breakthrough in diagnosis 6
  • 7. Chronic low back pain (5% probability of axial SpA) Inflammatory back pain yes (14% probability) no (<2% probability) Presence of other SpA-features: heel pain (enthesitis), dactylitis, uveitis, positive family history, Crohn‘disease, s alternating buttock pain, psoriasis, asymmetrical arthritis, positive response to NSAIDs, No further testing unless SpA is strongly suspected acute phase reactants (elevated ESR/CRP) because of the presence of other features.  SpA features 3 1-2 SpA feature(s) no SpA feature (80-95%) (35-70%)* (14%) X-rays pos neg HLA-27 HLA-27 pos neg pos neg (80-90%) (<10%) (59%) (<2%) MRI Consider other pos neg diagnosis (80-95%) (<15%) Consider other diagnosis AS Axial SpA** Axial SpA**Take home messageDiagnosis of SpA Thank you Clinical manifestations –Articular: axial, peripheral Articular: –Extra-articular Extra- 魏正宗 MD,PhD. MD,PhD. Familyhistory and/or HLA-B27 HLA- Image studies 中山醫學大學附設醫院過敏免疫風濕科 – -ray X Tel: 0975128095 –CT Email: –MRI 7