Outlines                                                                 發炎性背痛(inflammatory           back pain,       發炎...
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.                                  ...
脊椎關節炎Spondyloarthritis                          Diagnostic clues for SpA1.   僵直性脊椎炎(Ankylosing Spondylitis)             1....
European Spondyloarthropathy Study Group                                                        Classification Criteria fo...
Three Problems of the MNY criteria1.   Ignore the other features     associated with SpA, e.g.                      SpA,  ...
Sacroiliitis   Osteiitis condensans ilii                                           A breakthrough in diagnosis            ...
Chronic low back pain (5% probability of axial SpA)                                                                       ...
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Microsoft power poin t µo™¢© ≠iµh§ß∂e¬-∑s∂iæi

  1. 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. 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. 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. 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. 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. 6. Sacroiliitis Osteiitis condensans ilii A breakthrough in diagnosis 6
  7. 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: wei3228@gmail.com –MRI 7

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