Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group ASAS/EULAR Recommendations AS (refers)

http://ard.bmj.com/content/70/6/896.long

ASAS / EULAR 2010
Recommendations
2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis



This is an excellent bullet point paper. Posting here in case people might miss on the spondylitis research forum. (It is on the research forum, but have to dig it out...!)

http://www.clinexprheumatol.org/article.asp?a=1487

Imaging and scoring in ankylosing spondylitis

Summary
– In addition to clinics, sacroiliac xrays remain the basis for a diagnosis of
AS.
– MRI, using contrast material and fat
saturation techniques such as STIR, is
useful for the diagnosis of sacroiliitis in
early stages of disease.
– Spinal x-rays are the basis for the
detection of AS-specific bony changes
in the spine such as syndesmophytes
and ankylosis. Spinal x-rays are of very
limited value in clinical studies because
proposed scoring systems lack sensitivity to change. However, rapid change
does occur in a subgroup of patients
which are often diagnosed and recognized late.
– MRI, using contrast material and fat
saturation techniques such as STIR, is
useful for the detection of acute spinal
inflammation in AS.

http://www.patient.co.uk/doctor/ankylosing-spondylitis

Ankylosing spondylitis (AS) is a chronic seronegative spondyloarthropathy which primarily involves the axial skeleton (ie sacroiliitis and spondylitis). The aetiology is unknown but involves the interaction of genetic and environmental factors. The diagnosis is made by combining clinical criteria of inflammatory back pain and enthesitis (inflammation at the site of bone insertion of ligaments and tendons) or arthritis with radiological findings.[1]



Useful, general 'overview' paper on AS. Should have mentioned MRI in theopening paragraph and given more emphasis to MRI in the Imaging section - but, is UK provenance abd NHS is not overly keen on pushing MRI...MRI=EXPENSE ! But taking drawbacks into account is a reasonably useful paper.

Ankylosing Spondylitis
www.rheumatology.org.il/Ankylosing%20spondylitis.pps
Ankylosing spondylitis can impose significant physical limitations on the patient ... Delay in diagnosis; Recent survey of 1614 patients with AS illustrate the protracted delay between onset and Diagnosis ... Relative sensitivity of detecting active Sacroilliitis : MRI. Plain Radiography ... ASAS/EULAR recommendations for.



This is a slide show - can recommend. As it says under the imaging section :-

Relative sensitivity of detecting active sacroilliitis -
MRI
Plain Radiology
Scintagraphy
MRI............... 95%
Plain Rads.......19%
Scintagraphy....48%

Plain rads X-Rays, are not going to hack it, not, until and unless damage has occured. Need to see the inflammation which X-Rs cannot do. So, any doctor who insists on X-Rays please direct them to ASAS-EULAR.

Now, here's a bunch more papers relative to the above links - all much the same story - MRI; use and 'not' of NSAIDs; inflammatory markers - and all the rest of course. WIll answer so very many questions.

Moderastors, John Dragonslayer: could we have some of these basic papers posted up in the KA Links section. They are so crucial to the basic understanding of AS. Just a suggestion...

Diagnosis and management of ankylosing spondylitis
www.ncbi.nlm.nih.gov/pmc/articles/PMC1570004/ - Similar to Diagnosis and management of ankylosing spondylitis
16 Sep 2006 ... Ankylosing spondylitis is a chronic inflammatory rheumatic disorder ... criteria ( including magnetic resonance imaging) has been proposed to ..... ASAS/EULAR recommendations for the management of ankylosing spondylitis.

Ankylosing Spondylitis - Morphopedics
morphopedics.wikidot.com/ankylosing-spondylitis
http://morphopedics.wikidot.com/ankylosing-spondylitis
Ankylosing Spondylitis (AS) is one of the spondyloarthopathies which affects ... MRI is different than other diagnostic testing tools because it has the ability to view the ... ASAS and The European League Against Rheumatism (EULAR) have ... (snip...) "Magnetic Resonance Imaging (MRI) is also used in assessing AS. MRI is used to dectect inflammation of the axial skeleton as well as spinal changes better than X-rays. MRI is different than other diagnostic testing tools because it has the ability to view the inflammation that may occur in the thoracic spine. The main disadvantages to the use of the MRI is cost and availability.3")
[PDF]

Read references - EULAR
www.eular.org/myUploadData/files/chapter%2044%20-%20module%208.pdf
rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. ... 7 Østergaard, M Edmonds, J & McQueen, F. The EULAR-OMERACT rheumatoid arthritis MRI.
[PDF]

NEW CLASSIFICATION CRITERIA FOR RHEUMATOID ARTHRIT...
www.apiindia.org/pdf/medicine_update_2012/rheumatology_04.pdf
and ankylosing spondylitis (AS) revolves around early diagnosis and tight disease control. There is .... in the ACR and EULAR journals.17,18 The major aim was to permit early .... tendency of physicians to order MRI of the lumbosacral spine.

Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy
http://emedicine.medscape.com/article/332945-overview
emedicine.medscape.com/article/332945-overview - Similar to Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy
5 Aug 2013 ... Ankylosing spondylitis (AS) is a chronic, multisystem inflammatory ... in the SI joints and spine are useful in the diagnosis and ongoing evaluation of AS. ... Magnetic resonance imaging (MRI) or computed tomography (CT) ...... ASAS/ EULAR recommendations for the management of ankylosing spondylitis.

(might have duplicated along the way !)

Note: CT - suggest not. CT scan is heavy in radiation expossure - considered summat like to 180 plain X-Rays ! MRI Sagittal STIR etc etc is the way to go - so long as one can lye flat in that darn machind... Or, try to find a screening centre with the UPright FONAR MRI machine. The EOS-1 upright X-Ray machine is pretty useless. Poor definition, so a waste of time. Basically the EOS-1 is useful for the orthopaedist but for the rheumatologist, not useful. (I was 'fooled' into heading for it...had a full top to toe at a 'top' specialist screening unit in Paris. Ho-Hum. Very poor definition. Useless, irritating. Now awaiting the cervical MRI).

Reiterate : "MRI is used to dectect inflammation of the axial skeleton as well as spinal changes better than X-rays. MRI is different than other diagnostic testing tools because it has the ability to view the inflammation that may occur in the thoracic spine. The main disadvantages to the use of the MRI is cost and availability.3" That is 'why' we get stuffed along to getting those X-Rays, which in the initial AS diagnosis are not up to the job as...NO damage has yet occured that is going to 'show up' on plain radiographs! Full blown MRI is what is required: Coronal, e Sagittal STIR tau-1, tau-2, fat supression. Don't be fobbed off.

thank you. this is helpful.

Molly!! You are such a blessing.

I hope your feet feel better tomorrow. I woke up with my feet hurting this a.m. and my back hurting worse. We had a front come in with clouds and cooler temps. The weather changes are miserable.

Hugs.