Abstract
Ankylosing spondylitis (AS) represents a common, highly heritable prototype of an interrelated group of chronic inflammatory rheumatic diseases now referred to as spondyloarthritis (SpA), which characteristically affects the axial skeleton in the spine and bilateral sacroiliac joints, resulting in structural and functional impairments, such as inflammatory back pain, asymmetrical peripheral oligoarthritis (predominantly of lower limbs), enthesitis, and specific organ involvement including psoriasis, acute anterior uveitis (AAU), inflammatory bowel disease (IBD), and the so-called extra-articular manifestations (EAM) [1–4]. The past decade yields major advances in the recognition of AS as an entity, the understanding of genetic and pathophysiological mechanisms, and the management due to the new clinical and imaging techniques or therapies [3]. Proteomic and genomic findings while in an early stage have potential both as diagnostic/prognostic tools to investigate the pathogenesis of AS [5]. The strongest known contributing factor is the main histocompatibility complex (MHC) class I molecule human leukocyte antigen-B27 (HLA-B27); several other genes and genetic regions still remain to be identified [4, 6]. The blockers of tumor necrosis factor (TNF), a major therapeutic advance, have allowed patients refractory to conventional treatment [3]. However, whether the available nonsteroidal anti-inflammatory drugs and the treatment with physiotherapy or the other biological treatments is as yet unclear [7]. In addition, the development of defining better strategies and techniques for early diagnosis, therapeutic modulation, and induction of drug-free remission remains one of the major challenges in AS for clinical practice for the next decade.
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Stolwijk C, van Tubergen A, Castillo-Ortiz JD, et al. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(1):65–73.
Elewaut D, Matucci-Cerinic M. Treatment of ankylosing spondylitis and extra-articular manifestations in everyday rheumatology practice. Rheumatology (Oxford). 2009;48(9):1029–35.
Dougados M, Baeten D. Spondyloarthritis. Lancet. 2011;377(9783):2127–37.
Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379–90.
Thomas GP, Brown MA. Genetics and genomics of ankylosing spondylitis. Immunol Rev. 2010;233(1):162–80.
Bowness P. Hla-B27. Annu Rev Immunol. 2015;33:29–48.
Braun J, Baraliakos X. Imaging of axial spondyloarthritis including ankylosing spondylitis. Ann Rheum Dis. 2011;70(Suppl 1):i97–103.
Costantino F, Talpin A, Said-Nahal R, et al. Prevalence of spondyloarthritis in reference to HLA-B27 in the French population: results of the GAZEL cohort. Ann Rheum Dis. 2015;74(4):689–93.
Brown MA, Laval SH, Brophy S, et al. Recurrence risk modelling of the genetic susceptibility to ankylosing spondylitis. Ann Rheum Dis. 2000;59(11):883–6.
Liu Y, Jiang L, Cai Q, et al. Predominant association of HLA-B*2704 with ankylosing spondylitis in Chinese Han patients. Tissue Antigens. 2010;75(1):61–4.
Lopez-Larrea C, Sujirachato K, Mehra NK, et al. HLA-B27 subtypes in Asian patients with ankylosing spondylitis. Evidence for new associations. Tissue Antigens. 1995;45(3):169–76.
Rana MK, Luthra-Guptasarma M. Multi-modal binding of a ‘Self’ peptide by HLA-B*27:04 and B*27:05 allelic variants, but not B*27:09 or B*27:06 variants: fresh support for some theories explaining differential disease association. Protein J. 2016;35(5):346–53.
Reveille JD. The genetic basis of spondyloarthritis. Ann Rheum Dis. 2011;70(Suppl 1):i44–50.
Miceli-Richard C, Zouali H, Said-Nahal R, et al. Significant linkage to spondyloarthropathy on 9q31-34. Hum Mol Genet. 2004;13(15):1641–8.
Guncan S, Bilge NS, Cansu DU, et al. The role of MEFV mutations in the concurrent disorders observed in patients with familial Mediterranean fever. Eur J Rheumatol. 2016;3(3):118–21.
Davidson SI, Liu Y, Danoy PA, et al. Association of STAT3 and TNFRSF1A with ankylosing spondylitis in Han Chinese. Ann Rheum Dis. 2011;70(2):289–92.
Lau MC, Keith P, Costello ME, et al. Genetic association of ankylosing spondylitis with TBX21 influences T-bet and pro-inflammatory cytokine expression in humans and SKG mice as a model of spondyloarthritis. Ann Rheum Dis. 2017;76(1):261–9.
Sieper J, Braun J, Rudwaleit M, et al. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002;61(Suppl 3):iii8–18.
Chen DY, Chen YM, Hung WT, et al. Immunogenicity, drug trough levels and therapeutic response in patients with rheumatoid arthritis or ankylosing spondylitis after 24-week golimumab treatment. Ann Rheum Dis. 2015;74(12):2261–4.
Sieper J, Braun J, Kingsley GH. Report on the fourth international workshop on reactive arthritis. Arthritis Rheum. 2000;43(4):720–34.
Ciccia F, Accardo-Palumbo A, Rizzo A, et al. Evidence that autophagy, but not the unfolded protein response, regulates the expression of IL-23 in the gut of patients with ankylosing spondylitis and subclinical gut inflammation. Ann Rheum Dis. 2014;73(8):1566–74.
Onderdonk AB, Richardson JA, Hammer RE, et al. Correlation of cecal microflora of HLA-B27 transgenic rats with inflammatory bowel disease. Infect Immun. 1998;66(12):6022–3.
Hunter CA, Jones SA. IL-6 as a keystone cytokine in health and disease. Nat Immunol. 2015;16(5):448–57.
Evans DM, Spencer CC, Pointon JJ, et al. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility. Nat Genet. 2011;43(8):761–7.
Ciccia F, Guggino G, Rizzo A, et al. Type 3 innate lymphoid cells producing IL-17 and IL-22 are expanded in the gut, in the peripheral blood, synovial fluid and bone marrow of patients with ankylosing spondylitis. Ann Rheum Dis. 2015;74(9):1739–47.
Lin S, Qiu M, Chen J. IL-4 modulates macrophage polarization in ankylosing spondylitis. Cell Physiol Biochem. 2015;35(6):2213–22.
Ciccia F, Alessandro R, Rizzo A, et al. Macrophage phenotype in the subclinical gut inflammation of patients with ankylosing spondylitis. Rheumatology (Oxford). 2014;53(1):104–13.
Sezgin M, Tecer D, Kanik A, et al. Serum RDW and MPV in ankylosing spondylitis: can they show the disease activity? Clin Hemorheol Microcirc. 2017;65(1):1–10.
Steinbrich-Zollner M, Grun JR, Kaiser T, et al. From transcriptome to cytome: integrating cytometric profiling, multivariate cluster, and prediction analyses for a phenotypical classification of inflammatory diseases. Cytometry A. 2008;73(4):333–40.
Aufdermaur M. Pathogenesis of square bodies in ankylosing spondylitis. Ann Rheum Dis. 1989;48(8):628–31.
Wendling D, Claudepierre P. New bone formation in axial spondyloarthritis. Joint Bone Spine. 2013;80(5):454–8.
Chen HA, Chen CH, Lin YJ, et al. Association of bone morphogenetic proteins with spinal fusion in ankylosing spondylitis. J Rheumatol. 2010;37(10):2126–32.
Lv Q, Li Q, Zhang P, et al. Disorders of MicroRNAs in peripheral blood mononuclear cells: as novel biomarkers of ankylosing spondylitis and provocative therapeutic targets. Biomed Res Int. 2015;2015:504208.
Appel H, Wu P, Scheer R, et al. Synovial and peripheral blood CD4+FoxP3+ T cells in spondyloarthritis. J Rheumatol. 2011;38(11):2445–51.
Atagunduz P, Appel H, Kuon W, et al. HLA-B27-restricted CD8+ T cell response to cartilage-derived self peptides in ankylosing spondylitis. Arthritis Rheum. 2005;52(3):892–901.
del Rio-Martinez P, Navarro-Compan V, Diaz-Miguel C, et al. Similarities and differences between patients fulfilling axial and peripheral ASAS criteria for spondyloarthritis: results from the Esperanza cohort. Semin Arthritis Rheum. 2016;45(4):400–3.
Baraliakos X, Braun J. Spondyloarthritides. Best Pract Res Clin Rheumatol. 2011;25(6):825–42.
Braun J, Sieper J. Classification criteria for rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4 Suppl 55):S68–73.
Tan S, Wang R, Ward MM. Syndesmophyte growth in ankylosing spondylitis. Curr Opin Rheumatol. 2015;27(4):326–32.
Dougados M, van der Linden S, Juhlin R, et al. The european spondylarthropathy study group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34(10):1218–27.
Sieper J, Poddubnyy D. New evidence on the management of spondyloarthritis. Nat Rev Rheumatol. 2016;12(5):282–95.
Prajzlerova K, Grobelna K, Pavelka K, et al. An update on biomarkers in axial spondyloarthritis. Autoimmun Rev. 2016;15(6):501–9.
Maksymowych WP. Biomarkers in axial spondyloarthritis. Curr Opin Rheumatol. 2015;27(4):343–8.
de Vlam K. Soluble and tissue biomarkers in ankylosing spondylitis. Best Pract Res Clin Rheumatol. 2010;24(5):671–82.
Chen CH, Yu DT, Chou CT. Biomarkers in spondyloarthropathies. Adv Exp Med Biol. 2009;649:122–32.
Di Minno MN, Iervolino S, Zincarelli C, et al. Cardiovascular effects of Etanercept in patients with psoriatic arthritis: evidence from the cardiovascular risk in rheumatic diseases database. Expert Opin Drug Saf. 2015;14(12):1905–13.
Durham LE, Taams LS, Kirkham BW. Psoriatic arthritis. Br J Hosp Med. 2016;77(7):C102–8.
Dal Pont E, D’Inca R, Caruso A, et al. Non-invasive investigation in patients with inflammatory joint disease. World J Gastroenterol. 2009;15(20):2463–8.
Deodhar A, Strand V, Kay J, et al. The term ‘non-radiographic axial spondyloarthritis’ is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis. 2016;75(5):791–4.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361–8.
Baraliakos X, Listing J, Rudwaleit M, et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis. 2007;66(7):910–5.
Yang CH, Wu TH, Chiou YY, et al. Imaging quality and diagnostic reliability of low-dose computed tomography lumbar spine for evaluating patients with spinal disorders. Spine J. 2014;14(11):2682–90.
Baraliakos X, Hermann KG, Landewe R, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis. 2005;64(8):1141–4.
Braun J, Golder W, Bollow M, et al. Imaging and scoring in ankylosing spondylitis. Clin Exp Rheumatol. 2002;20(6 Suppl 28):S178–84.
Weber U, Jurik AG, Lambert RG, et al. Imaging in spondyloarthritis: controversies in recognition of early disease. Curr Rheumatol Rep. 2016;18(9):58.
Toprak H, Kilic E, Serter A, et al. Doppler US in rheumatic diseases with special emphasis on rheumatoid arthritis and spondyloarthritis. Diagn Interv Radiol. 2014;20(1):72–7.
Arend CF. Role of sonography and magnetic resonance imaging in detecting deltoideal acromial enthesopathy: an early finding in the diagnosis of spondyloarthritis and an under-recognized cause of posterior shoulder pain. J Ultrasound Med. 2014;33(4):557–61.
Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374(26):2563–74.
Slobodin G, Eshed I. Non-radiographic axial spondyloarthritis. IMAJ. 2015;17(12):770–6.
Kok HK, Mumtaz A, O’Brien C, et al. Imaging the patient with sacroiliac pain. Can Assoc Radiol J. 2016;67(1):41–51.
van der Linden S, Akkoc N, Brown MA, et al. The ASAS criteria for axial Spondyloarthritis: strengths, weaknesses, and proposals for a way forward. Curr Rheumatol Rep. 2015;17(9):62.
Lubrano E, Parsons WJ, Marchesoni A, et al. The definition and measurement of axial psoriatic arthritis. J Rheumatol Suppl. 2015;93:40–2.
Akkoc N, Khan MA. ASAS classification criteria for axial spondyloarthritis: time to modify. Clin Rheumatol. 2016;35(6):1415–23.
Wendling D. An overview of investigational new drugs for treating ankylosing spondylitis. Expert Opin Investig Drugs. 2016;25(1):95–104.
Palazzi C, D’Angelo S, Gilio M, et al. Pharmacological therapy of spondyloarthritis. Expert Opin Pharmacother. 2015;16(10):1495–504.
Del Rosso A, Maddali-Bongi S. Mind body therapies in rehabilitation of patients with rheumatic diseases. Complement Ther Clin Pract. 2016;22:80–6.
Moon KH, Kim YT. Medical treatment of ankylosing spondylitis. Hip Pelvis. 2014;26(3):129–35.
Lubrano E, Astorri D, Taddeo M, et al. Rehabilitation and surgical management of ankylosing spondylitis. Musculoskelet Surg. 2013;97(Suppl 2):S191–5.
Hoving JL, Lacaille D, Urquhart DM, et al. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis. Cochrane Database Syst Rev. 2014;11:CD010208.
Van Tubergen A, Boonen A, Landewe R, et al. Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum. 2002;47(5):459–67.
Dagfinrud H, Kvien TK, Hagen KB. The Cochrane review of physiotherapy interventions for ankylosing spondylitis. J Rheumatol. 2005;32(10):1899–906.
Kroon FP, van der Burg LR, Ramiro S, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis). Cochrane Database Syst Rev. 2015;7:CD010952.
Fendler C, Baraliakos X, Braun J. Glucocorticoid treatment in spondyloarthritis. Clin Exp Rheumatol. 2011;29(5 Suppl 68):S139–42.
Siu S, Haraoui B, Bissonnette R, et al. Meta-analysis of tumor necrosis factor inhibitors and glucocorticoids on bone density in rheumatoid arthritis and ankylosing spondylitis trials. Arthritis Care Res. 2015;67(6):754–64.
Chen J, Lin S, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev. 2014;11:CD004800.
Cipriani P, Ruscitti P, Carubbi F, et al. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol. 2014;10(11):1519–30.
Yang Z, Zhao W, Liu W, et al. Efficacy evaluation of methotrexate in the treatment of ankylosing spondylitis using meta-analysis. Int J Clin Pharmacol Ther. 2014;52(5):346–51.
Chen J, Veras MM, Liu C, et al. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev. 2013;2:CD004524.
Davis JC Jr, Huang F, Maksymowych W. New therapies for ankylosing spondylitis: etanercept, thalidomide, and pamidronate. Rheum Dis Clin N Am. 2003;29(3):481–94.
Haibel H, Rudwaleit M, Braun J, et al. Six months open label trial of leflunomide in active ankylosing spondylitis. Ann Rheum Dis. 2005;64(1):124–6.
Kaltwasser JP, Nash P, Gladman D, et al. Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: a multinational, double-blind, randomized, placebo-controlled clinical trial. Arthritis Rheum. 2004;50(6):1939–50.
Viapiana O, Gatti D, Idolazzi L, et al. Bisphosphonates vs infliximab in ankylosing spondylitis treatment. Rheumatology (Oxford). 2014;53(1):90–4.
Katsicas MM, Russo R. Biologic agents in juvenile spondyloarthropathies. Pediatr Rheumatol Online J. 2016;14(1):17.
Callhoff J, Sieper J, Weiss A, et al. Efficacy of TNF alpha blockers in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis. Ann Rheum Dis. 2015;74(6):1241–8.
Machado MA, Barbosa MM, Almeida AM, et al. Treatment of ankylosing spondylitis with TNF blockers: a meta-analysis. Rheumatol Int. 2013;33(9):2199–213.
Elalouf O, Elkayam O. Long-term safety and efficacy of infliximab for the treatment of ankylosing spondylitis. Ther Clin Risk Manag. 2015;11:1719–26.
Maxwell LJ, Zochling J, Boonen A, et al. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev. 2015;4:CD005468.
Murdaca G, Spano F, Contatore M, et al. Pharmacogenetics of etanercept: role of TNF-alpha gene polymorphisms in improving its efficacy. Expert Opin Drug Metab Toxicol. 2014;10(12):1703–10.
Scott LJ. Etanercept: a review of its use in autoimmune inflammatory diseases. Drugs. 2014;74(12):1379–410.
Murdaca G, Spano F, Contatore M, et al. Immunogenicity of infliximab and adalimumab: what is its role in hypersensitivity and modulation of therapeutic efficacy and safety? Expert Opin Drug Saf. 2016;15(1):43–52.
Lapadula G, Marchesoni A, Armuzzi A, et al. Adalimumab in the treatment of immune-mediated diseases. Int J Immunopathol Pharmacol. 2014;27(1 Suppl):33–48.
Wang H, Zuo D, Sun M, et al. Randomized, placebo controlled and double-blind trials of efficacy and safety of adalimumab for treating ankylosing spondylitis: a meta-analysis. Int J Rheum Dis. 2014;17(2):142–8.
Goh L, Samanta A. A systematic MEDLINE analysis of therapeutic approaches in ankylosing spondylitis. Rheumatol Int. 2009;29(10):1123–35.
Bonafede M, Fox KM, Watson C, et al. Treatment patterns in the first year after initiating tumor necrosis factor blockers in real-world settings. Adv Ther. 2012;29(8):664–74.
Heredia S, Aparicio M, Armengol E, et al. Rituximab therapy for ankylosing spondylitis associated to demyelinating disease of the central nervous system. Joint Bone Spine. 2016;83(1):105–6.
Fu D, Sun W, Shen J, et al. Inflammatory pseudotumor around metal-on-polyethylene total hip arthroplasty in patients with ankylosing spondylitis: description of two cases and review of literature. World J Surg Oncol. 2015;13:57.
Guan M, Wang J, Zhao L, et al. Management of hip involvement in ankylosing spondylitis. Clin Rheumatol. 2013;32(8):1115–20.
Van Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis. 1999;58(7):399–406.
Mundwiler ML, Siddique K, Dym JM, et al. Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurg Focus. 2008;24(1):E6.
Burton DC. Smith-Petersen osteotomy of the spine. Instr Course Lect. 2006;55:577–82.
Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg Am. 2008;90(11):2509–20.
Liu H, Yang C, Zheng Z, et al. Comparison of smith-petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine. 2015;40(8):570–9.
Boachie-Adjei O. Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance. Instr Course Lect. 2006;55:583–9.
Zhang X, Zhang Z, Wang J, et al. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis. Bone Joint J. 2016;98-B(5):672–8.
Wang Y, Lenke LG. Vertebral column decancellation for the management of sharp angular spinal deformity. Eur Spine J. 2011;20(10):1703–10.
Wang Y, Zhang Y, Zhang X, et al. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J. 2008;17(3):361–72.
Wang Y, Zhang Y, Mao K, et al. Transpedicular bivertebrae wedge osteotomy and discectomy in lumbar spine for severe ankylosing spondylitis. J Spinal Disord Tech. 2010;23(3):186–91.
Hoh DJ, Khoueir P, Wang MY. Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus. 2008;24(1):E9.
Chin KR, Ahn J. Controlled cervical extension osteotomy for ankylosing spondylitis utilizing the Jackson operating table: technical note. Spine. 2007;32(17):1926–9.
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Wang, Y., Ji, Q. (2019). Ankylosing Spondylitis. In: Wang, Y. (eds) Surgical Treatment of Ankylosing Spondylitis Deformity . Springer, Singapore. https://doi.org/10.1007/978-981-13-6427-3_1
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