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Infectious and Autoimmune Disease and Spine Pain

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Spine Pain Care

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Abstract

Autoimmune disorders of the spine are a diverse group of chronic inflammatory immune-mediated conditions with variable associated peripheral, axial, and extra-articular involvement. Autoimmune conditions associated with the spine, particularly in the early stages of disease, often present with nonspecific clinical features that are not uncommonly misdiagnosed as mechanical back pain. Delay in diagnosis is therefore common, resulting in exacerbated disease sequelae, unnecessary diagnostic procedures, and delay in efficacious therapies. Early identification of autoimmune inflammatory conditions can significantly improve functional outcomes and quality of life and minimize deleterious disease-related complications. This chapter will review common inflammatory immune-mediated diseases affecting the spine including relevant pathogenesis, epidemiology, clinical features, diagnosis, and treatment.

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References

  1. O’Shea F, Salonen D, Inman R. The challenge of early diagnosis in ankylosing spondylitis. J Rheumatol. 2007;34(1):5–7.

    PubMed  Google Scholar 

  2. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72(6):1037–47.

    PubMed  Google Scholar 

  3. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245–52.

    PubMed  Google Scholar 

  4. Krauss WE, Bledsoe JM, Clarke MJ, Nottmeier EW, Pichelmann MA. Rheumatoid arthritis of the craniovertebral junction. Neurosurgery. 2010;66(3 Suppl):83–95.

    Article  PubMed  Google Scholar 

  5. Kim DH, Hilibrand AS. Rheumatoid arthritis in the cervical spine. J Am Acad Orthop Surg. 2005;13(7):463–74.

    Article  PubMed  Google Scholar 

  6. Oberstein EM, Carpintero M, Hopkins A. Neck pain from a rheumatologic perspective. Phys Med Rehabil Clin N Am. 2011;22(3):485–502.. ix

    Article  PubMed  Google Scholar 

  7. Klarenbeek NB, Kerstens PJ, Huizinga TW, Dijkmans BA, Allaart CF. Recent advances in the management of rheumatoid arthritis. BMJ. 2010;341:c6942.

    Article  PubMed  Google Scholar 

  8. Jacoby RK, Jayson MI, Cosh JA. Onset, early stages, and prognosis of rheumatoid arthritis: a clinical study of 100 patients with 11-year follow-up. Br Med J. 1973;2(5858):96–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Raychaudhuri SP, Deodhar A. The classification and diagnostic criteria of ankylosing spondylitis. J Autoimmun. 2014;48–49:128–33.

    Article  PubMed  Google Scholar 

  10. Martindale J, Goodacre L. The journey to diagnosis in AS/axial SpA: the impact of delay. Musculoskeletal Care. 2014;12(4):221–31.

    Article  CAS  PubMed  Google Scholar 

  11. Ramonda R, Marchesoni A, Carletto A, Bianchi G, Cutolo M, Ferraccioli G, et al. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey. Arthritis Res Ther. 2016;18:78.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Garrido-Cumbrera M, Hillmann O, Mahapatra R, Trigos D, Zajc P, Weiss L, et al. Improving the management of psoriatic arthritis and axial spondyloarthritis: roundtable discussions with healthcare professionals and patients. Rheumatol Ther. 2017;4(2):219–31.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial Spondyloarthritis. N Engl J Med. 2016;375(13):1303.

    Article  PubMed  Google Scholar 

  14. de Winter JJ, van Mens LJ, van der Heijde D, Landewe R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther. 2016;18:196.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sieper J, Holbrook T, Black CM, Wood R, Hu X, Kachroo S. Burden of illness associated with non-radiographic axial spondyloarthritis: a multiperspective European cross-sectional observational study. Clin Exp Rheumatol. 2016;34(6):975–83.

    PubMed  Google Scholar 

  16. Malaviya AN, Rawat R, Agrawal N, Patil NS. The nonradiographic axial spondyloarthritis, the radiographic axial spondyloarthritis, and ankylosing spondylitis: the tangled skein of rheumatology. Int J Rheumatol. 2017;2017:1824794.

    PubMed  PubMed Central  Google Scholar 

  17. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73–84.

    Article  PubMed  Google Scholar 

  18. Deodhar A, Strand V, Kay J, Braun J. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Ehrenfeld M. Spondyloarthropathies. Best Pract Res Clin Rheumatol. 2012;26(1):135–45.

    Article  CAS  PubMed  Google Scholar 

  20. Rudwaleit M, Haibel H, Baraliakos X, Listing J, Marker-Hermann E, Zeidler H, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum. 2009;60(3):717–27.

    Article  CAS  PubMed  Google Scholar 

  21. Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(1):65–73.

    Article  PubMed  Google Scholar 

  22. Eriksson JK, Jacobsson L, Bengtsson K, Askling J. Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis? Ann Rheum Dis. 2017;76(2):364–70.

    Article  PubMed  Google Scholar 

  23. Rosenow E, Strimlan CV, Muhm JR, Ferguson RH. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc. 1977;52(10):641–9.

    CAS  PubMed  Google Scholar 

  24. Nugent M, Berney MJ, Morris S. Clinical outcomes following spinal fracture in patients with ankylosing spondylitis. Ir J Med Sci. 2017;186(3):677–81.

    Article  CAS  PubMed  Google Scholar 

  25. Vosse D, Landewe R, van der Heijde D, van der Linden S, van Staa TP, Geusens P. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis. 2009;68(12):1839–42.

    Article  CAS  PubMed  Google Scholar 

  26. Thumbikat P, Hariharan RP, Ravichandran G, McClelland MR, Mathew KM. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine (Phila Pa 1976). 2007;32(26):2989–95.

    Article  Google Scholar 

  27. Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–83.

    Article  CAS  PubMed  Google Scholar 

  28. Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. 2004;69(12):2853–60.

    PubMed  Google Scholar 

  29. Schmitt SK. Reactive arthritis. Infect Dis Clin N Am. 2017;31(2):265–77.

    Article  Google Scholar 

  30. Hamdulay SS, Glynne SJ, Keat A. When is arthritis reactive? Postgrad Med J. 2006;82(969):446–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ozgul A, Dede I, Taskaynatan MA, Aydogan H, Kalyon TA. Clinical presentations of chlamydial and non-chlamydial reactive arthritis. Rheumatol Int. 2006;26(10):879–85.

    Article  PubMed  Google Scholar 

  32. Toivanen A, Toivanen P. Reactive arthritis. Curr Opin Rheumatol. 2000;12(4):300–5.

    Article  CAS  PubMed  Google Scholar 

  33. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72(5):736–40.

    Article  PubMed  Google Scholar 

  34. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005;53(4):573.

    Article  PubMed  Google Scholar 

  35. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957–70.

    Article  PubMed  Google Scholar 

  36. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–50.

    Article  PubMed  Google Scholar 

  37. Cohen MR, Reda DJ, Clegg DO. Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans Affairs Cooperative Study Group on Seronegative Spondyloarthropathies. J Rheumatol. 1999;26(8):1752–6.

    CAS  PubMed  Google Scholar 

  38. Gladman DD, Anhorn KA, Schachter RK, Mervart H. HLA antigens in psoriatic arthritis. J Rheumatol. 1986;13(3):586–92.

    CAS  PubMed  Google Scholar 

  39. Baraliakos X, Coates LC, Braun J. The involvement of the spine in psoriatic arthritis. Clin Exp Rheumatol. 2015;33(5 Suppl 93):S31–5.

    PubMed  Google Scholar 

  40. Smith CH, Barker JN. Psoriasis and its management. BMJ. 2006;333(7564):380–4.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Gladman DD. Current concepts in psoriatic arthritis. Curr Opin Rheumatol. 2002;14(4):361–6.

    Article  PubMed  Google Scholar 

  42. Peluso R, Di Minno MN, Iervolino S, Manguso F, Tramontano G, Ambrosino P, et al. Enteropathic spondyloarthritis: from diagnosis to treatment. Clin Dev Immunol. 2013;2013:631408.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Voulgari PV. Rheumatological manifestations in inflammatory bowel disease. Ann Gastroenterol. 2011;24(3):173–80.

    PubMed  PubMed Central  Google Scholar 

  44. Rodriguez-Reyna TS, Martinez-Reyes C, Yamamoto-Furusho JK. Rheumatic manifestations of inflammatory bowel disease. World J Gastroenterol. 2009;15(44):5517–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Salvarani C, Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol. 2009;15(20):2449–55.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347(4):261–71.

    Article  PubMed  Google Scholar 

  47. Unwin B, Williams CM, Gilliland W. Polymyalgia rheumatica and giant cell arteritis. Am Fam Physician. 2006;74(9):1547–54.

    PubMed  Google Scholar 

  48. Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013;381(9860):63–72.

    Article  PubMed  Google Scholar 

  49. Achkar AA, Lie JT, Hunder GG, O’Fallon WM, Gabriel SE. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med. 1994;120(12):987–92.

    Article  CAS  PubMed  Google Scholar 

  50. Lener S, Hartmann S, Barbagallo GMV, Certo F, Thome C, Tschugg A. Management of spinal infection: a review of the literature. Acta Neurochir. 2018;160(3):487–96.

    Article  PubMed  Google Scholar 

  51. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355(19):2012–20.

    Article  CAS  PubMed  Google Scholar 

  52. Pradilla G, Ardila GP, Hsu W, Rigamonti D. Epidural abscesses of the CNS. Lancet Neurol. 2009;8(3):292–300.

    Article  PubMed  Google Scholar 

  53. Alerhand S, Wood S, Long B, Koyfman A. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med. 2017;12(8):1179–83.

    Article  PubMed  Google Scholar 

  54. Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. 2016;2016:1614328.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Cooper K, Glenn CA, Martin M, Stoner J, Li J, Puckett T. Risk factors for surgical site infection after instrumented fixation in spine trauma. J Clin Neurosci. 2016;23:123–7.

    Article  PubMed  Google Scholar 

  56. Danner RL, Hartman BJ. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987;9(2):265–74.

    Article  CAS  PubMed  Google Scholar 

  57. Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol. 1992;38(3):225–31.

    Article  CAS  PubMed  Google Scholar 

  58. Griffiths DL. Tuberculosis of the spine: a review. Adv Tuberc Res. 1980;20:92–110.

    CAS  PubMed  Google Scholar 

  59. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175–204; discussion 5.

    Article  CAS  PubMed  Google Scholar 

  60. Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore). 1992;71(6):369–85.

    Article  CAS  Google Scholar 

  61. Kindler CH, Seeberger MD, Staender SE. Epidural abscess complicating epidural anesthesia and analgesia. An analysis of the literature. Acta Anaesthesiol Scand. 1998;42(6):614–20.

    Article  CAS  PubMed  Google Scholar 

  62. Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008;101(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  63. Davis DP, Wold RM, Patel RJ, Tran AJ, Tokhi RN, Chan TC, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004;26(3):285–91.

    Article  PubMed  Google Scholar 

  64. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364(9431):369–79.

    Article  CAS  PubMed  Google Scholar 

  65. Jensen AG, Espersen F, Skinhoj P, Rosdahl VT, Frimodt-Moller N. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. J Infect. 1997;34(2):113–8.

    Article  CAS  PubMed  Google Scholar 

  66. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26–46.

    Article  PubMed  Google Scholar 

  67. Boody BS, Jenkins TJ, Maslak J, Hsu WK, Patel AA. Vertebral osteomyelitis and spinal epidural abscess: an evidence-based review. J Spinal Disord Tech. 2015;28(6):E316–27.

    Article  PubMed  Google Scholar 

  68. Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362(11):1022–9.

    Article  CAS  PubMed  Google Scholar 

  69. Nolla JM, Ariza J, Gomez-Vaquero C, Fiter J, Bermejo J, Valverde J, et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum. 2002;31(4):271–8.

    Article  PubMed  Google Scholar 

  70. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  71. Carragee EJ. The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976). 1997;22(7):780–5.

    Article  CAS  Google Scholar 

  72. Murray MR, Schroeder GD, Hsu WK. Granulomatous vertebral osteomyelitis: an update. J Am Acad Orthop Surg. 2015;23(9):529–38.

    Article  PubMed  Google Scholar 

  73. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.

    Article  PubMed  Google Scholar 

  74. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(suppl 2):ii1–ii44.

    Article  PubMed  Google Scholar 

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  1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Shane J. Volney

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Correspondence to Shane J. Volney .

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  1. Richard J. Kitz Professor of Anesthesia Research Harvard Medical School, Harvard University, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jianren Mao

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Volney, S.J. (2020). Infectious and Autoimmune Disease and Spine Pain. In: Mao, J. (eds) Spine Pain Care. Springer, Cham. https://doi.org/10.1007/978-3-030-27447-4_16

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  • DOI: https://doi.org/10.1007/978-3-030-27447-4_16

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