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Poor awareness of #axSpA among healthcare professionals
--among UK chiropractors: https://doi.org/10.1093/rap/rkz034
--among subspecialists: https://doi.org/10.1007/s10067-016-3305-y
#ACR20
--among UK chiropractors: https://doi.org/10.1093/rap/rkz034
--among subspecialists: https://doi.org/10.1007/s10067-016-3305-y
#ACR20
Inflammatory back pain: remember, "not a diagnosis but a concept to prompt physicians to consider #axSpA"
#ACR20
#ACR20
Patients with extra-musculoskeletal manifestations (previously called EAMs): often seen in non-rheum specialty clinics, like ophtho, derm, GI. But often don't make it to rheum for evaluation, or there is a long delay.
#ACR20
#ACR20
Remember: the CLASSIFICATION criteria for #axSpA should only be applied AFTER you've made the diagnosis.
#ACR20
#ACR20
The pathway to #axSpA diagnosis is challenging.
Next: @LianneGensler with a case: 54 y/o woman, referred for SAPHO evaluation with a T7 lesion on spine MRI.
By history, doesn't quite sound like she has IBP. But how much does this matter in this clinical context?
#ACR20
Next: @LianneGensler with a case: 54 y/o woman, referred for SAPHO evaluation with a T7 lesion on spine MRI.
By history, doesn't quite sound like she has IBP. But how much does this matter in this clinical context?
#ACR20
The T7 lesion: with bone marrow edema and vertebral erosion. This was suspicious for TB, but the biopsy was negative for infx.
Back to HPI: she had a h/o hip pain.
Remember to get details on WHERE this pain is located.
#ACR20
Back to HPI: she had a h/o hip pain.
Remember to get details on WHERE this pain is located. #ACR20
XR: no jt space narrowing or ankylosis of the SI joints
BUT, erosive sacroiliitis without bone marrow edema seen on the MRI
Diagnosis: #axSpA (OR could consider psoriatic spondylitis vs axial PsA)
#ACR20
BUT, erosive sacroiliitis without bone marrow edema seen on the MRI
Diagnosis: #axSpA (OR could consider psoriatic spondylitis vs axial PsA) #ACR20
The classic Feldtkeller study: women had a longer diagnosis delay
Blurry slides, so I provided the original https://doi.org/10.1007/s00296-002-0237-4
#ACR20
Blurry slides, so I provided the original https://doi.org/10.1007/s00296-002-0237-4
#ACR20
Redeker, et al on #axSpA diagnostic delay
https://doi.org/10.1093/rheumatology/kez090
The presence of psoriasis associates with a longer diagnostic delay
#ACR20
https://doi.org/10.1093/rheumatology/kez090
The presence of psoriasis associates with a longer diagnostic delay
#ACR20
Back to Dr. Gaffney for the spectrum of #axSpA
@clemenlpez et al, systematic review & meta-analysis on characteristics & burden of disease in r- vs nr-axSpA https://doi.org/10.1136/rmdopen-2019-001108
#ACR20
@clemenlpez et al, systematic review & meta-analysis on characteristics & burden of disease in r- vs nr-axSpA https://doi.org/10.1136/rmdopen-2019-001108
#ACR20
. @LianneGensler citing Yi, et al's systematic review
Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review https://doi.org/10.1007/s40744-020-00194-8
#ACR20
Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review https://doi.org/10.1007/s40744-020-00194-8
#ACR20
Dr. Gaffney: strategies to reduce delay to #axSpA diagnosis?
"promote yourself" (which I'm doing right now!)
rheum collaborations with MSK radiology
public awareness campaigns, such as from @NASS_ASone
online learning platforms for other clinicians
referral systems
"promote yourself" (which I'm doing right now!)rheum collaborations with MSK radiologypublic awareness campaigns, such as from @NASS_ASone online learning platforms for other cliniciansreferral systems
Q&A:
spondyloarthritis -- useful to think of as an "umbrella"?
@LianneGensler: "Well, it depends on if you're a lumper or a splitter."
[ @AlisonBays
]
#ACR20
spondyloarthritis -- useful to think of as an "umbrella"?
@LianneGensler: "Well, it depends on if you're a lumper or a splitter."
[ @AlisonBays
]#ACR20
How to make #axSpA diagnosis without diagnostic criteria?
LG: We need to be flexible w diagnosis. But can use terms of like "probable" or "definite" for a diagnosis
Gaffney: due to heterogeneity, complexity of this & other rheum conditions, not possible to have dx criteria
LG: We need to be flexible w diagnosis. But can use terms of like "probable" or "definite" for a diagnosis
Gaffney: due to heterogeneity, complexity of this & other rheum conditions, not possible to have dx criteria
Q: Should structural changes on imaging be incorporated into @Official_ASAS classification criteria?
A: Good question -- this work is currently in progress
#ACR20
A: Good question -- this work is currently in progress
#ACR20
https://twitter.com/rheum_cat/status/1325739911144673280?s=20
More in the spondyloarthritis community hub later today! #ACR20
More in the spondyloarthritis community hub later today! #ACR20
