1. Ankylosing Spondylitis
Introduction & Epidemiology
Iraj Salehi-Abari MD., Internist Rheumatologist

2. Iraj Salehi-Abari
Definition:
Ankylosing Spondylitis (AS) is a chronic inflammatory disease of the axial skeleton manifested by inflammatory LBP and progressive stiffness of the spine accompanied by enthesitis and/or arthritis
Amir Alam Hosp.

3. Iraj Salehi-Abari
Amir Alam Hosp.

4. Iraj Salehi-Abari
Amir Alam Hosp.

5. Previous names: Marrie Strumble disease Bechtereve disease
Iraj Salehi-Abari
Previous names:
Marrie Strumble disease
Bechtereve disease
Amir Alam Hosp.

6. Name in nowadays: Ankylosing Spondylitis Ankylos: Bony bridging
Iraj Salehi-Abari
Name in nowadays:
Ankylosing Spondylitis
Ankylos: Bony bridging
Spondylos: Vertebra
Amir Alam Hosp.

7. Names in future: Spondylo-sacroiliitis Rheumatoid Spondylitis
Iraj Salehi-Abari
Names in future:
Spondylo-sacroiliitis
Rheumatoid Spondylitis
Amir Alam Hosp.

8. Iraj Salehi-Abari
Introduction:
AS is the prototype member of the Spondyloarthritis (SpA) family of disorders
SpA are characterized by:
Spondylitis
Sacroiliitis
Enthesitis
Arthritis
HLA-B27 positivity
Usually RF negativity
Amir Alam Hosp.

9. Historic names of SpA: Seronegative Rheumatism Spondyloarthropathies
Iraj Salehi-Abari
Historic names of SpA:
Seronegative Rheumatism
Spondyloarthropathies
SEA syndrome:
Spondylitis, Enthesitis, Arthritis
BASE syndrome:
B27, Arthritis, Sacroiliitis, Enthesitis
SpondyloArthritis
Amir Alam Hosp.

10. Iraj Salehi-Abari
Amir Alam Hosp.

11. SpA family members: Ankylosing Spondylitis (AS)
Iraj Salehi-Abari
SpA family members:
Ankylosing Spondylitis (AS)
Reactive arthritis (ReA): Reiter’s Synd.)
Psoriatic Arthritis (PsA)
Enteropathic Arthritis (IBDrA)
Juvenile Spodyloarthropathy (JSpA)
Undifferentiated SpA (USpA)
Amir Alam Hosp.

12. Sacroiliitis: History: Buttock pain
Iraj Salehi-Abari
Sacroiliitis:
History: Buttock pain
Ph. Exam: Positive Sacral push test
Pelvic X-Ray:
Sclerosis
Erosion
Narrowing
Ankylosis
Bilateral: AS
Unilateral: other SpA
Amir Alam Hosp.

13. Iraj Salehi-Abari
Enthesitis:
The Enthesis is the region of attachment of tendons and ligaments to bone
Enthesitis: Inflammation of Enthesis
Achille tendinitis, Plantar fasciitis, Costochondritis, …
Amir Alam Hosp.

14. SpA-Iraj Salehi-Abari

15. SpA-Iraj Salehi-Abari

16. SpA-Iraj Salehi-Abari

17. Epidemiology-I: Chronic LBP is a common symptom
Iraj Salehi-Abari
Epidemiology-I:
Chronic LBP is a common symptom
5% of chronic LBP is inflammatory
Prevalence of Axial SpA: 1%
Amir Alam Hosp.

18. Epidemiology-II: Young adults Peak age of onset: 20-30 years
Iraj Salehi-Abari
Epidemiology-II:
Young adults
Peak age of onset: years
Prevalence of AS: %
AS in (+)HLA-B27 population: 5-6%
Amir Alam Hosp.

19. Epidemiology-III: M/F ratio: (+)FH of AS  5.6–16 fold increases AS
Iraj Salehi-Abari
Epidemiology-III:
M/F ratio:
Many years ago: > 3/1
A few years ago; 3/1 t0 2/1
Nowadays: #1/1
(+)FH of AS  5.6–16 fold increases AS
FH and HLA-B27 both positivity:
AS rate of 10-30%
Amir Alam Hosp.

20. Epidemiology in Iran*:
Iraj Salehi-Abari
Epidemiology in Iran*:
Mean age at diagnosis: years
Male; 75%, Female: 25%
Definite inflammatory LBP: #65%
Probable inflammatory LBP: 25%
Positive family history of AS:
First-degree relatives: 8.5%
Second-degree relatives: 1%
HLA-B27 positivity in Iranian AS: 45%
*Iraj Salehi-Abari, Early diagnosis of AS, Rheumatol Int. 2012, table 3
Amir Alam Hosp.

21. Attention please: Rate of AS is increased by: Hx of chronic LBP: X 10
Iraj Salehi-Abari
Attention please:
Rate of AS is increased by:
Hx of chronic LBP: X 10
Positive FH of AS: X 10
Positive HLA-B27: X 10
Amir Alam Hosp.