User:Fineptpen/Axial spondyloarthritis

Lead
// what's below has been edited for redundancy and flow.

plan to edit further to reference newly added material when I'm done doing my other proposed edits.

may add references to back up more of what's here too.

need to make sure everything here is referenced elsewhere

Axial spondyloarthritis (also often referred to as axSpA) is a chronic, autoinflammatory disease predominantly affecting the axial skeleton (sacroiliac joints and spine). The phrase itself is an umbrella term characterizing a diverse disease family united by shared clinical and genetic features, such as the involvement of the axial skeleton. [1] The best-known member of the axial spondyloarthritis disease family is ankylosing spondylitis. The 2009 introduction of the expression axial spondyloarthritis made it possible to refer to (1) less severe forms of spondylitis, (2) the early phase of ankylosing spondylitis and (3) ankylosing spondylitis itself collectively.

//change redundancy of axial skeleton reference as a shared feature

Classification
Along with peripheral spondyloarthritis, reactive arthritis, psoriatic arthritis and enteropathic arthritis (or inflammatory bowel disease-associated spondyloarthritis), axial spondyloarthritis belongs to the spondyloarthritis disease family, also known as the spondyloarhritides or spondyloarthropathies. These arthritic conditions can sometimes overlap with one another. For example, psoriatic arthritis can cause both peripheral and axial symptoms. Likewise, reactive arthritis can transform into chronic axial spondyloarthritis. All are considered inflammatory rheumatic disorders because they involve immune system-mediated attacks on the joints, muscles, bones and organs.

Axial spondyloarthritis can be differentiated from peripheral spondyloarthritis in terms of the areas of the body affected. The axial form of the disease primarily affects the spine, pelvis and thoracic cage, whereas the peripheral form mainly targets the arms and legs.

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//as opposed to peripheral spondyloarthritis

//differentiate between spondyloarthropathy, AS, spondylitis, spondyloarthritities (see history section??)

// speaks to types of SpA and distinction between autoimmune and autoinflammatory diseases

//going to expand on difference between non-radiographic and radiographic forms (what types of patients (genders, those with certain comorbidities etc.) tend to fall in one category or another)

Signs and Symptoms
Axial spondyloarthritis is predominantly marked by inflammatory pain and/or stiffness affecting one or both sides of the lower back and potentially the hips and/or buttocks. The side affected may alternate. Some may also experience symptoms in the eyes, rib cage, shoulders or cervical spine or neck as well. Inflammatory back pain tends to come on gradually, become worse at night or after periods of rest (such as in the morning after waking up) and improve after exercise or the use of anti-inflammatory medications such as ibuprofen. People with axial spondyloarthritis may experience periods of remission and flare-ups.

It is recommended that patients be formally evaluated for axial spondyloarthritis if they complain of inflammatory back pain and stiffness lasting at least three months, particularly if they are under the age of 45 and/or have a family history of the disease.

//going to insert this new section here

Diagnosis
Patients being examined for axial spondyloarthritis may have x-rays, or radiographs, taken of their pelvis and lower spine to check for signs of sacroilitis (often one of the first signs of the disease) and structural damage to the spine. It can take several years from symptom onset for these changes to be visible, and some may never develop these changes at all. This distinguishes radiographic axial spondyloarthritis from nr-axSpA.

Patients may also undergo an MRI in place of or in addition to radiography. MRI technology is sensitive to inflammatory changes such as enthesitis and synovitis and is more specific overall.

Blood work may also play a role in the diagnosis of axial spondyloarthritis. More than 80% of patients with the ankylosing spondylitis variant test positive for the HLA-B27 biomarker, but not everyone with this biomarker will develop disease. Some may test positive for elevated C-reactive protein, or CRP, depending on disease activity. Spondyloarthritis is generally considered to be a seronegative disease, meaning tests for rheumatoid factor and other autoantibodies typically come back negative.

Depending on the results of the above tests, patients may be referred to a rheumatologist for confirmation and follow-up.

//going to add as per July 2018 flag

//reference significance of seronegativity

//reactive arthritis or chronic? (not mutually exclusive, rea can turn into SpA)

//xrays and mris

Prognosis
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Some with more severe disease may experience fusion of their vertebrae, a condition referred to as bamboo spine. Those assigned male at birth are more likely to accrue radiographic joint damage, whereas those assigned female at birth tend to experience comparatively worse quality of life and disease activity.

Management
//add information about biologics and JAK inhibitors and uncertainty about their effect on progression (just efficacy in regard to symptoms)

//steroids?

There is currently no cure for axial spondyloarthritis.

Those who cannot tolerate these medications or who require more intensive treatment may be prescribed biologic medications such as a tumor necrosis factor-inhibitor in an attempt to alter the immune response driving the disease.

Physical therapy and exercise have also been found to effectively address symptoms.

Some make dietary changes to better cope with axial spondyloarthritis, but these interventions are not yet backed by evidence.

Causes
//going to insert this new section here

Pathophysiology
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History
//might break up into paragraphs, but not planning on changing the actual content all that much

//mention Spondylitis Association of America?

//fixed missing citation

Notable cases
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 * Beau Biden
 * Talia Dean, The X-Factor
 * Zach Kornfeld, The Try Guys
 * Mick Mars, Motley Crue
 * Dan Reynolds, Imagine Dragons