AXIAL SPONDYLOARTHRITIS. CLINICAL DEFINITION AND DIAGNOSTIC APPROACHES

Zhdan V. M., Volchenko H. V., Babanina M. Yu., Tkachenko M. V., Kyrian O. A.

LITERATURE REVIEWS

Scentific article

Seronegative spondyloarthritis combines a group of chronic inflammatory diseases of the spine, often with involvement of peripheral joints, which is characterized by a difficult differential diagnosis, as well as limited possibilities of specific clinical, laboratory and instrumental tests, especially in the debut of the disease. Often, it is objectively impossible to determine its exact nosological affiliation. A long part of time the diagnosis is limited to syndromic characteristics, and it is formulated as undifferentiated spondyloarthritis. Such uncertainty dictated the need for the concept of axial spondyloarthritis with or without radiographic signs for patients in whom the clinical manifestation of spondyloarthritis, its nosological affiliation, and further evolution remain unknown. The purpose of the study was the analysis of modern clinical concepts and diagnostic approaches presented in the literature regarding the problem of early diagnosis of axial spondyloarthritis, the importance of its clinical definition and separation from other forms of spondyloarthritis. Diagnostic criteria for inflammatory back pain and axial spondyloarthritis, regardless of its further clinical evolution, allow to minimize the number of diagnostic errors and delays in starting specific treatment. According to the criteria, the diagnosis of axial spondyloarthritis can be assumed with high probability in the case of complaints of long-lasting, more than three months, inflammatory back pain, age under 45 years in the presence of radiographic signs of sacroiliitis or HLA-B27 positive test in combination with two or more additional signs: iritis or anterior uveitis, hereditary history, effectiveness of nonsteroidal anti-inflammatory drugs, dactylitis, inflammatory bowel disease, peripheral arthritis, enthesitis, psoriasis, and positive laboratory markers of systemic inflammation. Classic manifestations of sacroiliitis are a change in the width of the iliac-sacral joints, erosion, osteosclerosis, and ankylosis. Differential diagnosis of axial spondyloarthritis requires comparison with other pathological conditions with a dominant clinical manifestation of chronic back pain syndrome, especially in adolescence or early adulthood, as well as a largely similar radiological picture. The diagnosis of axial spondyloarthritis can be difficult, but modern laboratory-instrumental methods of diagnosis, as well as the formation of skills of a wide range of doctors of various specializations, generally a simple diagnostic algorithm for a patient with chronic back pain, create conditions for a successful solution to the problem of early diagnosis.

spondyloarthritis,sacroiliitis,dorsalgia,iliosacral joints.

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«Bulletin of problems biology and medicine» Issue 4 (167), 2022 year, 49-58 pages, index UDK 616.721-002.77-071

10.29254/2077-4214-2022-4-167-49-58