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ACR American College of Rheumatology AS ankylosing spondylitis ASAS
assessment of spondyloarthritis international society ASDAS
ankylosing spondylitis disease activity score axSpA axial
spondyloarthritis BASDAI Bath ankylosing spondylitis disease
activity index BASFI Bath ankylosing spondylitis functional index
BASMI Bath ankylosing spondylitis metrology index CASPAR
classification criteria for psoriatic arthritis DISH diffuse
idiopathic skeletal hyperostosis DMARDs disease–modifying
anti-rheumatic drugs ESR erythrocyte sedimentation rate ESSG
European Spondylarthropathy Study Group -
EULAR European League Against Rheumatism FM fibromyalgia IBD
inflammatory bowel diseases ILAR International League of
Associations for Rheumatology JAK janus kinase JIA juvenile
idiopathic arthritis LEI Leeds enthesitis index MASES Maastricht
ankylosing spondylitis enthesitis score MEI Mander/Newcastle
enthesitis index mSASSS modified stoke ankylosing spondylitis score
MTX methotrexate nr-axSpA non-radiographic axial spondyloarthritis
X NSAIDs non-steroidal anti inflammatory drugs OA osteoarthritis
PsA psoriatic arthritis pSpA peripheral spondyloarthritis RA
rheumatoid arthritis r-axSpA radiographic axial spondyloarthritis X
ReA reactive arthritis RF rheumatoid factor SASP
salazosulfapyridine SNSA seronegative spondyloarthropathies SpA
spondyloarthritis SPARCC Spondyloarthritis Research Consortium of
Canada TNF tumor necrosis factor uSpA undifferentiated
spondyloarthritis
xiv
A
1 2 GalenRA AS 1691 Conner 1824Wenzel
ASDISH 1850 Brodie AS 19 Strumpell1884 Marie1898Bekhterev1893 3 AS
1 AS Bechterew 2X 18951930 X AS ASPsA ReAIBD SpARArheumatoid
variants rheumatoid spondylitis1963 American Rheumatism
Associa-
tionARA“ankylosing spondylitis” 1974Moll “spondyloarthritisSpA”
SNSA Moll BehçetWhipple SpA HLAB27 1973 Schlosstein BrewertonHLA
B27 BehçetWhipple SpA SpA HLAB27 HLAB27 8%AS HLAB27
9095%IBD HLAB27 IBDHLAB27
75% PsA HLAB27 PsA45% 1
2 1830 Lyons ReA PsA Reiter1916 Reiter 3 Reiter Reiter ReA 3 1818
Ailbert 1956Wright PsA41974 Brewerton
HLAB27 5 IBD 1850 IBD AS 19506 1974Morris HLAB27 7
1 SpA “spondyloarthropathies”“spondy-
loarthritides” SpA 18
1
2
2
uSpA nraxSpA
3
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with Crohn’s disease and ulcerative
colitis ReA uSpA juvenileonset SpA
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nosis AS
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.
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Rome New York New York
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NY uSpA ESSGEuropean Spondy-
loarthropathy Study GroupAmor SpA 2 410,11
2 3
Gold standard
/
1ASAS ASASaxSpA
2009 512 1325p. 136
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7
2 definite 1
a3 bSchober 5 cm c 4 2.5 cm
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p.138
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8
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6
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PsAGRAPPAGroup for Research
and Assessment of Psoriasis and Psoriatic Arthritis CASPAR2006
615
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18
AS 1123 HLAB27 24 pathogenassociated molecular patternsPAMPs IL 17
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ASHLAB27 HLA B27 SpA 5HLAB27 4 HLAB27 CD8 HLAB27 killer cell
immuno-
globulinlike receptorKIR NK T HLAB27misfolding
IL23
a 1
3
1 X nraxSpAA nraxSpA AS AS Deodhar A, et alThe term nonradiographie
axial spondyloarthritis is much more important to classify
than diagnose patients with axial spondyloarthritis. Ann Rheum Dis
2016 791794.
Inflammatory back pain
nr-axSpA9.2%
a
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g
i
AS
HLAB27Th17 HLA B276 HLAB27 1.36.0%
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axSpA AS axSpA PsAIBD ReAnraxSpA
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X
nraxSpA AS AS X European Medicines AgencyEMA axSpA X 2012 20132014
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1
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43
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14nraxSpA
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AdministrationFDA nraxSpA 1 5CAXSPAND
6 2019 3 nraxSpA FDA nraxSpA X X grade 2AS SpA X 7
Calin A, et al.1 Rudwaleit M, et al.2 IBPASAS3
40 30
30
SPARCC MRI sacroiliac joint structural scoreSSS MRI
2005112015
Validation12 VAS MRI AS 411
1BASFI
cmBASFI
VAS 10 VAS10 cmASAS VAS 0 10 VAS10 cm 12p.143
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4
49
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ASAS 20 ASAS 40 ASAS 204 3 20 1010 20 1 010 ASAS 404 3 40
2010
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a
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9.8±0.47 100
3 axSpA 9.8±0.47 100
4 axSpA 9.4±0.91 93
5 axSpA axSpA 9.3±1.17 90
van der Heijde D,et al.2016 update of the ASASEULAR management
recommendations for axial spondyloarthritis. Ann Rheum Dis
2017 978991.
ing/pamphlet.pdf
etyASAS AS 42010 update5 2016 axSpA
update 2 21 NSAIDs NSAIDs SASP MTX csDMARDs NSAIDs BASDAI 4 ASDAS
2.1 TNF 2010 2018 12 IL17 201911AS TNF 6TNF1 IL172 TNF 37IL17
nraxSpA AS 2020 3 nraxSpA
1 NSAIDs
csDMARDs AS SASPAS 13SASP 1g 4g MTX1415 AS
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11 bDMARDs 2 B 9.1±1.57 97%
12
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13
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van der Heijde D, et al.2016 update of the ASASEULAR management
recommendations for axial spondyloarthritis. Ann Rheum Dis 2017
978991.
TNF NSAIDs AS 2 NSAIDs BASDAI 4 ASDAS 2.1 TNF 41 2020 3AS TNF TNF
BASDAIASDASMRI 1718
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2627
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37IL12/23p4038IL12/ 34p1939CD20 40 JAK AS 41 JAK1 AS 4243
AS QOL AS Andersson
lesion
d
XTNF IL 17
XCTMRI
on markers of inflammation and bone turn-
over and associations with bone mineral
density in patients with ankylosing spondy-
litis. Ann Rheum Dis 200968175182.
2Sidiropoulos PI, et al.Evidence-based
recommendations for the management of
ankylosing spondylitis: systematic literature
involving a broad panel of experts and prac-
tising rheumatologists. Rheumatology
psoriatic nail dactylitis PsA PsA PsA 3 AS HLAB27
SpA 1 pSpA
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1
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leeds dactylitis instrument
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activityMDA DAPSAlow disease activity LDA8,9g p. 76
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AhvonenReA 1 Reiter ReA LeroyFiessingerReiter 23Reiter ReA ReA
poststreptcoccal reactive arthritisPSRA Lyme ReA ReA 1999 ReA ReA
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ReA 100,000 45 67 712% ReA 81112 2016 38% ReA13 123 10.8% ReA14
8,145 ReAReA 0%
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17 HLAB27 ReA
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2
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AS PsA
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memo
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10
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PsA
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3 chronic widespread painCWSP FM 1
FM
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symptom severitySS 2010 3 widespread pain
indexWPI SS 3
3 FM 2010 1990 2010
1
2
110
SpA FM SpA 10.1% 3SpA SpA FM FM SpA
SpA FM
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N257
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1
2 18 11
2
4 kg
3
2
Wolfe F, et al.The American College of Rheumatology 1990 crite- ria
for the classification of fibromyalgiareport of the Multicenter
Criteria Committee. Arthritis Rheum 199033160172.
2
1990
Wolfe F, Smythe HA, Yunus MB, et alThe American College of
Rheumatology 1990 criteria for the classification of fibromyalgia
report of the Multicenter Criteria Committee. Arthritis Rheum 1990
33160172.
1
C57
2 2cm 4
111
3
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2
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2 SpAFM SpA FM ADL/QOL SpA TNF FM FM
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FMACR 1990
2010
ACR
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0% 5 ESRCRPHLAB27
FM ASAS 20095 FM axSpA 0% pSpA
4
Amor1990 14.9 24/161
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ASNY1981 definite
ReA1999 0 0/66
ESSGEuropean spondyloarthritis study groupAS PsANYNew York
ReA
5
114
HLAB27JSpA SpA 5.8±7.86107AS 6.7
8 JSpA101.442.1 910 JIA “PsA” “ ” 10 0.160.5 1112 SpA 16 850%13 AS
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ADE
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D
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York
NY JSpA 1Amor ESSGEuropean
Spondyloarthropathy Study Group 23 ASAS
ASAS23JPsA ILAR 58 70.9%2425CASPARclassification
criteria for psoriatic arthritis 59.8%25 JSpA 5
1 2 3 4 5 6
10 mg 10 mg 10 mg 10 mg 20 mg 20 mg 20 mg 20 mg 30 mg 30 mg 30
mg
136
Clinical criteria
1 Low back pain and stiffness for more than 3 months, not relieved
by test
2 Pain and stiffness in the thoracic region
3 Limited motion in the lumber spine
4 Limited chest expansion
Radiologic criterion
exclude bilateral osteoarthritis of the sacroiliac joints Definite
ankylosing spondylitis if
1 Grade 3 or 4 bilateral sacroiliitis with at least one clinical
criterion
2 At least four clinical criteria
bNew York, 1966
Diagnosis
1 limitation of motion of the lumber spine in all three planes
anterior flexion, lateral flexion, and extension
2 Pain at the dorsolumbar junction or in the lumber spine
3 Limitation of chest expansion to 2.5 cm or less measured at the
level of the fourth inter costal space
Grading of radiographs
Normal. 0suspicious, 1minimal sacroiliitis, 2moderate sacroiliitis,
3ankylosing, 4
Definite ankylosing spondylitis if 1 Grade 3 or 4 bilateral
sacroiliitis with at least one clinical criterion
2 Grade 3 or 4 unilateral or grade 2 bilateral sacroiliitis with
clinical criterion 1 or with both clinical criteria
2 and 3
Probable ankylosing spondylitis
Grade 3 or 4 bilateral sacroiliitis with no clinical criteria
2 ASAS
IBP
IBP 5 4 140 2 3 4 5
NSAID NSAIDs2448