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3.1 Inflammatory Spine Pain, pain - Coggle Diagram

- - - - anti-TNF antibodies
      - MRI
      - x-ray
      - CT scan
      - radionuclide bone scan
    - - oedema around vertebrae
      - kyphotic spine
      - calcification of vertebral ligaments
      - erosion / calcification of sacroiliac joints
  - - - IBD associated , 1/7 IBD pts will get an inflamm psoriasis
      - psoriatic arthritis
      - ankylosing spondylitis
      - reactive arthritis
    - - peripheral involvement: i.e. distal joints of fingers & feet
    - - uveitis
        synovitis
        pulmonary fibrosis
        IBD
        psychiatric disorders
- - - - 8-9 years
      - longer for females bc M:F = 2:1
    - - 2/4
        
        nocturnal back pain, 2nd half of night ONLY
        
        alternating buttock pain
        
        improvement @ exercise , worsening @ rest
        
        morning stiffness >30 min
    - - acute pain, radicular radiation => mechanical/degenerative disease
      - absence of inflammation in pelvis & lumbosacral spine, doesn't exclude early spondyloarthropathies, as it takes years
  - - - raises risk of AS
      - only 0.1% of pop have AS
  - - - TNF blocker
        
        infliximab, etanercept, adalimumab - genetically engineered
        
        €10-15k /pt/annum
        
        SE:
        
        infection mgmt
        
        TB activation
        
        non melanoma neoplasma
        
        only prevent X-ray progression w good exercise
      - IL-17 blockade (e.g. secukinumab)
      - JAK-STAT inhibitors
    - - ineffective