ASAS Online Case Library // Demonstration of Case 33 by Denis Poddubnyy and Kay G. Hermann

A patient with advanced axial spondyloarthritis. Are his symptoms due to active inflammation or degeneration? Find it out and watch the video review of the case by Denis Poddubnyy and Kay G. Hermann.

You can view the case online in the ASAS online case library for free!
https://cases.asas-group.org/491570.html

This is the case of a 68-year-old male patient with known axial spondyloarthritis who presented with progressive back pain. In this case, imaging was used not only to confirm the correct diagnosis but also to determine whether the back pain was due to inflammation or other problems. Indeed, mechanical complications such as fractures of the bamboo spine, segmental osteochondrosis, or facet joint arthrosis can occur late in the course of ankylosing spondylitis.

MRI of the sacroiliac joints, in this case, showed evidence of bilateral ankylosis without inflammatory activity. At the same time, an MRI of the lumbar spine showed advanced SpA-related structural changes (including syndesmophytes/ankyloses) and a degenerated disc with reactive bone marrow edema in the L5/S1 segment. These changes are likely mechanical/degenerative in origin. The absence of other active inflammatory changes in the anatomic regions examined also suggests that the current complaints are not inflammatory in nature. The normal CRP value also indicates the absence of relevant inflammatory activity.

In this case, it was recommended to continue the treatment with NSAIDs and to apply physiotherapy, which resulted in a significant relief of symptoms after two weeks.

Bonus: In this video, Kay G. Hermann illustrates the different types of disc ankylosis in the context of axial spondyloarthritis.

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#spondyloarthritis #elearning #spine #sacroiliacjoint #asas

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0:00 Introduction
0:30 Case presentation
4:05 Sacroiliac joints
5:10 Spine
10:31 Discussion of findings
14:40 End