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發炎性背痛之診斷新進展 魏 正 宗  MD., PhD. 中山醫學大學附設醫院過敏免疫風濕科主任 中藥臨床試驗中心主任 醫學研究所副教授
Outlines ,[object Object],[object Object],[object Object],[object Object]
Diagnosis of AS / SpA ,[object Object],[object Object],[object Object],[object Object],[object Object]
下背痛 ,[object Object],[object Object],[object Object]
下背痛的臨床診斷 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Royal National Hospital for Rheumatic Diseases, Bath, UK.
指導教授 Andrei Calin 是僵直性脊椎炎臨床研究的權威, 已出版兩百多篇論文及數本教科書。
 
 
 
Inflammatory back pain is key feature of axial SpA Back pain IBP SpA AS
脊椎關節炎 Spondyloarthritis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic clues for SpA ,[object Object],[object Object],[object Object],[object Object],[object Object]
Finger to floor test
 
Posterior SI  compression test Patrick test
Enthesopathy, dactylitis
Uveitis Psoriasis Extra-articular manifestations of SpA
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dougadous, 1991
International Congress on Spondyloarthropathy Gent, Belgium
 
Anterior Squaring of  vetebral bodies Syndesmophyte Corner enthesitis X ray finding of spondylitis
Lt: AS with bamboo spine Rt: Diffuse idiopathic skeletal  Hyperostosis(DISH)
Three Problems of the MNY criteria ,[object Object],[object Object],[object Object]
 
 
HLA-B27, when to test? ,[object Object],[object Object]
薦腸關節炎 sacroiliitis
Rt side grade 3 sacroiliitis Lt side grade 2 sacroiliitis
Sacroiliitis Osteiitis condensans ilii
 
 
 
 
A breakthrough in diagnosis
 
Chronic low back pain  (5% probability of axial SpA)   Inflammatory back pain   yes  (14% probability) no  (<2% probability) HLA-27 No further testing unless SpA is strongly suspected because of the presence of other features.  Presence of other SpA-features: heel pain (enthesitis), dactylitis, uveitis, positive family history, Crohn‘s disease, alternating buttock pain, psoriasis, asymmetrical arthritis, positive response to NSAIDs, acute phase reactants (elevated ESR/CRP) MRI Axial SpA** pos (80-90%) neg (<10%) Consider other diagnosis X-rays pos neg AS HLA-27 ,[object Object],[object Object],1-2 SpA feature(s)  (35-70%)* no SpA feature  (14%) pos (59%) neg (<2%) pos (80-95%) neg (<15%) Consider other diagnosis Axial SpA**
Take home message Diagnosis of SpA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you 魏正宗  MD,PhD.       中山醫學大學附設醫院過敏免疫風濕科 Tel: 0975128095  Email: wei3228@gmail.com

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