Category Archives: ankylosing spondylitis

What’s a “sausage finger” or “sausage toe”?

Many types of arthritis can cause a sausage digit.  The technical term for this is “dactylitis.”sausage-toe

This is not the kind of sausage you would have with your eggs and pancakes.

Sausage digits are typically seen in conditions such as psoriatic arthritis (the arthritis that accompanies psoriasis), Reiter’s disease, inflammatory bowel disease, and occasionally ankylosing spondylitis.  Of these, psoriatic arthritis is probably the most common culprit. Dactylitis means inflammation of an entire finger or whole toe.

It is caused by inflammation involving the synovium (lining of the joint) as well as the lining of the tendon sheath.  Tendons are tough fibrous bands that connect muscles to bones.  Most tendons glide through a lubricated sheath lined with synovium. When the synovium in the joint and the tendon sheath becomes inflamed, the entire finger or toe will swell.

The tendons that are most often affected are the tendons that allow a person to bend or flex their fingers or toes.

If a patient has dactylitis, their prognosis is poorer in that the joints are more likely to sustain damage.  The presence of dactylitis indicates a greater chance for disease progression.

Early on, dactylitis may be extremely painful.  However, over time, as destructive changes occur, the inflamed tissue is replaced with bony deformity and the dactylitis no longer causes severe pain.  However, the swelling persists.

The presence of dactylitis should prompt a diagnostic workup.  Diagnosis can be substantiated by magnetic resonance imaging (MRI).  Recently, diagnostic ultrasound has also been found to be helpful.

The treatment of dactylitis depends on the number of digits affected.  If only a few fingers or toes are involved, ultrasound-guided steroid injection can be helpful for the acute situation.

However, the more important part of treatment is to initiate disease modifying therapy as soon as possible.

Generally, the dactylitis is often accompanied by enthesitis.  This is inflammation at tendon insertions such as the Achilles tendon, patellar tendon (the tendon that connects the kneecap to the tibia-lower leg bone, and the iliac crest.

Every disease that causes dactylitis is a systemic disease.  This is because the underlying pathology involves an abnormal immune response. So other organ systems can become affected.  An example is the eye where uveitis- inflammation of the middle layer of the eye- can occur.  Uveitis is a potentially serious complication that can lead to blindness.

Institution of drugs like methotrexate or sulfasalazine (Azulfidine) may be useful.

However, most patients will require the use of biologic therapies.

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Are you at risk for the complications due to ankylosing spondylitis? Discover what they are…

Ankylosing spondylitis (AS) is an inflammatory form of arthritis that preferentially attacks the spine.  Many people are under the impression it’s one of the less serious forms of arthritis. Uh-uh.  Unfortunately, it has a number of potential complications associated with it.  These include:

  1. Acute eye inflammation, termed “uveitis”, in one-third of patients.  Symptoms include pain, redness, blurred vision, light sensitivity, and if left untreated, blindness.
  2. Osteoporosis occurring in a significant number of patients.  This is a condition where the bones become brittle and more likely to fracture.
  3. Approximately 10-15% of patients have inflammatory bowel disease such as Crohn’s or ulcerative colitis.
  4. Skin involvement occurs in as many as a quarter of patients.  The most common skin condition is psoriasis.
  5. AS can lead to conduction abnormalities in the heart as well as inflammation of the aorta.
  6. Fibrosis of the lungs can cause restrictive lung disease.
  7. Neurologic complications are due to compression of the spinal cord and can be life-threatening.
  8. Long term ankylosing spondylitis can cause a condition called amyloidosis of the kidneys leading to kidney failure.

Comment: Not such a benign condition is it?

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TNF Inhibitors and the Placenta… Which Should You Worry About During Pregnancy?

Mary Ann Moon writing in Rheumatology News reported on the conclusions of two studies. One concern rheumatologists have had is what to do about pregnant patients who are on TNF inhibitors.  Two observational studies (one from University California San Francisco and the other from Erasmus Medical Center, pregnant-womanRotterdam) provide some information.

The upshot is that stopping Remicade and Humira at the end of the second trimester reduces the amount of antibody transferred to the infant and shortens the time for the infant to clear the antibody. Cimzia doesn’t need to be stopped since it doesn’t cross the placenta.

Comment: This is important since it reduces the likelihood of opportunistic infection in the infant.

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What’s the cause of my back pain?

There are four categories of low back pain.  The first is mechanical back pain low-back-painwhich is the most common category.  This pain is made worse with movement and made better with rest.  It gets worse with prolonged sitting or standing.  It generally doesn’t radiate into the legs and there is no evidence of a neurologic problem.  The most common causes are ligament dysfunction, postural abnormalities, and osteoarthritis.

The second category is inflammatory spine pain.  The pain is worse in the morning and there is extended morning stiffness.  Movement and exercise make the pain better.  Examples of this type of pain are conditions such as ankylosing spondylitis.

Neurogenic back pain is the third category.  This is a mechanical type pain that radiates down the leg, often to the foot. Numbness and tingling are common.  The pain can be intense.  Neurologic exam shows evidence of reflex change and muscle weakness.  Maneuvers designed to stretch the sciatic nerve on exam make the pain worse.  The most common causes are disc herniation, osteoarthritis, fractures, and malignancy.

Systemic back pain comes from more serious causes such as infection, malignancy, or diseases affecting internal organs.  Pain is constant and unrelieved by rest.  Symptoms such as fever, chills, appetite loss, weight loss, and abdominal pain may provide clues to diagnosis.

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Are anti-TNF drugs worth the cost?

No question… anti-TNF drugs, the new biologics that are used to treat diseases like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, are expensive. Are they worth the cost?anti-tnf-drugs

A new study says they are…

Susan London writing in Rheumatology News reported that a study presented at the Canadian Rheumatology Association from the Alberta Biologics Pharmacosurveillance Program, showed that “patients achieving remission were significantly less likely to have had a recent hospitalization, had lower monthly costs for over-the-counter drugs, and were less likely to have been unable to do usual activities in the past month, to have needed help from others with activities of daily living in the past month, and to have had to reduce their work hours in the past six months because of poor health, compared to other patients with high disease activity.”

In essence, then what is the price you place on quality of life?

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Smoking makes ankylosing spondylitis worse

Data from two large studies, one from France and the other from the University cigarette-smokingof Rochester,  has shown that cigarette smoking worsens the course of anklylosing-spondylitisankylosing spondylitis causing earlier development of inflammatory low back pain, more inflammation, and a higher likelihood of developing x-ray changes showing damage to the sacroiliac joints in the spine.

For a long time we have known that smoking causes lung disease and this can aggravate the restrictive chest component in ankylosing spondylitis.  Now we have more evidence of the deleterious effects.

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