Demonstrating case #31 of the ASAS Online Case Library // by Dr. Kay G. Hermann

This is a manifestation of axial spondyloarthritis (radiographic form) in a 45-year-old patient.
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The challenge was to assess the pain of the thoracic spine, which occurred despite seemingly sufficient therapy with TNF blockers over many years. In case of long-standing disease, late complications have to be considered in addition to pain related to the primary condition (i.e., resulting from inflammation associated with loss of response to a bDMARD). These include degenerative changes in the last open segments of the bamboo spine, insufficiency fractures of the bamboo spine due to osteoporosis and loss of flexibility of the vertebral column, or cauda equina syndrome, in which the nerve roots are caked together due to many years of inflammation, resulting in accumulation of cerebrospinal fluid in the pockets of the spinal roots.
All these complications are not present here, but it is a matter of remaining inflammation in one of the thoracic vertebral segments. Here, in addition to bone marrow edema as seen on MRI, erosions, incipient ankylosis, and sclerosis are present, as shown by low-dose computed tomography.
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#spondyloarthritis #elearning #spine #sacroiliacjoint #asas
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