Tubercular Arthritis Research Articles

Trends in scientific publications of Indian arthroplasty surgeons over 15 years (2001–2015)

BackgroundThe quality and number of scientific publications reflect the developmental status of research in a country. However, the contribution of Indian arthroplasty surgeons toward global research publications is unknown yet increasing. This study aims at determining the active role of Indian arthroplasty surgeons for scientific publications between 2000 and 2015. Materials and methodsA literature search of the publications by Indian arthroplasty surgeons was performed using PUBMED. The search terms used were India and several joint related terminologies. The main information of the selected papers including the scientific journal, publication year, type of pathology, or Orthopedic study center, type of study, and the type of article was analyzed. ResultsA total of 20,485 Total Hip Arthroplasty articles; 17,151 Total Knee Arthroplasty articles; 400 Total shoulder arthroplasty articles; and 250 Total Elbow Arthroplasty articles were identified using PUBMED and after exclusion, 68 Total Hip Arthroplasty articles; 125 Total Knee Arthroplasty articles; 2 Total shoulder arthroplasty articles; and 3 Total Elbow Arthroplasty articles were analyzed. A growth of 250% in the number of publications in THR & 530% in the number of publications in TKR was observed in the period between 2011 and 2015, during which 35 of the articles in THR, 82 in TKR were published. The three most common pathologies studied for knee were (osteoarthritis, post-traumatic arthritis and complex fracture of a knee); for hip were (osteoarthritis, avascular necrosis, developmental dysplasia of the hip and post tubercular hip arthritis). ConclusionThe current study concept reveals that publications in arthroplasty have been on growing rate in the last decade, although seems to be less. Further efforts such as research training of arthroplasty surgeons, international collaborations, and allocation of adequate funds, proper English tutorials are key factors to improve the scientific publications from India.

Rice bodies: a rare presentation of tubercular arthritis of the knee joint

Rice bodies are most of the times encountered in rheumatological disorders. They have also been seen in tuberculosis, though rarely. With tuberculosis, rice bodies are usually associated with bursae and tenosynovium and very rarely with large joints. We report a rare case of intra articular rice bodies associated with tuberculosis of the knee joint that mimicked monoarticular rheumatoid arthritis and pigmented villonodular synovitis clinically, with absent constitutional and laboratory features suggestive of tuberculosis.

Atypical presentation of intra-articular osteochondroma of knee in adolescent- case report

<p>Osteochondroma is most common benign bone tumor around knee joint. They occur during the period of growth, grows away from joint line and rarely responsible for mechanical symptoms. This paper reports a rare presentation of intra-articular osteochondroma in knee with mechanical instability symptoms, mild to moderate pain and swelling of knee joint. Patient was 20 years old male and misdiagnosed as chronic nonspecific synovitis, tubercular arthritis and anterior cruciate ligament tear of knee. We assessed him clinically and radiologically and diagnosis was established based on MRI and arthroscopy. He was treated by open excision of tumor, and patients recover uneventfully. Instability of knee joint in this case can be attributed due to rough surface of osteochondroma just beneath lower attachment of patellar tendon.</p>

Tubercular infection after arthroscopic rotator cuff repair.

Tubercular septic arthritis after shoulder arthroscopy has not been reported in the English literature to our knowledge. A case of Tubercular septic arthritis of the shoulder following arthroscopic rotator cuff repair is presented. The sinus and the wound healed well, and laboratory parameters returned to normal, which suggests that the infection was well controlled with the treatment follow-up of 1year. But the functional score was poor due to repeated surgeries; long-standing infection and the arthritic changes developed. Tubercular infection can occur after arthroscopic shoulder surgery especially in healthcare workers in zones endemic for Tuberculosis. Level of evidence V.

Rice bodies: a rare presentation of tubercular arthritis of the knee joint

Rice bodies are most of the times encountered in rheumatological disorders. They have also been seen in tuberculosis, though rarely. With tuberculosis, rice bodies are usually associated with bursae and tenosynovium and very rarely with large joints. We report a rare case of intra articular rice bodies associated with tuberculosis of the knee joint that was managed by joint lavage, debridement and anti tubercular therapy.

Magnetic resonance imaging evaluation of tubercular arthritis of the ankle and foot.

Ankle and foot tuberculosis is relatively uncommon. Magnetic resonance imaging (MRI) is highly sensitive in detecting the changes but there is limited experience with MRI evaluation and differentiation from other mono-articular arthritis, particularly pyogenic arthritis, is a challenge. To report MRI findings in ankle and foot tuberculosis. MRI was performed in 17 selected patients with ankle and foot tuberculosis. T1-weighted, proton density (PD) weighted, T2-weighted, and postcontrast sequences were performed in multiple imaging planes. Recorded findings included: number of bones involved; specific bones involved; extent of involvement; erosions; joint effusion, synovial thickening, tenosynovitis; joint effusion; adjacent soft-tissue changes; and involvement of sinus tarsi. Clinical data of all patients were also reviewed. Radiographic correlation at the time of MRI was available in selected patients. The most common abnormality was synovial thickening. Signal abnormality was noted most frequently in the talus (n = 14). Erosions and intra-osseous abscesses were noted in 10 (58%) and eight (47%) patients, respectively. Tenosynovitis was present in eight (47%) patients. Soft tissue changes were noted in all patients, including abscesses in 13 patients (76%). A multiplicity of findings (both osseous and extra-osseous) on MRI favors the diagnosis of tuberculosis. Three findings (intra-osseous abscess, soft tissue abscess, tenosynovitis), when present together, have a high sensitivity and specificity.

Magnetic resonance imaging findings in tubercular arthritis of elbow

ObjectiveTo evaluate magnetic resonance imaging (MRI) features of tubercular involvement of elbow joint. MethodsFourteen patients with tubercular arthritis of elbow were evaluated. The following findings were recorded on MRI (n=12): bones involved; erosions, intraosseous abscesses, synovial thickening, and effusion; hypointensity within the thickened synovium on T2-weighted images; and periarticular soft tissue changes. ResultsThe common abnormalities on MRI were synovial thickening and bone erosions (n=12), soft tissue (n=9)/intraosseous (n=5) abscesses, and T2 hypointensity within the thickened synovium (n=5). ConclusionsA diagnosis of elbow tuberculosis should be considered if there is a combination of findings involving bone and soft tissue.

Total knee replacement in triple deformity with posterior subluxation of the knee joint

Dislocation or subluxation following total knee arthroplasty has been extensively reported, but vice versa that is total knee replacement for subluxed or dislocated knee has not been published. Triple deformity of knee that is flexion, external rotation, valgus at knee associated with posterior subluxation of tibia occurs in rheumatoid arthritis, advanced tubercular arthritis and neglected posttraumatic residual dislocated knee. A 50 year old female with seropositive rheumatoid arthritis had the above disabling deformity in left lower limb and varus with medial tibial thrust in the other. Bilateral total knee arthroplasty was planned. Conservative method of reduction of left knee posterior subluxation preoperatively by 90-90 skeletal traction failed; hence patient was subjected to a staged bilateral total knee replacement using an innovative technique. The most difficult and determining initial surgical step of knee replacement in such dislocated/subluxed knee is reduction of posterior subluxation and gaining flexion at knee, as only after gaining flexion and reducing dislocated tibia, will we be able to do knee arthroplasty in triple deformity of knee. These knees are grossly unstable as most of the capsule-ligamentous structures are attritioned/non-existent. So, a fine balance of bone cuts and soft-tissue release needs to be done in a sequential manner to fine tune valgus and posterior subluxation correction without jeoparadising neurovascular structures. After 3 years of knee arthroplasty the patient has painless, stable knee with good range of motion and is able to do all her activities, of living in a hilly terrain.

Total hip replacement for arthritis following tuberculosis of hip.

To present the results of total hip arthroplasty (THA) for post tubercular arthritis of the hip joint. Sixty-five patients (45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years (range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded. The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years (range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min (range, 65-125) whereas the mean blood loss was 600 mL (range, 400-900 mL). The average follow up was 8.3 years (range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabular protrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There were no other complications recorded. Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip.

Ankle arthrodesis in tubercular arthritis using anterior bridge plating: A report of 2 cases

Ankle arthrodesis is a common procedure for tubercular arthritis in India. However, attaining fusion in osteoporotic bones is difficult to achieve by both external and internal fixation methods described in the literature. We report two cases for ankle arthrodesis using an anterior approach to the ankle and internal fixation with a bridging anteriorly placed AO L/AO T plate. Both ankles were fused. The surgical technique is simple, easily reproducible and gives excellent results.

Isolated calcaneocuboid joint tuberculosis: A rare case report

Tubercular arthritis affecting the foot is uncommon. Isolated calcaneocuboid joint tuberculosis has never been reported in the literature. Herein we report a case of 43-year-old male who presented with insidious onset pain in hindfoot of 4 months duration. Radiograph revealed destruction of calcaneocuboid joint along with cuboid. Computed Tomography scan further consolidated the findings. Diagnosis was confirmed from aspiration from joint with culture of mycobacterium tuberculosis. Anti-tubercular chemotherapy was started and good clinical response was noted. We reported this case because of its rarity to involve calcaneocuboid joint and the excellent outcome with medical treatment.

Image of the Month: Answer

Journal of Paediatrics and Child HealthVolume 49, Issue 2 p. 162-162 ViewpointFree Access Image of the Month: Answer First published: 18 February 2013 https://doi.org/10.1111/jpc.12096_2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Radiological findings are consistent with a diagnosis of synovial chondromatosis, confirmed by histological findings after synovectomy. Synovial chondromatosis is an uncommon, monoarticular, proliferative disease of the synovium that usually affects large joints. The disorder is characterised by the presence in the synovial space of multiple highly cellular cartilaginous nodules, that results from metaplasia of the synovial tissue. As the disease progresses, the cartilaginous nodules become partially calcified, the synovium thickens and the joint surfaces may become eroded. Only when calcification of nodules occurs, radiographs reveal radiopaque loose bodies within the joint. Initially MRI can be negative, because in unmineralised synovial chondromatosis the signal intensity of the nodules resembles that of fluid.1 Malignant transformation has been reported. Clinical manifestations can mimic a monoarticular JIA since, as in our case, it may be characterised by recurrent relapses and remissions. Repeating a radiograph is therefore mandatory in all cases of oligoarticular JIA characterised by frequent relapses. The differential diagnosis should consider tubercular arthritis.2 Knee tuberculosis is characterised by a chronic indolent monoarthritis resulting in destruction of the joint. Tuberculin skin test and culture of the synovial fluid confirm the diagnosis. Other conditions to be considered are intra-articular chondroma and synovial sarcoma, which require histologic evaluation. Synovial fluid examination, MRI and biopsy might be useful to exclude pigmented villonodular synovitis, haemarthrosis, vascular malformation, foreign body synovitis and sarcoidosis. The treatment of synovial chondromatosis is surgical. Open surgery or arthroscopic intervention is performed with resection of the diseased synovium and removal of any loose intra-articular bodies. Recurrence is frequent after partial synovectomy, hence total synovectomy has been suggested as the preferred treatment.3 References 1 Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27: 1465– 1488. CrossrefPubMedWeb of Science®Google Scholar 2 Kiritsi O, Tsitas K, Grollios G. A case of idiopathic bursal synovial chondromatosis resembling rheumatoid arthritis. Hippokratia 2009; 13: 61– 63. CASPubMedWeb of Science®Google Scholar 3 Jesalpura JP, Chung HW, Patnaik S, Choi HW, Kim JI, Nha KW. Arthroscopic treatment of localized synovial chondromatosis of the posterior knee joint. Orthopedics 2010; 33: 49. CrossrefPubMedGoogle Scholar Volume49, Issue2February 2013Pages 162-162 ReferencesRelatedInformation

Loose bodies in right elbow joint: Post traumatic? or post infective?

Tuberculous osteomyelitis after open fracture is uncommon. Early diagnosis of tubercular arthritis is difficult because of insidious onset, indolent process and mild or non specific local or systemic symptoms. This case report describes the fibrinous loose bodies in elbow joint of a patient who sustained a compound fracture presented with chronic non healing discharging sinus. Intra-operatively some suspected seed like bodies were removed and sent for histopathological examination which showed circumscribed homogenous fibrinous bodies with focal area of hyalinization and few embedded tiny osteolytic fragments. Acid Fast Bacilli staining was positive. The patient had a good recovery after treatment with anti-tuberculosis drugs.

Use of amplified Mycobacterium tuberculosis direct test (Gen-probe Inc., San Diego, CA, USA) in the diagnosis of tubercular synovitis and early arthritis of knee joint

Background:The diagnosis of knee joint tuberculosis, especially in early stages of synovial disease, has more often been based on clinicoradiological suspicion, with no single test claiming to be a dependable rapid diagnostic test with high sensitivity and specificity. Nuclear amplification tests in vogue like the polymerase chain reaction have shown variable sensitivity and false positivity rates in various studies. We evaluated the role of Amplified Mycobacterium tuberculosis Direct Test (AMTDT) or Genprobe in the diagnosis of knee joint tuberculosis in early, especially, early synovitis and arthritis cases.Patients and Methods:Thirty two patients of suspected knee joint tuberculosis were subjected to diagnostic arthroscopy during the study period. The synovial fluid and tissue were subjected to mycobacterial culture, histopathology, and AMTDT. A comparative analysis of the sensitivity and specificity of this new test with culture and histopathology was done and the time taken for reporting was calculated for each test.Results:Out of 32 tissue samples, 8 were found to be positive with mycobacterial culture [Lowenstein Jensen (LJ)/Bactec], 11 were positive with histopathology, and 5 were found to positive with AMTDT. The sensitivity of AMTDT was found to be 62.5% and specificity was 100% with a P value of 0.083. The results were obtained earliest with AMTDT with a mean reporting time of 1.2 days, while the results of histopathology were obtained in a mean time of 6.8 days, BacT alert in 22.5 days, and conventional LJ medium culture results in 48.6 days.Conclusion:AMTDT or Genprobe is a rapid diagnostic test for early diagnosis of tubercular arthritis, but has low sensitivity in knee joint tuberculosis. Nuclear amplification tests are still far from being a single promising alternative to conventional tests in cases of joint tuberculosis. Routine use of arthroscopic biopsies in all suspected cases is helpful in the early diagnosis of knee joint tuberculosis.

Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision.

Context:Arthritis is an important cause of morbidity, presenting as monoarticular or polyarticular lesion. Arthroscopic synovial aspiration and biopsy can help in arriving specific etiological diagnosis.Aim and Objectives:To evaluate the efficacy of arthroscopic synovial biopsy as a diagnostic aid and study the characteristics of synovial fluid in various joint diseases.Materials and Methods:Arthroscopic synovial biopsy along with synovial fluid analysis was studied in 30 of the 50 enrolled cases arthritis. The fluid was subjected to physical, biochemical, and cytological analysis.Results:Both rheumatoid (n = 14, 28%) and tubercular (n = 13, 26%) arthritis were found to be more common compared to other etiologies. Next common etiology observed was chronic nonspecific synovitis (n = 10, 20%). Clinicopathological correlation was seen in 34 out of 50 cases. As a diagnostic tool, synovial biopsy had a sensitivity of 85%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%.Conclusion:Arthroscopic synovial biopsy is a simple and easy to perform technique and is an important useful investigative adjunct that may give conclusive diagnosis where clinical diagnosis is equivocal.

Hydroxyapatite crystal deposition causing rapidly destructive arthropathy of the hip joint

Destructive arthropathy of the hip joint can be attributed to various etiologies like rheumatoid arthritis, aseptic necrosis of the femur head, Charcot's joint, subacute septic arthritis, and tubercular arthritis. A disease that results in much rapid destruction of the hip joint and is not associated with clinical syndrome of above mentioned disease has been reported way back in 1970. However, no evidence-based study has been published to support hydroxyapatite (HA) crystals as a probable cause of rapidly destructive arthropathy of the hip joint. We report a case with microscopic and biochemical confirmation of HA crystal deposition causing destructive arthropathy of the hip joint.

IgG RF and anti-CCP2 antibody can be positive in undifferentiated arthritis due to streptococcal infection, hepatitis B virus, tuberculosis, trauma and hypothyroidism: a preliminary study

Anti-CCP2 antibody and rheumatoid (RF) tests are used for the diagnosis of rheumatoid arthritis (RA). Out of these two, anti-CCP2 antibody is supposed to be more specific for RA. Aim of the study was to present 33 cases of undifferentiated arthritis (UA) in which features of RA were not present, but anti-CCP2 antibody was positive. Out of the 33 cases of UA, 19 had well-known disease like hyperthyroidism, hypothyroidism, tubercular arthritis, traumatic arthritis, pneumonia with arthritis, varicose vein with pain in legs, cervical spondylitis and SSA. The duration of disease was more than one year in 67.86% cases. Majority of the patients were females (63.64%). Knee joint involvement was seen in maximum number (i.e. 20 cases). All 33 cases were positive for anti-CCP2 Ab. Maximum number of cases (78.78%) had involvement of one or two joints. CRP positivity was seen in 23.07% cases. Morning stiffness was present in (36.36%) cases, while swelling of the joint was present in 33.33% cases. In 16 cases, only serum sample was available for further analysis. About 62.5% cases showed IgG RF positivity. Antitubercular IgM and IgG were detected in 18.75% cases; ASO was elevated in 12.5% cases, and HBs Ag was positive in 6.25% cases. None of the controls (30 cases) were positive for these infections, anti-CCP2 antibody or RF. Thus, our study concludes that chronic infections like streptococcus, hepatitis B, tuberculosis and autoimmune thyroid diseases can produce raised levels of anti-CCP2 antibody and IgG RF.

Tri-compartmental tubercular arthritis of knee masquerading as popliteal fossa tumor: a case report

A 50-year old woman of moderate socioeconomicstatus presented to the outpatient clinic of the Ortho-paedics Department at NEIGRIHMS, Shillong, India,complaining of gradual onset of swelling at the back ofher right knee and flexion deformity of the same knee for6 months.She had experienced dull aching pain from 1–2monthsaftertheappearanceof theswelling.Thepainwasgradually increasing and the patient had suffered sleepdisturbance due to pain for the last 2 weeks. She gave ahistory of feeling feverish, especially in the evenings, andof loss of appetite for the last month with no history ofweight loss . The patient did not have symptoms pertain-ing to any other joint. There was no history of swelling,paresthesiae or weakness of the right leg, foot or ankle,and no history of chest pain, cough or hemoptysis, orexposure to tuberculosis.Physical examination revealed atender globular swelling which was soft to firm in consis-tency and measured 6 cm ¥ 8 cm in the right poplitealfossa.Wasting of the right thigh and leg was present. Theskin over the swelling was normal with no dischargingsinus around the knee. There were no dilated veins. Thelocal temperature was not raised. Both medial and lateraljoint lines were tender. There was no joint effusion orsynovial thickening. The patella had restricted mobilitybut was non-tender.The range of motion (flexion) of theknee was from 30

Primary cemented total hip arthroplasty: 10 years follow-up.

Background:Primary cemented total hip arthroplasty is a procedure for non-traumatic and traumatic affections of the hip. Long term follow-up is required to assess the longevity of the implant and establish the procedure. Indo-Asian literature on long term result of total hip arthroplasty is sparse. We present a 10-year follow-up of our patients of primary cemented total hip arthroplasty.Materials and Methods:We operated 31 hips in 30 patients with primary cemented total hip arthroplasty. We followed the cases for a minimum period of 10 years with a mean follow-up period of 12.7 years. The mean age of the patients was 60.7 years (range 37–82 yrs) male to female ratio was 2:1. The clinical diagnoses included - avascular necrosis of femoral head (n=15), sero positive rheumatoid arthritis (n=5), seronegative spondylo-arthropathy (n=4), neglected femoral neck fractures (n=3), healed tubercular arthritis (n=2) and post traumatic osteoarthritis of hip (n=2). The prostheses used were cemented Charnley’s total hip (n=12) and cemented modular prosthesis (n=19). The results were assessed according to Harris hip score and radiographs taken at yearly intervals.Results:The mean follow-up is 12.7 yrs (range 11-16 yrs) Results in all operated patients showed marked improvement in Harris hip score from preoperative mean 29.2 to 79.9 at 10 years or more followup. However, the non-inflammatory group showed more sustained long term improvement as compared to the inflammatory group, as revealed by the Harris hip score. Mean blood loss was 450ml (±3.7 ml), mean transfusion rate was 1.2 units (±.3). The complications were hypotension (n=7), shortening >1.5 cm (n=9), superficial infection (n=2) and malposition of prosthesis (n=1).Conclusion:The needs of Indian Asian patients, vary from what is discussed in literature. The pain tolerance is greater than western population and financial constraints are high. Thus revision surgery among Indian-Asian patients is less compared to western yard sticks.

O7 Our experience with 26 cases of tubercular arthritis

Las espondiloartritis comprenden un conjunto de enfermedades que comparten en gran medida sus características clínicas y su etiopatogenia. Las enfermedades que pertenecen a este grupo son la espondilitis anquilosante, la espondiloartritis axial no radiográfica, la espondiloartritis periférica, la artritis psoriásica, la artritis reactiva y la asociada a enfermedad inflamatoria intestinal (EII).En su patogenia se ven implicados varios factores, como la microbioma intestinal, el HLA-B27 y el eje IL23-IL17. Generalmente comienzan con dolor axial inflamatorio y/u oligoartritis de miembros inferiores, junto con dactilitis y entesitis. La manifestación extraarticular más frecuente es la uveítis.Existen unos nuevos criterios clasificatorios desarrollados por el grupo ASAS para poder realizar un diagnóstico y tratamiento precoz de estos pacientes, mejorando de esta manera la calidad de vida, la rigidez matutina y el dolor articular.El tratamiento debe realizarse de forma escalonada, comenzando con los antiinflamatorios no esteroideos. Según la respuesta y la afectación del paciente, se pueden emplear fármacos modificadores de enfermedad, infiltraciones articulares y fármacos biológicos como los antifactor de necrosis tumoral y secukinumab. El tratamiento no farmacológico con fisioterapia y el abandono del hábito tabáquico deben recomendarse en todos los pacientes.Spondyloarthritis (Spa) is the term used to describe patients with similar clinical features. There are ankylosing spondylitis, non-radiographic axial SpA (nr-axSpA), peripheral SpA, psoriatic arthritis, reactive arthritis and arthritis associated with gastrointestinal disease.In the pathogenesis of spondyloarthritis are involved gut microbiome, HLAB27 and the axis interleukin 23-interleukin 17. Patients with Spa have usually chronic inflammatory back pain, oligoarthritis in the lower extremities, dactylitis and enthesitis. Uveitis is the most frequent non-musculoskeletal disease.There are new classification criteria developed by the Assessment of Spondiloarthritis International Society (ASSAS). It allows us to make a diagnosis and early treatment of these patients, thus improving the quality of life, the morning stiffness and pain.The treatment should be phased, starting with nonsteroidal anti-inflammatories. According to the response, and the involvement of the patient, disease modifying drugs, infiltrations articular and biological agents may be used. Non-pharmacological treatment with physiotherapy and the abandonment of the smoking habit should be recommended in all patients.