Back & Neck | BJC Health Connected Care

Spondyloarthritis: Demonstrating Lumbar Lateral Flexion 0

By Dr Irwin Lim, Rheumatologist

The response to our Modified Schober Test demonstration was great, with over 700 views so far!

Our patients with inflammatory back pain have Spondyloarthritis or the prototype condition, Ankylosing Spondylitis.

While the Modified Schober Test is a well known examination used for these diseases, the restriction measured with forward flexion can be a late event.

Often, the loss of lumbar spinal movement is seen earlier and more markedly in lateral flexion. This video demonstrates this examination.

Rachael Butterworth, our Spondyloarthritis physiotherapist demonstrates on our model, Errol while Dr Roberto Russo facilitates.

We’ve created a range of videos highlighting some of the examination techniques used to help make a diagnosis in spondyloarthritis. You can find these on our Youtube channel.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

Arthritis requires an integrated approach. We call this, Connected Care. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 01-8-2012
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory, Back & Neck

Demonstrating the Modified Schober Test 3

By Dr Irwin Lim, Rheumatologist

We see a lot of patients with inflammatory back pain in our clinics. Some of these patients have Spondyloarthritis or the prototype condition, Ankylosing Spondylitis.

Given our expertise in this area, we’ve decided to create a range of videos highlighting some of the examination techniques used to help make a diagnosis. You can find these on our Youtube channel.

Rachael Butterworth, our Spondyloarthritis physiotherapist demonstrates on our model, Errol while Dr Roberto Russo facilitates.

This video is an example, and highlights the Modified Schober Test, a test commonly used to help measure the lumbar spine flexibility (or lack of).

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

Arthritis requires an integrated approach. We call this, Connected Care. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 12-7-2011
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory, Back & Neck, Physiotherapy

When is your back pain INFLAMMATORY? 0

Lumbar Spine Xray showing syndesmophytes

Dr Roberto Russo, Rheumatologist

The characteristic presenting symptom in the majority of patients with Spondyloarthritis (a group of diseases with the prototype being Ankylosing Spondylitis) is inflammatory back pain.

The definition of inflammatory back pain has been debated for many years. No single clinical feature of back pain is sufficiently specific nor sensitive and as such composite criteria have been developed.

The Calin criteria, published in 1977, suggested inflammatory back pain is present when back pain has 4 of the following 5 features:

Age at onset <40 years
Duration of pain > 3 months
Insidious onset
Improvement in pain with exercise
Presence of morning stiffness

The Berlin criteria followed in 2006, which defined inflammatory back pain as present when 2 of the following are present:

Morning stiffness >30 minutes
Improvement in back pain with exercise but not with rest
Alternating buttock pain
Waking during the second half of the night

Most recently, in 2009, the Assessment in SpondyloArthritis international Society (ASAS) gathered a panel of experts who put forward the following criteria:

Age at onset <40 years
Insidious onset
Improvement with exercise
No improvement with rest
Pain at night (with improvement upon getting up)

The ASAS group found that when 4 of the 5 features are present, the back pain was very likely to be inflammatory in nature (sensitivity of 77% and specificity of 91%).

In subsequent studies, the ASAS criteria was found to have the best overall performance, where as the Calin criteria was most sensitive and the Berlin criteria most specific.

In essence if patients present with back pain and have a number of the features presented above, then a spondyloarthritis should be considered and referral to a Rheumatologist is most appropriate.

Dr Roberto Russo is both a rheumatologist and a nuclear medicine physician, as well as a director of BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.

Posted on: 10-16-2011
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory, Back & Neck, Psoriatic Arthritis

iAnkylosingSpondylitis is here! 5

By Irwin Lim, Rheumatologist

It was a wet long weekend, October 2010. I was searching the itunes store for apps to showcase on my ipad and lamenting the fact that there were so few useful apps for rheumatologists. I then found iSpineCare. A large download but definitely worth it. Gorgeous animation of the cervical and lumbar spine, both anatomy and pathology. This was going to be useful in my practice.

I decided that weekend that I wanted to help create a rheumatology specific app. So, I contacted the man responsible for iSpineCare, Dr John Hart of Anatomate-Apps.

Fate. He lived in Sydney, on the same side of the Harbour Bridge as me.

A number of mobile phone exchanges, a flurry of emails, help from our BJC Health team (Errol Lim, Roberto Russo & Herman Lau) and 8 months of work by the Anatomate-Apps crew. It’s here!

A special thank you to Karen Howard & Abbott pharmaceuticals for providing sponsorship to help Anatomate-Apps fund development.

iAnkylosingSpondylitis

This app is unique in highlighting the disease, Ankylosing Spondylitis, in an innovative and exciting way. We hope it will help generate awareness of this relatively common cause of spinal pain, a disease which is so commonly under-diagnosed & unrecognised.

iAnkylosingSpondylitis includes sections with the latest clinical, diagnostic and treatment information, with bulleted points & a voiceover.

It’s a large download at 697MB! This download is free ~~and the free unlocked section is useful. An in-app purchase can and should be made by most, as it unlocks much more detailed content, with a whole lot of multimedia.~~ As of August 2011, the full version is sold on the iTunes store as iAnkylosingSpondylitis Pro.

The full version contains a large medical imaging library, exercise animation library, and pdfs on history taking, physical examination, assessment tools (printable), medication information, and practice points.

There are wonderful animations highlighting both normal anatomy and the pathology involved in Ankylosing Spondylitis.

iAnkylosingSpondylitis should be really useful for rheumatologists, rheumatology nurses, medical educators, medical students, family physicians, chiropractors, osteopaths & physiotherapists. We also think that patient advocates as well as patient support groups will find it useful.

It would be wonderful if people who have Ankylosing Spondylitis find it helpful to further their understanding of their condition.

Download iAnkylosingSpondylitis on iTunes. Please tell us what you think.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 07-1-2011
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory, Back & Neck, Social Media & Communication

Ankylosing Spondylitis: “Wonder Drugs” do exist! 2

By Irwin Lim, Rheumatologist

It’s (almost) true. Yes, doctors do tend to prescribe medications, and all medications have potential side effects. However, this is one example of medication which is truly life changing. In this case, the benefits can far outweigh the risks.

Ankylosing Spondylitis (AS) is a chronic disease characterised by inflammatory low back pain and stiffness. Over time, this spinal inflammation leads to progressive spinal restriction, with pain, deformity and loss of the ability to perform the daily activities that we take for granted.

The whole spine can be involved. The disease can also target other areas, including arthritis at the joints of the upper and lower limb (commonly at the hips or knees). It can cause inflammation of the eye (uveitis), and inflammation at the region where tendons insert into bone (enthesitis). The lungs, heart and gastrointestinal tract can also be affected.

For many years, treatment was limited to exercise and anti-inflammatory medication (NSAIDs & Cox-2 inhibitors). These remain very useful. However, a significant number of patients have persistent, debilitating symptoms.

Tumour necrosis factor-alpha (TNF) is a potent chemical (cytokine) produced by the immune system. TNF seems to be a key player in causing the manifestations of Ankylosing Spondylitis. Drugs which block the action of TNF have essentially revolutionized the management of AS.

And yet, many patients and doctors remain unaware of these new biologic agents as highly effective treatments for rheumatic disease. This is a shame as in AS in particular, they are life-changing.

In Australia, the TNF inhibitors available for use in Ankylosing Spondylitis include Infliximab, Etanercept, Adalimumab and Golimumab. Infliximab is given by intravenous infusion while the other 3 are self-administered injections.

These are powerful drugs, with their own set of problems. The cost is prohibitive, currently more than A$20,000 a year. They have a range of potential side effects, some nasty, such as severe infections.

And yet, in most cases, the benefit greatly outweighs the risk.

Patients respond quickly, sometimes within a week. The improvement is usually marked, and most importantly, patients report a vast improvement in quality of life.

Often, to a degree they didn’t think possible after years of suffering. Ask an AS sufferer who responds to these drugs, and the person will very likely agree that “wonder drugs” do exist.

If you suffer from Ankylosing Spondylitis, please go and find out more. Use the internet. See a rheumatologist. Things have changed a lot.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.

Stop Press: For Physiotherapists only. Attend the BJC Health Professional Development Seminar on February 20, 2011. Register to attend and link or join the professional page on Facebook. Our Hootcourse will also be online soon. Details on Facebook.