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1

Characteristics of Spondyloarthropathies

Inflammatory axial spine involvement
Asymmetrical peripheral arthritis
Enthesitis
Inflammatory eye disease
Mucocutaneous features
Negative RF
High frequency of HLA-B27 antibodies
Familial aggregation

2

Define Spondyloarthropathies

Group of inflammatory arthropathies that share distinctive clinical, radiographic, & genetic features

3

Types of Spondyloarthropathies

Ankylosing spondylitis
Reactive arthritis (Reiter's syndrome)
Psoriatic arthritis
Enteropathic arthritis (Crohn's & UC)

4

Define Ankylosing Spondylitis

Chronic inflammatory disease of the joints of the axial skeleton

5

Describe Ankylosing Spondylitis

Changes in SI joints & hips
Inflammation around enethesis

6

Extra-Articular Manifestations of Ankylosing Spondylitis

Anterior uveitis
Aortic valvular disease
Restricted chest expansion
Skin rashes

7

Diagnostic Features of Ankylosing Spondylitis

Insidious onset low back pain >3 months
Improves with exercise
Morning stiffness >30 minutes
Awakened by pain during 2nd half of the night
Alternating buttock or posterior thigh pain
Sites of enthesitis
Sacroiliitis on x-ray

8

Radiographic Changes in Ankylosing Spondylitis

Erosion & sclerosis of SI joints
Involvement of apophysial joints of the spine
Ossification of the annulus fibrosus
Calcification of the anterior & lateral spinal ligaments
Squaring & generalized demineralization of the vertebral bodies
"Bamboo spine"

9

Characteristics of Ankylosing Spondylitis

Male 20-40
Insidious onset
Chronic pain & stiffness of middle spine- referred to one buttock or back of thigh
Morning stiffness that improves with exercise

10

Criteria for Diagnosing Ankylosing Spondylitis

Limited lumbar motion
Low back pain >3 months
Reduced chest expansion
Bilateral grade 2-4 sacroillitis on x-ray
Unilateral grade 3-4 sacroiliitis on x-ray

11

Define Reactive Arthritis

Acute inflammation arthritis occurring 1-3 weeks after infectious event

12

Reactive Arthritis TRIAD

Arthritis
Urethritis (cervicitis)
Conjunctivitis

13

Complications of Reactive Arthritis

Acute anterior uveitis
Myocarditis
Fasciitis

14

Signs/Symptoms of Reiter's Syndrome

Arthritis
Enthesitis
Dactylitis
Dysuria
Pelvic pain
Conjunctivitis
Oral ulcers
Rashes
Nail changes
Genital lesions

15

Common Pathogens of Reactive Arthritis

Shigella
Salmonella
Yersinia enterocololitica
Campylobacter
Chlamydia trachomatis
C. pneumoniae
Ureaplasma urealyticum

16

Define Psoriatic Arthritis (PsA)

Chronic inflammatory arthropathy in setting of psoriasis

17

Nail Changes in Psoriatic Arthritis (PsA)

Pitting
Dystrophy
Onycholysis

18

Clinical Manifestations of Psoriatic Arthritis (PsA)

Inflammatory arthritis in DIPs
Asymmetric arthritis
Sausage digits
Onycholysis
No rheumatoid nodules
RF negative
Erosive arthritis without osteopenia
Sacroiliitis
Paravertebral ossification
Enthesopathy
Pencil & cup deformity

19

Treatment for Spondyloarthropathies

NSAIDs
PT, stretching & exercise
Maintain good posture
Sulfasalazine
Methotrexate
TNF inhibitors: Remicade, Humira, Enbrel
Prevent eye complications

20

NSAIDs effective for

Inflammatory back pain
Spinal stiffness
Peripheral arthritis
Enthesopathy

21

NSAIDs more Effective in Spondyloarthropathies

Penylbutazone
Indomethacine
Diclofenac

22

Use DMARDs When?

Anti-inflammatory therapy insufficient
Progression of inflammatory axial disease noted
Active persistent polyarthritis
Uncontrolled extra-articular disease

23

Medications for Uncontrolled Extra-Articular Disease

TNF inhibitors
Sulfasalazine
Methotrexate

24

Polymyalgia Rheumatica Characterized by

Aching & stiffness in the neck, shoulder & pelvic girdles

25

Epidemiology of Polymyalgia Rheumatica

Females > Males
Higher incidence at higher latitudes

26

Etiology of Polymyalgia Rheumatica

Polygenic
Multiple environmental & genetic factors
Possible viruses: adenovirus, RSV, parvovirus, parainfluenza
Possible bacteria: mycoplasma, chlamydia pneumoniae

27

Clinical Manifestations of Polymyalgia Rheumatica

Persistent pain >1 month
Aching & morning stiffness in neck, shoulders, & pelvis lasting 30 minutes
Bilateral discomfort: interferes with ADLs

28

Systemic Signs of Polymyalgia Rheumatica

Fever
Malaise/fatigue
Anorexia, weight loss

29

Distal Manifestations of Polymyalgia Rheumatica

Nonerosive, self-limiting, asymmetric arthritis
Carpal tunnel syndrome
Distal extremity swelling & pitting edema

30

Labs for Polymyalgia Rheumatica

ESR >40
CRP
Modest anemia
Mildly abnormal LFTs
RF & ANA negative
CK & CPK normal