Inflammatory Spondyloarthropathy (2)

Question 1

What are the 3 common features of this family of conditions?

What is the most common type in this family?
→ What are the other types?

Answer 1

➊ • Inflammation, pain and stiffness in spine and pelvic joints
• Enthesitis – Inflammation at the insertion point of a ligament/tendon
• HLA-B27 gene

➋ Ankylosing Spondylitis
→ Psoriatic arthritis, Reactive arthritis, Enteropathic arthritis (related to IBD), and Bechet’s disease

Question 2

Ankylosing Spondylitis:
What occurs here?

How does it present?

What is a key complication with this?

What are the extra-articular complications?

Answer 2

➊ Progressive stiffness and pain in spine and pelvis due to inflammation

➋ • Lower back pain – Often early morning stiffness (worse with rest, better with movement), with tenderness of sacroiliac joints
• Peripheral enthesitis can occur in 1/3 pts – e.g. Achilles tendonitis, Plantar fasciitis

➌ Vertebral fractures

➍ • Anterior uveitis
• Aortitis – Can lead to AR
• Upper lobe PF – Reduced chest expansion

Question 3

Investigations:
Which bloods should be done?

What may be seen on a Lumbar XR?
→ How may this progress in late disease?

What special test could be done?

Management:
What is involved in it?

Answer 3

➊ CRP/ESR

➋ Vertebral bodies may become squared, with bony bridges (syndesmophytes) forming between them, and ossification of spinal ligaments
→ There may be complete fusion of the vertebral column → Bamboo spine

➌ Schober’s test (assess for any restricted lumbar movement)

➍ Management – NSAIDs, Steroids, Physio, Exercise, Stop smoking, Treat complications
• Steroid injections as an adjunct