Spondyloarthritis of the Spine

Question 1

What are spondyloarthropathies?

Answer 1

• a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases affecting, but not limited to the spine and pelvis
• HLA-B27 is present in 8% of healthy white persons of which about 90% will never develop these diseases
• the risk for spondyloarthropathies amongHLA-B27 positive patients who have a first degree relative with ankylosing spondylitis is increased threefold
• in eskimo and inuit persons the prevalence of HLA-B27 is 25-40%

Question 2

Classification of spondyloarthropathy

Answer 2

1. 3 month duration
2. onset before age of 45
3. insidious gradual onset
4. improved with exercise
5. morning spinal stiffness

Question 3

Ankylosing Spondylitis- Definition

Answer 3

• inflammatory back pain caused by sacroilittis and inflammation in other locations of the axial skeleton
• manifestation in other organs such as heart are rare

Question 4

Ankylosing spondylitis- clinical features

Answer 4

• loss of spinal mobility
• insidious onset before 45yrs
• worsens with inactivity
• improvement with physical activity
• resultant tenderness over the S.I joint and the spine and sometimes sites such as heels, iliac crest, anterior chest wall
• positive family history
• history of acute anterior uveitis
• eye inflammation (uvea)
• hip involvement regarding a bad prognostic sign
• mostly occurs in lower limbs but not always

Question 5

Ankylosing Spondylitis- Diagnosis ( 4 criterion)

Answer 5

1. low back pain of atleast 3 month duration that improved by exercise and was not relieved by rest
2. limited lumbar spinal motion in sagital and frontal planes
3. chest expanison decreased relative to normal values for sex and age
4. bilateral/ unilateral sacroiliitis
   (number 4has to be present)

Question 6

Reactive Arthritis - Definition

Answer 6

• Aseptic peripheral arthritis occurring within 1 month of a primary infection elsewhere in the body, usually genitourinary infection

Question 7

Reactive arthritis- clinical features

Answer 7

• acute
• asymmetrical
• ocular inflammation
• dactylitis (sausage digits)
• mucocutaneous lesion
• carditis on are occassion
• conjunctivitis occurs in1/3 of patients

Question 8

What is Reiter syndrome

Answer 8

• traid of arthritis, conjunctivitis and urethritis

Question 9

Causes of bone overproduction in axial skeleton

Answer 9

• DISH
• Spondylosis
• Trauma
• Neuroarthropathies
• Acromegaly

Question 10

DISH- Clinical features

Answer 10

• some are asymptomatic others have acute or subacute episodes
• some complain of severe symptoms with no objective findings while others are the opposite
• dysphagia from oesophageal compression
• rigidity
• decreased mobility
• spinal column pain

Question 11

DISH- Definition

Answer 11

• Diffuse idiopathic skeletal hyperostosis is a degenerative disorder of unknown cause, affecting mostly older patients 48-85 yrs and male predominance

Question 12

DISH- Distinctive signs

Answer 12

1. vertebral bodies: exuberant paravertebral ossification; large osteophytes and bone ankylosis
2. intervertbral discs; normal or slightly reduced height
3. interapophyseal joints; normal or slightly sclerotic
4. sacro-iliac joint; para-articular osteophytes
5. peripheral skeleton; para articular osteophytosis, whiskering, calcification and/or ossification of ligaments, hyperostosis

Question 13

spondyloarthropathies consist of several disorders, what are these?

Answer 13

1. Reactive arthritis
2. psoriatic arthritis
3. arthritis associated with inflammatory bowel disease
4. ankylosing spondylitis