The spondyloarthritides

Question 1

characterised by

Answer 1

The seronegative spondyloarthropathies are

a group of disorders characterised by;

1. involvement of the sacroiliac joints with an ascending spondylitis
2. extraspinal manifestations such as;

• oligoarthritis
• enthesopathies

Question 2

Typical features

Answer 2

Young men 15–30

Aching throbbing pain of inflammation

LBP radiating to buttocks

Back stiffness, esp. in mornings

Absent lumbar lordosis

Positive sacroiliac stress tests

Question 3

Diagnosis confirmation:

Answer 3

X-ray of pelvis (sacroiliitis)

Bone scans and CT scans

ESR usu. elevated

HLA-B27 antigen positive in >90%

Question 4

Treatment

Answer 4

The earlier the better the outlook for the pt

the prognosis is usually good.

Advice on good back care and posture

Exercise programs to improve the range of movement

Drug therapy, esp. tolerated NSAIDs (e.g. indomethacin)

Sulfasalazine—a useful second-line agent if the disease progresses despite NSAIDs. Consider methotrexate and other DMARDs, including biological agents.

Urgently refer any pt with suspected acute uveitis to ophthalmologist