Gout
No pathognomonic signs for gout
- identification of negative birefringent crystals under polarising light
- trial of indomethacin if suspected
Inflammatory Bowel Disease / Enteropathic
Crohn's & Ulcerative Colitis
- spinal manifestation similar to Ankylosing Spondylitis
- 15-60% of IBD
Two different forms
- mild & asymptomatic
- HLA B27 positive with progressive & aggressive disease
Colectomy does not improve spondylosis
Psoriasis
20% develop spondylitis
Reiter's Spondylitis
Men more common
- 3rd decade
- post infectious reactive arthritis
Back pain &/or Sacroiliitis
- 20-30%
- usually unilateral compared with Ankylosing Spondylitis
Xray
- see juxta-articular osteoporosis
- joint space narrowing & erosive changes
Behcet's Syndrome
Rare seronegative disease involving many systems
- oral & genital ulcers
- uveitis
- CNS involvement
- + arthritis, thrombophlebitis & skin lesions
Aetiology
- ? viral ? immunolgical
- endemic in parts east Europe and Asian
Clinical
- asymmetric appendicular arthritis especially knee
- sacroiliitis & spondylitis may occur
Alkaptonuria & Ochronosis
Inborn error of metabolism in which homogentisic acid can not be oxidised
A form of HA
- black deposit in tissues
- deposited in connective tissue containing hyaline & fibrocartilage
Most common spinal problem is spondylosis
- deposits in disc with ossification & marginal syndesmophytes
- SIJ usually unaffected
Neuropathic Spondyloarthropathy
Causes
- tabes dorsalis
- syrinx in cervical spine
Clinically
- deformity, instability, crepitation & hyper-mobility