Diseases
1. Reiter's Disease
2. Ankylosing Spondylitis
3. Psoriatic Arthritis
4. Enteropathic Arthritis
Clinical overlap between them
- typically young men with asymmetric lower limb oligoarthritis
- associated with HLA B27
Reiter's Disease
Definition
Reactive arthritis after veneral infection or dysentery
Young man with triad of
- oligoarticular arthritis
- urethritis
- conjunctivitis
Epidemiology
Almost exclusively young males
- M:F 10:1
- age 16-35 years
Aetiology
Obscure
- ? infectious trigger in genetically predisposed
- Shigella or Salmonella
- Mycoplasma or Chlamydia
HLA B27
- 75%
Clinical
Arthritis
- acute / asymmetrical
- usually knee & ankle
- settles after 2/52 & disappears after 3/12
- 50% have chronic disease
Tendonitis
- inflammation at tendinous insertions
- heel pain / plantar Fasciitis / achilles tendinitis
- back pain
Urethritis
- may be asymptomatic
Conjunctivitis & Iritis
Investigations
Raised ESR
HLA B27 75%
Psoriatic arthritis
Definition
Inflammatory arthropathy associated with psoriasis
- 7% of patients with psoriasis
NHx
Often less aggressive
- typically DIPJ more involved
- may have less synovitis but bone and soft tissue destruction still occur
Classification
1. Classic - Involvement of DIPJ jts of hands
2. Deforming - with ankylosis & arthritis mutilans
3. RA like - similar to RA but without RF
4. Monarthritis
5. Ankylosing Spondylitis like
Pathology
Joint changes sim to RA
Spine & SIJ changes sim to AS
Clinical
Joints
- usually mild asymmetrical polyarthritis
- IPJ of hands & toes
Skin
- typical skin lesions of Psoriasis
- usually precede arthritis
- scaling erythematous papules
- scalp, elbows & knees
Nails
- 80% have nail changes compared with 30% with psoriasis alone
- pitting / subungual keratosis / transverse ridging
X-ray
Hands
- periarticular phalangeal erosions along phalangeal shaft with scalloping
- P3 tuft resorption & whittling (acro-osteolytis)
- typical 'Pencil in cup' deformity of DIPJ
SIJ
- indistinguishable from AS
Large joints
- similar to RA
Treatment
Similar to RA
Enteropathic arthritis
Definition
Inflammatory arthropathy associated with IBD
- Crohn's
- Ulcerative Colitis
Incidence
Arthropathy in 15% of IBD
Spondyloarthropathy in 5% IBD
Clinical
Peripheral arthritis
- acute migratory attacks ~ 1 / year
- associated with flare of IBD
- affects large joints
- transient / lasts < 1 month
- non-deforming
- synovitis only
Spine
- classic AS
- persists if present
- treatment IBD does not treat spinal symptoms
Treatment
Treatment of IBD causes arthritis to abate
- sulphasalazine effective