Spondyloarthropathy

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

 

Inflammatory Arthritis Knee

 

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