Inflammatory Arthopathies

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