General features
- -ve for Rheumatoid Factor
- Genetic predispostion
- Initiated by environmental factors
- eg. infectious trigger
- Manifestations are
- immune mediated T cell response
Spondyloarthropaties
- Definition
- A group of inflammatory arthropathies that share distinctive clinical, radiological and genetic features
- The 4 main diseases
- Ankylosing Spondylitis
- Reiter’s disease (reactive arthritis)
- Psoriatic arthritis
- Enteropathic arthritis
- Crohn’s disease
- Ulcerative colitis
- Whipple’s disease
- History
- physical examination
- Inflammation of the axial joints
- sacroiliitis
- spondylitis
- Peripheral arthritis
- Enthesitis
- inflammation at tendinous or ligamentous attachment
- Inflammation of the insertion points (entheses) of ligaments, tendons, fascia and fibrous joint capsule
- leading to fibrosis & ossification of the insertions
- Rheumatoid Arthritis attacks the synovial membrane
- HLA-B27 +ve
- HLA B-27 +ve
- Basic pathology is enthesitis
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1) Ankylosing spondylitis
- General
- Chronic inflammation of the axial joints
- Sacroiliac joints ascending to cervical spine
- Starts in the 2nd/3rd decade
- Insidious/gradual onset
- Men:women, 5:1
- 90% are HLA-B27 +ve
- Classical triad of symptoms
- inflammatory low back pain
- immobility
- morning stiffness
- Typical presentation
- young man with
- low back pain
- immobility
- morning stiffness
- Extraspinal manifestation
- enthesitis
- high impact areas
- around hips, ankle
- uveitis
- blurry vision
- painful red eye
- excessive lacrimation
- watery eye
- peripheral arthritis
- Complications
- spinal fusion
- bamboo spine
- aortic valve insufficiency
- Investigation
- AP Xray
- bamboo spine
- sacroiliac joint fusion (pelvis)
Bamboo Spine
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2) Reactive arthritis
- Classic triad
- arthritis
- uretritis/vaginitis
- conjunctivitis
- Typically an acute arthritis 1-3 weeks after an infective event
- Urogenital
- Chlamydia
- Ureaplasma urealyticum
- Gastrointestinal/Enteric
- shigella
- salmonella typhimurium
- campylobacter
- idiopathic
- Molecular mimicry
- Unexpected sharing of limited aminoacid sequence
- between bacterial antigen and self protein
- Common aminoacid sequence between HLA-B27 molecule and
- Klebsiella nitrogenase protein
- arthrogenic Shigella plasmid peptides
- HIV & Reactive arthritis
- HLA-B27+ HIV+ patients
- have a more severe form of reactive arthritis
- The incidence is decreased by the use of antivirals
- Not associated with Ankylosing Spondylitis/uveitis
- Features
- Arthritis usually
- asymmetrical
- oligoarticular
- few joints involved
- Circinate balanitis
- in male patients
- A form of skin inflammation around the penis
- The skin around the shaft and tip (glans) penis can become inflamed and scale
- Self-limiting course
- less than 6 months
- Can be chronic and intermittent
- Decreasing incidence due to increase use of condoms
- Complications
- Acute anterior uveitis
- inflammation of middle layer of the eye
- Carditis
- Bony proliferation
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3) Psoriatic Arthritis
- General
- Chronic inflammatory arthropathy & psoriasis
- occurs together
- Occurs in 5 – 10% of patients with psoriasis
- Typically distal interphalangeal joint involvement
- pencil in cup deformity
- Nail changes are prominent
- pitting
- discolouration
- dystrophy
- onycholysis
- Course
- a chronic destructive arthritis in 30% of patients
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4) Enteropathic arthritis
- General
- 5% – 20% of patients with chronic inflammatory bowel disease
- Risk increases with
- extent of colonic involvement
- presence of other extra-intestinal manifestations
- Peripheral arthritis parallels disease in gut
- but not the spinal disease
- Gut disease may be asymptomatic especially ileatis
- an inflammation of the ileum
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Lyme disease
- Only chronic inflammatory arthritis with a known aetiology
- Borrelia burgdorferi
- Can be cured
