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Info on seronegative spondyloarthropathies, including Sx, Ix, Dx, Mx
Background Information
Inflammatory condition mainly affecting the spine, causing fusion |
Causes stiffness and pain |
Main joints involved = SI joints and vertebral column |
90% have HLA-B27 gene |
Investigations
Raised CRP + ESR |
HLA-B27 |
Schober test |
Assesses mobility of spine between 10cm above L5 and 5cm below
<20cm indicates a restriction |
XR changes |
Bamboo spine
Squaring of vertebral bodies
subchondral sclerosis + eriosions
Syndesmophytes
ossification
fusion of facet, SI and costovertebral joints |
MRI |
Bone marrow oedema |
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Management
Medication |
NSAIDs
Steroids in flares
Anti-TNF or monoclonals (etanercept, infliximab)
Secukinumab (against IL-17) |
Other |
Physio
Exercise
Avoid smoking
Bisphosphonates
Treat complications
Surgery if deformities |
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Presentation
20 year old, gradual spinal stiffness over >3 months |
Lower back pain + stiffness |
Worse with rest/at night/in morning |
Takes 30 minutes for pain to improve in morning |
Experience flare ups |
Vertebral fractures |
Bamboo spine |
Associations
Systemic |
Weight loss, fatigue |
Chest pain |
Enthesitis |
Plantar fasciitis, achilles tendonitis |
Dactylitis |
Anaemia |
Anterior uveitis |
Aortitis |
Heart block |
Restrictive lung disease |
Pulmonary fibrosis of upper lobes |
IBD |
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