Related Subjects:
|Monoarticular arthritis
|Polyarticular arthritis
|Seronegative Spondyloarthropathies
|Ankylosing spondylitis
|Enteropathic Spondyloarthritis
|Reactive Arthritis
|Psoriatic Arthritis
Inflammatory arthritis spine and/or joints
without the presence of rheumatoid factor
or CCP antibodies
About: Characteristics
- Axial skeleton involvement
- An insidious onset inflammatory lower back pain
- Age 45 or younger
- Asymmetrical peripheral arthritis
- Inflammation of the enthesis
- Strong association with HLA B27 but relevance unclear
Aetiology
- Relationship with HLA B27
Several Different types
- Axial spondylarthritis/Ankylosing spondylitis
- Reactive arthritis (Sexually acquired/Reiter's syndrome/Dysentery)
- Psoriatic arthritis: nail changes and skin changes seen
- Arthritis with inflammatory bowel disease (UC/CD)
Major criteria
- Inflammatory back pain - lower back pain and Morning stiffness - relief by exercise but not by rest.
- Oligo arthritis (asymmetric) of the lower limbs - knees or ankles asymmetrical
Minor criteria
- Enthesitis - inflammation of the tendon and ligament insertion into bone
- Alternating buttock pain
- Preceding symptomatic infection
- Psoriasis, Crohn-like gut lesions
- Dactylitis - inflammation of a whole finger (usually psoriatic)
- Anterior uveitis, Family history
Investigations
- FBC, ESR: Elevated CRP/ESR
- Presence of HLA B27
- CT/MRI: Radiographic evidence of sacroiliitis - sclerosis, erosions, fusion. MRI can often detect sacroiliitis earlier.
- Positive findings of urogenital infection or gastroenteritis
Management
- Physiotherapy and daily morning stretching and strengthening exercises to maintain flexibility and prevent fixed syndesmophyte formation and calcification
- Slow release NSAIDS taken at night can help reduce morning stiffness
- Orthopaedic surgery to correct spinal deformities
- Sulphasalazine, Methotrexate helps peripheral disease but not the spinal disease
- TNF alpha-blockers can reduce pain and inflammation
- Uveitis may need topical or systemic steroids
- Treat any Chlamydial infection
References