SPONDYLOARTROPATHIES

1. SPONDYLOARTROPATHIES Prof. Dr. Şansın Tüzün

2. Definition • A family inflammatory arthritides characterized by involvement of both synovium and entheses leading to spinal and oligoarticular peripheral artritis,principally in genetically predisposed (HLA B27 +) individuals • İnfective causes are considered likely • Ankylosing spondylitis, reactive arthritis, Psöriatic arthritis and enteropathic arthritis are the principle clinical entities

3. Clinical Features • Sacroiliitis or spondylitis may be dominant clinical problem • Peripheral arthritis is typically asymmetric and involves the lower limb • Entesopathy is prominent at both axial and peripheral skeletal sites

4. Inflammatory bowel disease-overt or covert-is common • Extra-articular features, including uveitis,carditis,skin and mucous membrane lesions,occur in the minority • Patients are seronegative for rheumatoid factor • HLA-B27 is present in most individuals

5. Classification Criteria for Spondiloarthropathy

6. Positive family history (AS, Psöriasis, Uveitis, reactive arthritis,inflammatory bowel disease) • Psöriasis • İnflammatory bowel disease • Urethritis or cervicitis(nongonococcal), or acute diarrhea • Buttock pain • Enthesopathy • Sacroiliitis

7. Enthesopathy • Pathologic alteration at an enthesis(a site of insertion of a tendon or ligament into bone • Manifests radiographically as ossification of entheses • Primer entesopathy (lat. Epicondylit, med. Epicondylit) • Sekonder entesopathy (with spondyloarthropathies)

10. ANKYLOSING SPONDYLITIS • Chronic systemic inflammatory disorder that mainly affects the axial skeleton • Sacroiliitis is its hallmark • Strong genetic predisposition with HLA-B27 • Primary; idiopathic

11. Clinical features • Typical presentation, is with low back pain of insidious onset • Age less than 40 years • Persistance for more than three months • Morning stiffness • İmprovement with exersize • Arthritis of hips, shoulders and entesopathies are common • Limitation of spinal mobility

13. Radiologic Findings • Squaring of the vertebral bodies • Bamboo spine • Osteopenia • Bilateral sacroiliitis

14. Acute anterior uveitis as an extra-articular manifestation • With psöriasis,chronic inflammatory bowel disease, reactive arthritis in some patients • Good symptomatic response to NSAID

22. Physıcal Examination • Muscle spasm and loss of the normal lordosis • Mobility of the lumber spine is decreased symmetrically in both anterior and lateral planes • Lomber schober < 3 cm

23. Peripheral joint involvement(%20-%30) hip-shoulder,especially • Enthesopathic features;plantar fasciitis achilles,tendinitis

28. Laboratory Findings • HLA-B27 (90%) (should not be used as a routine screening procedure) • ESR is frequently but not invariably elevated • There are no pathognomotic tests

29. New york Criteria For AS • 1-Presence of history of pain at dorsalumbar junction or in lumber spine • 2-Limitation of motion in anterior flexion, lateral flexion and extension • 3-Limitation of chest expansion to 2.5 cm or less at the fourth intercostal space

30. Requirements • Either one positive radiographs and one or more clinical criteria, or grade 3-4 unilateral or grade 2 bilateral sacroiliit with clinical criterion 2 or with clinical criteria 1 and 3

31. In Turkey 1436 persons studied, all of them were males and in 2 of them AS found • HLA-B 27 of these people are not studied • The prevelance of AS was %0.14 • In Canada this ratio was %6.20

32. Management • Early diagnosis, patient education and physical therapy are essential for the successful management of AS • The goals of physical therapy- to restore and maintain posture and movement to as near normal as possible

33. Self-management with exercises must be continued on a lifelong basis • NSAID relieve pain and stiffness and facilitate pyhsical therapy • Sulfasalazine appears to be the most effective of the second-line drugs

37. Comparison Of Spondyloarthropathies