Summary Spondyloarthropathies

Spondyloarthropathies
Friday, 8 May 2020 08:52



~ Predominantly axial, asymmetrical, sero-negative arthritis
(related disorders with shared genetic predisposition and shared
musculoskeletal phenotype)

- Ankylosing spondylitis
- Reactive arthritis
- Psoriatic arthritis
- Enteropathic arthritis

Common features of spondyloarthritis

Pathology • ↑T cell and macrophages at sites of inflammation with ↑IFNγ
and TNFα production
• Primary event thought to be enthesitis
• HLA-B27 gives x20 ↑risk → tendency for familial aggregation

Presentation General
- Fatigue
- Anorexia
- Weight loss

Musculoskeletal
- Asymmetrical inflammatory oligoarthritis (lower > upper
limb)
- Axial spondyloarthritis
- Sacroiliitis
- Enthesitis
- Dactylitis

Extra-articular
- Mucosal inflammation: conjunctivitis, ulceration (buccal &
bowel), urethritis, prostatitis
- Pustular skin lesions & nail dystrophy
- Anterior uveitis
- Aortic root fibrosis (aortic incompetence, conduction
defects)
- Erythema nodosum

Investigations Syndesmophytes - paravertebral ossifications that run parallel
with spine (c.f. osteophytes which protrude perpendicular) →
squaring

, defects)
- Erythema nodosum

Investigations Syndesmophytes - paravertebral ossifications that run parallel
with spine (c.f. osteophytes which protrude perpendicular) →
squaring

Treatment 1. Physiotherapy & NSAID
2. DMARD for persistent peripheral joint involvement
(methotrexate, leflunomide, sulfasalazine)
3. Biologics: anti-TNF (adalimumab, etanercept) or IL-17
(secukinumab) for resistant psoriatic arthritis or ankylosing
spondylitis