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Questions and Answers
What is the term for the tissue attaching tendons and joint capsules to bone?
What is the term for the tissue attaching tendons and joint capsules to bone?
Which of the following is a characteristic of Ankylosing Spondylitis?
Which of the following is a characteristic of Ankylosing Spondylitis?
What is the name of the disease characterized by acute arthritis associated with an infection?
What is the name of the disease characterized by acute arthritis associated with an infection?
What is the name of the disease seen in 5-42% of psoriasis patients?
What is the name of the disease seen in 5-42% of psoriasis patients?
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What is the result of healing in Enthesis?
What is the result of healing in Enthesis?
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What is the classification of Ankylosing Spondylitis related to inflammatory bowel disease?
What is the classification of Ankylosing Spondylitis related to inflammatory bowel disease?
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What is the term for the radiograph grading system used to diagnose Osteoarthritis?
What is the term for the radiograph grading system used to diagnose Osteoarthritis?
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What is the name of the disease traditionally referred to as the idiopathic spondyloarthropathy?
What is the name of the disease traditionally referred to as the idiopathic spondyloarthropathy?
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What is the typical sex ratio for Psoriatic Arthritis?
What is the typical sex ratio for Psoriatic Arthritis?
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Which of the following is a characteristic radiological feature of Ankylosing Spondylitis?
Which of the following is a characteristic radiological feature of Ankylosing Spondylitis?
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What is the typical age range for men to develop Reiter's syndrome?
What is the typical age range for men to develop Reiter's syndrome?
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Which of the following radiological features is commonly seen in Psoriatic Arthritis?
Which of the following radiological features is commonly seen in Psoriatic Arthritis?
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What is the primary pathology in Ankylosing Spondylitis?
What is the primary pathology in Ankylosing Spondylitis?
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Which of the following is a frequent sign of Reiter's syndrome?
Which of the following is a frequent sign of Reiter's syndrome?
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What is the primary pathology in Reiter's syndrome?
What is the primary pathology in Reiter's syndrome?
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What is the typical age range for Psoriatic Arthritis?
What is the typical age range for Psoriatic Arthritis?
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Which of the following is a common symptom of Ankylosing Spondylitis?
Which of the following is a common symptom of Ankylosing Spondylitis?
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Which of the following is a frequent sign of Psoriatic Arthritis?
Which of the following is a frequent sign of Psoriatic Arthritis?
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In Reiter's disease, which of the following is a characteristic feature?
In Reiter's disease, which of the following is a characteristic feature?
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Which of the following is a characteristic of Ankylosing Spondylitis?
Which of the following is a characteristic of Ankylosing Spondylitis?
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In Psoriatic Arthritis, which of the following is a characteristic X-ray finding?
In Psoriatic Arthritis, which of the following is a characteristic X-ray finding?
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Which of the following is a common extra-articular manifestation of Ankylosing Spondylitis?
Which of the following is a common extra-articular manifestation of Ankylosing Spondylitis?
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Reiter's disease is often associated with which of the following?
Reiter's disease is often associated with which of the following?
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In Psoriatic Arthritis, which of the following is a common feature?
In Psoriatic Arthritis, which of the following is a common feature?
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Which of the following is a characteristic of Inflammatory Bowel Disease (IBD)-associated arthritis?
Which of the following is a characteristic of Inflammatory Bowel Disease (IBD)-associated arthritis?
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In Ankylosing Spondylitis, which of the following is a goal of rehabilitation?
In Ankylosing Spondylitis, which of the following is a goal of rehabilitation?
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Which of the following is a common feature of Reiter's disease?
Which of the following is a common feature of Reiter's disease?
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In Psoriatic Arthritis, which of the following is a characteristic skin lesion?
In Psoriatic Arthritis, which of the following is a characteristic skin lesion?
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Study Notes
Ankylosing Spondylitis (AS)
- Spine is usually stiff in flexion
- Iritis (inflammation of the uveal tract) and aortic valve disease are common
- Goal of rehabilitation is to keep the patient functional as long as possible
- Exercises aim to maintain erect posture or stiffness in extension
- Exercise helps maintain aerobic capacity
- In females, involvement of the hip is common
- Arthroplasty done in AS commonly develops post-op heterotopic ossification
New York Criteria for AS (1984)
- History of inflammatory back pain
- Onset is insidious
- Duration is more than 3 months before medical consultation
- Morning stiffness
- Improvement with exercise and activity
- Limited lumbar mobility in both sagittal and frontal planes
- Limited chest expansion (less than 4 cm or more)
- Definite radiographic sacroiliitis
Epidemiology
- Affects young adults (F:3:1)
- Gradual onset
Clinical Manifestations
- Skeletal findings:
- Axial arthritis (sacroiliitis and spondylitis)
- Arthritis of girdle joints
- Peripheral arthritis (uncommon)
- Enthesopathy
- Extraskeletal findings:
- Acute anterior uveitis
- Cardiovascular involvement
- Pulmonary involvement
- Cauda equine syndrome
- Enteric mucosal lesion
Course and Outcome
- Generally, a variable course
- Good prognosis in females
- Poor prognosis with onset in adolescence
- Severe early disease
- Presence of extraarticular complications
- Complete cervical ankylosis with kyphosis
- Lifespan is usually normal
- Potential complications:
- Cervical spine fracture
- Cauda equine
- Pulmonary fibrosis
- Prostatitis
- Aortic insufficiency
- Heart block
Reiter's Disease
- Classic triad of arthritis, urethritis, and conjunctivitis (now uncommon)
- Varied presentation from monoarthritis to severe multisystem disease
- History of antecedent infection or new sex partner
- Constitutional symptoms:
- Fatigue
- Malaise
- Low-grade fever
- Weight loss
- Manifestations:
- Asymmetric, additive arthritis
- Often affects knee, ankle, subtalar joint, MTP, toe, and IP
- Dactylitis or sausage digit (diffuse swelling of one finger or toe)
- Tendinitis and fasciitis (plantar fascia)
- Low back pain
- Urogenital lesions
- Prostatitis
- Ocular:
- Conjunctivitis
- Uveitis
- Musculo-cutaneous lesions:
- Oral ulcers
- Keratoderma blenorrhagica (characteristic skin lesion of Reiter's)
- Nail changes:
- Onycholysis
- Distal yellowish discoloration
- Hyperkeratosis
Course and Outcome
- 30-60% have persistent joint symptoms
- 25% will have disabilities
- Tendency for recurrence
- Chronic heel pain
- Yersinia infection has a better prognosis
Psoriatic Arthritis
- Arthritic problem may present as tendinitis, enthesitis, or synovitis
- Affects both peripheral and spinal joints
- Often asymmetric, but symmetric involvement is not uncommon
- Spinal involvement is usually asymmetrical, so more responsive to exercise
- Prescribe high toe box if involving toes
- Heel lift and arch support are helpful for associated plantar fasciitis
- For spinal involvement:
- Injections for costochondral joint pain
- Superficial heating
- Spine extension exercises
- Koebner or isomorphic phenomenon is a finding seen in dermatologic psoriasis
- X-ray findings:
- Similar to RA: soft tissue swelling, loss of cartilage space, erosion, bony ankylosis of fingers, subluxations, and subchondral cysts
- But less demineralization
- Unique, highly suggestive findings:
- Erosion at DIP joints
- Base of terminal phalanx expanded
- Proximal phalanx tapered
- Distal terminal phalanx cup-like erosions and bony proliferation (pencil-in-cup appearance)
- Proliferation of the bone near osseous erosions
- Terminal phalangeal osteolysis, bone proliferation, and periostitis (especially of phalanges)
Outcome
- Asymmetric and spondylitic subgroups have a better prognosis
- Symmetric type: 50% develop arthritis mutilans
Inflammatory Bowel Disease (IBD)
- Refers to the enteropathic type of spondyloarthropathy
- Equal male and female predilection
- Presents as symmetric, migratory, polyarthritis affecting mainly the large joints
- Predominant spondylitis is more common in males
- May be seen in Crohn's disease, colitis, and other inflammatory bowel diseases
- Radiograph grading system for OA:
- Grade 0: normal
- Grade 1: doubtful
- Grade 2: minimal
- Grade 3: moderate
- Grade 4: severe
Spondyloarthropathies
- Definition: a group of clinical conditions that have:
- Spondylitis
- Inflammatory peripheral arthritis
- Positive HLA-B27 antigen
- Negative Rheumatoid factor (seronegative)
Classification of Spondyloarthropathy
-
- Primary Ankylosing Spondylitis
-
- Secondary Ankylosing Spondylitis
- a. Reactive arthritis (Reiter's disease)
- b. Psoriatic arthritis
- c. Enteropathic arthritis
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Description
This quiz covers the symptoms, diagnosis, and treatment of Ankylosing Spondylitis, a chronic inflammatory disease that affects the spine. It also touches on the goals of rehabilitation and exercises to maintain aerobic capacity.
