Podcast
Questions and Answers
What is the recommended treatment approach for patients who fail to respond or cannot tolerate NSAIDs?
What is the recommended treatment approach for patients who fail to respond or cannot tolerate NSAIDs?
Which medication has no impact on spinal symptoms or disease progression in SpA?
Which medication has no impact on spinal symptoms or disease progression in SpA?
What is the typical age range and sex affected by Reactive arthritis?
What is the typical age range and sex affected by Reactive arthritis?
What is the characteristic skin feature of Reactive arthritis?
What is the characteristic skin feature of Reactive arthritis?
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What is the typical duration of the first attack of Reactive arthritis?
What is the typical duration of the first attack of Reactive arthritis?
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What is the likelihood of recurrent arthritis in patients with Reactive arthritis?
What is the likelihood of recurrent arthritis in patients with Reactive arthritis?
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What is the primary method of diagnosis for ankylosing spondylitis?
What is the primary method of diagnosis for ankylosing spondylitis?
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What is the frequency of uveitis in patients with Reactive arthritis during the first attack?
What is the frequency of uveitis in patients with Reactive arthritis during the first attack?
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What percentage of ankylosing spondylitis patients are usually positive for HLA-B27?
What percentage of ankylosing spondylitis patients are usually positive for HLA-B27?
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What is the typical presentation of Reactive arthritis?
What is the typical presentation of Reactive arthritis?
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What is the most common extra-articular feature of ankylosing spondylitis?
What is the most common extra-articular feature of ankylosing spondylitis?
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What is the primary reason for fatigue in ankylosing spondylitis patients?
What is the primary reason for fatigue in ankylosing spondylitis patients?
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What is the characteristic radiographic feature of ankylosing spondylitis in the thoracolumbar spine?
What is the characteristic radiographic feature of ankylosing spondylitis in the thoracolumbar spine?
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What is the primary goal of management in ankylosing spondylitis?
What is the primary goal of management in ankylosing spondylitis?
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What is the recommended treatment for ankylosing spondylitis patients with pain and inflammation?
What is the recommended treatment for ankylosing spondylitis patients with pain and inflammation?
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What is the primary role of physical therapy in ankylosing spondylitis management?
What is the primary role of physical therapy in ankylosing spondylitis management?
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What is the characteristic feature of Axial Spondyloarthropathy (AxSpA) visible on MRI?
What is the characteristic feature of Axial Spondyloarthropathy (AxSpA) visible on MRI?
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What is the primary distinguishing feature of SpA compared to RA?
What is the primary distinguishing feature of SpA compared to RA?
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What is the percentage of association with HLA-B27 in ankylosing spondylitis?
What is the percentage of association with HLA-B27 in ankylosing spondylitis?
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What is the typical symptom of Axial Spondyloarthropathy (AxSpA)?
What is the typical symptom of Axial Spondyloarthropathy (AxSpA)?
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What is the suggested pathogenesis of SpA?
What is the suggested pathogenesis of SpA?
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What is the characteristic feature of Axial Spondyloarthropathy (AxSpA) in its later stages?
What is the characteristic feature of Axial Spondyloarthropathy (AxSpA) in its later stages?
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What is the common feature of Reactive Arthritis (ReA)?
What is the common feature of Reactive Arthritis (ReA)?
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What is the association between Reiter’s disease and bacterial dysentery or chlamydial urethritis?
What is the association between Reiter’s disease and bacterial dysentery or chlamydial urethritis?
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Study Notes
Spondyloarthropathies (SPA)
- A group of inflammatory musculoskeletal diseases with overlapping clinical features, associated with HLA-B27.
- Includes axial spondyloarthritis (AxSpA), ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthropathy, enteropathic arthritis, and others.
Pathogenesis
- Aberrant response to infection in genetically predisposed individuals.
- Triggering organism may be identified (e.g., bacterial dysentery or chlamydial urethritis) or remain obscure.
Axial Spondyloarthropathy (AxSpA)
- Includes classical ankylosing spondylitis (AS) as well as axial spondyloarthritis.
- Characterized by inflammatory changes in the entire axial skeleton (visible on MRI), bony changes with syndesmophytes and ankylosis develop later.
- Symptoms include low back pain radiating to the buttocks or posterior thighs, early morning stiffness, and musculoskeletal symptoms at entheses.
Clinical Features of AxSpA
- Low back pain radiating to the buttocks or posterior thighs.
- Early morning stiffness exacerbated by inactivity and relieved by movement.
- Musculoskeletal symptoms may be prominent at entheses.
- Sacroiliitis and structural spinal changes are seen on X-ray, eventually progressing to bony fusion of the spine.
Reactive Arthritis (ReA)
- Affects young men, following an episode of bacterial dysentery or nonspecific urethritis (formerly known as Reiter’s disease).
- Present with acute-onset, inflammatory enthesitis, spinal inflammation, and/or oligoarthritis affecting the lower limbs.
- Symptoms of urethritis and conjunctivitis may be present.
Clinical Features of ReA
- Insidious onset of single joint involvement, minimal features of urethritis and conjunctivitis, and no clear history of trigger illness.
- Achilles tendinitis or plantar fasciitis may occur.
Skin and Nail Features of ReA
- Circinate balanitis: causes painless vesicles on the glans of the penis.
- Buccal erosions.
- Keratoderma blennorrhagica: waxy, yellow-brown skin lesions, particularly on the palms and soles.
- Nail dystrophy identical to psoriatic nail dystrophy.
Course of the Disease (ReA)
- First attack is usually self-limiting, with spontaneous remission within 2 to 4 months.
- Recurrent arthritis develops in more than 60% of patients.
- Uveitis is rare in the first attack but occurs in 30% of patients with recurring arthritis.
Investigations
- Diagnosis is made by MRI of the sacroiliac joints.
- X-rays show sacroiliitis with irregularity, sclerosis, joint space narrowing, and fusion.
- Ultrasound detects entheitis at the enthesis.
- ESR and CRP are usually raised in active disease but may be normal.
- HLA-B27 is usually positive in 95% of AS patients.
Management and Prognosis
- Patient education, NSAID use, and physical therapy with mobilizing exercises.
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Description
This quiz introduces spondyloarthropathies, a group of inflammatory musculoskeletal diseases with overlapping clinical features, including axial spondyloarthritis, ankylosing spondylitis, and psoriatic arthropathy.
