USMLE and Medical PG Entrance- Sponyloarthropathies

Hello Students, 

This topic is very important for USMLE and Medical PG entrance exam preparation. So let us discuss some important points related to this topic.

Spondyloarthropathies are disorders of joints which affect them over a long period of time and are chronic disorders. Some of the most important Spondyloarthropathies include Psoriatic arthritis, Reiter disease, Ankylosing spondylitis and  Enteropathic arthritis associated with Inflammatory Bowel Disease like Crohn disease. There can occur involvement of Spine, joints of arms and legs, intestines and eyes.There is involvement of ligament and tendons where they join the joints.

The common symptoms include, Low back pain, pain in joints of arms and legs, common in males over females, HLA B27 association.

Reiter Disease: It is characterized by Arthritis, Conjuctivitis and Urethritis which constitutes the Reiter Triad. There occurs involvement of Distal Interphalangeal joints of upper limb, and knee ankle joint involvement in lower limbs. There is urethritis and formation of vesicles over male genital organs i.e. Penile vesicles also called as Balanitis circinata, formation of vesicles over palms and soles called as Keratoderma Blanorhhagica.Eye disease is characterized by redness and watering due to conjuctivitis.

The Reiter disease results due to some infection with organisms like Shigella, Chlamydia, Yersinia, Ureaplasma, HIV and Salmonella. Doxycycline may be used for treatment.

Ankylosing spondylitis: This is one of the common causes of low back pain in adult population and more common in males of less than 40 years of age. 

The disease is characterized by low backache of more than 3 months which worsens in early morning.It is characterized by presence of HLA B27 positivity which is about 90% sensitive and 30-40 % specific for Ankylosing spondylitis.Extraarticular manifestations include Uveitis which is seen in around 30% of patients.Clinically Schoeber test is used for making a diagnosis of Ankylosing spondylitis. 

Radiology findings:

X-ray will show involvement of B/L symmetric sacroiliac joints characterised by inflammation i.e. Sacroileitis. In addition other changes include Bamboo spine, Trolly track appearance and Dagger sign which is characterized by ossification of interspinous ligaments.

Treatment for AS include NSAIDS like Ibuprofen and intraarticular injections of corticosteroids. In advanced disease, TNF alpha blockers like Infliximab, Etanercept, Adlumimab drugs may be used.

Psoriatic Arthritis:

 It involves small joints of hands and feet and sacroiliac joints which is asymmetric involvement of sacroiliac joint. It is destructive type of arthritis called as Arthritis mutilans. There can be involvement of less than four joints( Oligo articular disease) or more than four joints( Poly articular disease).There can be involvement of nails and it leads to pitting of nails.Methotrexate and Etanercept are used for treatment of Psoriatic arthritis.

 

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