Spondyloarthropathies

Reiter's HLA B27

Psoriatic

Ankylosing spondylitis HLA B27

GI associated

Whipples dz

post Sx

IBD

Characteristics

seronegative (RF, ANA)

asymmetric joints

HLA b27 +ve -not screening test

extra-articular disorder

inflammation of ligaments & tendons

Rx

1st NSAIDs

indomethacin

2nd sulfasalazine, methotrexate or azithroprine

3rd methotrexate

uveitis - topical steroids

REITER'S SYNDROME/ reactive arthritis

3 signs

arthritis

conjunctivitis

urethritis often chlamydia

(uveitis)

1-3 wks after infection

diarrhea (Salm, Shig, Camph, Yersinia)

Genitourinary (non gonococcal)

painless mucocutaneous lesion on glans penis or soles of feet

inflammatory

HLA B27

Inv

opthalmologic exam

stool Cx

stool WBC

UA

C diff toxin if Hx of abx

urethral DNA probe

gonococcal (exclude)

chlamydia (include)

Rx

NSAID Indomethacin

if chlamydia - add tetracyclines (prolonged 3m)

if enteric S/S or not responding add sulfasalazine

intra-articular glucocorticoids - upto 2 joint involvement

PSORIATIC ARTHRITIS

Rash

Pencil in cup deformity on hand xray

Sausage finger

DIP

Spooning & pitting of nails

Rx

Rx psoriasis

Psoralen UV Rx

methotrexate

ANKYOSING SPONDYLOSIS

HLA B27

male>female

S/S

sacroillitis (Must!)

spinal Dx - fusion of vert

bamboo spine

large joints

eyes - uveitis

heart - aortic insufficiency

arrythmia

lung - pulmonary fibrosis

Imaging

SI joint x ray

sacroillitis

syndesmophtes

osteoporosis

bamboo spine

Rx

NSAID

strengthen back muscles

uveitis - pain,

photophobia,

decreased vision

ARTHRITIS OF IBD

peripheral at same time as IBD

spinal not at same time

Rx

Same