Tasty Morsels of EM 051 – Spondyloarthropathy

15 May

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure. This one from a recent training day with a rheumatologist. Some is literature based some his good old fashioned doctoring and experience.

  • can be axial (think ank spond) or peripheral (think psoriatic)
  • most important ones
    • ankylosing spondylitis
    • reactive arthritis (formerly Reiter’s)
    • arthritis of inflammatory bowel disease (enteropathic arthritis)
    • psoriatic
  • enthesitis (tendons or ligs into bone) and dactylitis are distinctive features
  • lots of systemic features/associations
    • uveitis
    • skin rash
  • For ank spond MRI will show the SI joint changes so much earlier than plain films and you’re likely wasting your time with plain films (my own opinion on that one)
  • NICE Guidelines suggest diagnosis of ank spond based on radiological and clinical evidence. Beware of unilateral sacroilitis as it’s often infective (esp IDU)
  • Psoriatic
    • nail disease v common
    • back pain, dactylitis and enthesitis all common
    • psoriatic skin changes prior to the arthritis in 60%

 

References:

  • Excellent rheumatology lecture somewhere in the midlands of Ireland Spring 2015
  • Rosen’s 8th Edition Chap 115

 

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