Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1362 Spondyloarthropathies

■Reiter’s syndrome: triad of arthritis, urethritis, conjunctivitis

■Assoc w/psoriasis or inflammatory bowel disease

History

■Firm diagnosis of spondyloarthropathy requires at least 1 of the

following:

➣Spinal pain esp. in low back, inflammatory in type (insidious

onset, <40 years of age at onset, persisting >3 months, improves

w/exercise, assoc w/morning stiffness)

➣Joint swelling in 4 or fewer joints; asymmetrical or predominantly

of the lower extremities

➣And one of the following additional features:

Positive family history of spondyloarthropathy, psoriasis,

inflammatory bowel diseases or iritis

Psoriasis

Inflammatory bowel disease

Urethritis, cervicitis or acute diarrhea within 1 month before

arthritis, alternating buttock pain

Enthesopathy (eg, Achilles tendinitis, plantar fasciitis or

sausage digits)

Other Features

■Unilateral iritis (∼30%)

■Mucocutaneous lesions: painless erythematous lesions of the glans

penis or oral mucosa (infrequent)

■Keratoderma blennorrhagica: lesions resembling pustular psoriasis

on the soles (infrequent)

■In advanced & severe disease:

➣Limitation of range of motion of lumbar and/or cervical spine

➣Decreased chest expansion

➣Flexion contracture of neck

➣Hip pain & limitation of motion

➣Aortic insufficiency (rare)

➣Cauda equina syndrome from arachnoiditis

tests

Blood Tests

■HLA-B27 is very helpful in 2 ways. If it is negative, the probability of

ankylosing spondylitis is very low. If a pt has inflammatory low back

pain & positive HLA-B27, there is a high probability of ankylosing

spondylitis even though other features are negative.