2. COMMON FEATURES
• Negative rheumatoid factor( sero negative)
• No subcutaneous nodules( highly pathognomic in RA)
• Strong familial inheritance- HLA B27+ve (60-95 percent)
• Radiological sacroilitis
3. CLINICAL PICTURE
• Young and middle age men (<40 years)are commonly involved
• Skeleton: primarily axial skeleton involved
sacroiliac joints
Vertebral joints
• Peripheral joints : oligoarticular and assymetric
Erosive type of arthritis
lower limb commonly involved
• Enthesopathy; inflammation of tendon sheaths at insertion site to bone
are charecteristic
5. IT’S A FAMILY OF RAPE RS
• REITERS SYNDROME (REACTIVE ARTHRITIS)
• ANKYLOSING SPONDYLITIS
• PSORIATIC ARTHRITIS
• ENTEROPAHY ASSOSIATED ARTHRITIS
• BEHCETS SYNDROME( recurrant oro genital ulcerations with arthritis)
• UNDIFFERENTIATES SPONDYLOSRTHROPATHY
6. ANKYLOSING SPONDYLITIS
• Generalised chronic inflammatory disease
• affects mainly spine and sacroiliac joints
• males, 15-25 years
• HLAB27 IN 60-95%
7. PATHOLOGICALLY
• SYNOVITIS;
• sacroiliac, facet joints
• Costovertebral joints- diminished respiratory excursion
• Peripheral joints- erosive type of arthritis
• Inflammation of fibro-osseous junctions
• Affects intervertebral discs,sacrospinal ligaments,pubic symphysis,manubrium sternei,
insertion of large tendons(plantar fasciitis)
• pathology progress to bony ankyloses of joints and ossification of periarticular ligaments
( syndesmophytes)
8. CLINICAL FEATURES
• Recurrant low back pain and stiffness, often long standing ,
often confusing between mechanical backache and disc
prolapse
• In early stages flat back , decreased lumbar spine
extension(early feature which loose movement), sacroiliac
tenderness can be seen.
• Gradually pain and stiffness become continuous, with morning
stiffness
• In advanced cases the entire spine may get involved leading to
typical posture –
• loss of normal lumbar lordosis
• Increased thoracic kyphosis
• Forward thrust of neck
• Upright posture is maintained by hip and knee flexion
9. CLINICAL FEATURES CONTINUED…
• Decreased chest expansion(normal >7cm in young men)
• Peripheral joints - usually shoulder, hip,knees involved in 1/3rd of patients with features of
inflammatory arthritis
• Multiple tender areas of bone tendon insertions can be seen over manubrium sternei, iliac crest,
pubic symphysis, greater tuberosity, costochondral junctions, plantar fasciitis
• Extraskeletal AS;
acute anterior uveitis( common- 25%)
Carditis, aortic valve diseases
Apical pulmonary fibrosis(rare)
10.
11. DIAGNOSIS
• Sacroiliac joints;
• Earliest : erosion and haziness of joint
• Later : sclerosis on iliac side
• Very late: bony ankyloses
• Vertebral features:
• Early :Squaring of vertebra( flattening of anterior concavity)
• Bamboo spine( bridging syndesmophytes)
• Romanus (shiny corner ) sign
• Osteoporosis
• Thoracic hyperkyphosis and other deformities
12. • Peripheral joints: erosive arthritis or bony ankyloses
• MRI: helps in early diagnosis
• ESR, CRP are elevated in active phase– prognostic indicator
• RF is negative
13. MANAGEMENT
• The disease is not usually as damaging as rheumatoid arthritis and many patients
continue to lead an active life.
• General measures: encouraged to remain active and follow their normal activities.
Avoid rest and immobilization.
• Train them to maintain normal posture and spinal extension exercises every day
• Swimming, dancing, gymnastics are ideal forms of recreation
14. MANAGEMENT……
• NSAIDS
• TNF INHIBITORS
• SURGERIES: hip replacements provides moderate mobility
deformities of spine corrected by lumbar or cervical osteotomy. They are
difficult and hazardious.
15. COMPLICATIONS
• Spinal fractures: c5-c7 fractures are common
• Spinal cord compression
• Hyperkyphosis and postural difficulties
• Lumbosacral nerve root compressions are rare
16. REITERS DISEASE( REACTIVE ARTHRITIS)
• Triad of
• URETHRITIS ( cervicitis, cystitis)
• CONJUNCTIVITIS
• ARTHRITIS ( inflammatory arthritis assymetric, oligoarticular of ankle and foot
• Most gives history of bowel infection(shigella/salmonella dysentery) or urogenital infection few
weeks before arthritis features to appear
• Pustular dermatitis of feet a/k keratoderma blenorrhagicum classically seen in reiters disease.
17. PSORIATIC ARTHRITIS
• Arthritis of distal interphalyngeal joints(dactilitis)….ARTHRITIS MUTILANS a
severe form of psoriatic arthritis.
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