1. Sero-negative arthritis refers to types of inflammatory arthritis that are negative for rheumatoid factor and other autoantibodies. These include spondyloarthropathies like ankylosing spondylitis.
2. Ankylosing spondylitis is a chronic inflammatory disorder affecting the spine and sacroiliac joints. It is strongly associated with the HLA-B27 gene. Symptoms include back pain and stiffness that improves with exercise.
3. Treatment involves NSAIDs, TNF inhibitors, exercise and maintaining posture. Surgery may be used for joint replacement.
This document discusses seronegative arthritis, specifically focusing on spondyloarthropathies. It defines spondyloarthropathies as a group of inflammatory arthropathies that share clinical, radiographic, and genetic features, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It then provides detailed information on the pathogenesis, clinical manifestations, diagnostic findings, and treatment approaches for ankylosing spondylitis and reactive arthritis. Psoriatic arthritis is also briefly discussed.
The document discusses seronegative spondyloarthropathies, a group of disorders that share clinical features like inflammatory axial arthritis and enthesitis. It focuses on ankylosing spondylitis (AS), describing its pathology, clinical manifestations including stiffness and fusion of the spine, extra-articular involvement like uveitis, and treatments including NSAIDs and TNF inhibitors. Surgical treatments for severe AS spinal deformities like osteotomies and joint replacement are also summarized.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
Spondyloarthritis refers to a group of inflammatory diseases affecting the spine and joints. Key characteristics include inflammatory back pain, enthesitis, and extra-articular manifestations like psoriasis and uveitis. Ankylosing spondylitis is the prototype spondyloarthritis, typically causing inflammation in the sacroiliac joints and spine that leads to bony fusion over time. Psoriatic arthritis is another common subtype associated with psoriasis. Treatment focuses on reducing inflammation and preventing joint damage and deformity.
This document provides information on Ankylosing Spondylitis (AS), including:
- It is an inflammatory arthritis affecting the spine and sacroiliac joints, causing stiffness and fusion of the joints. HLA-B27 gene and TNF play a role in its pathogenesis.
- Signs and symptoms include back pain, limited spinal mobility, chest expansion and peripheral joint involvement. Imaging shows bone erosion and formation in affected areas.
- Treatment involves exercise, NSAIDs, and biologics targeting TNF. Surgery may be needed in advanced cases to correct deformities.
- Stabilizes shoulders
- Asks patient to rotate head to
maximum left and right
- Measures angle between chin and
sternum with goniometer
Normal: >60° each side
AS: <45°
1) Osteoarthritis is a progressive degenerative disease affecting synovial joints that results from stresses that damage joint tissues.
2) It is most common in people over 40 and prevalence increases with age, making it a major cause of disability in the elderly.
3) Treatment involves both non-pharmacologic options like exercise and weight loss as well as pharmacologic options like acetaminophen, NSAIDs, and opioids to manage pain.
This document discusses seronegative arthritis, specifically focusing on spondyloarthropathies. It defines spondyloarthropathies as a group of inflammatory arthropathies that share clinical, radiographic, and genetic features, including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It then provides detailed information on the pathogenesis, clinical manifestations, diagnostic findings, and treatment approaches for ankylosing spondylitis and reactive arthritis. Psoriatic arthritis is also briefly discussed.
The document discusses seronegative spondyloarthropathies, a group of disorders that share clinical features like inflammatory axial arthritis and enthesitis. It focuses on ankylosing spondylitis (AS), describing its pathology, clinical manifestations including stiffness and fusion of the spine, extra-articular involvement like uveitis, and treatments including NSAIDs and TNF inhibitors. Surgical treatments for severe AS spinal deformities like osteotomies and joint replacement are also summarized.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
Spondyloarthritis refers to a group of inflammatory diseases affecting the spine and joints. Key characteristics include inflammatory back pain, enthesitis, and extra-articular manifestations like psoriasis and uveitis. Ankylosing spondylitis is the prototype spondyloarthritis, typically causing inflammation in the sacroiliac joints and spine that leads to bony fusion over time. Psoriatic arthritis is another common subtype associated with psoriasis. Treatment focuses on reducing inflammation and preventing joint damage and deformity.
This document provides information on Ankylosing Spondylitis (AS), including:
- It is an inflammatory arthritis affecting the spine and sacroiliac joints, causing stiffness and fusion of the joints. HLA-B27 gene and TNF play a role in its pathogenesis.
- Signs and symptoms include back pain, limited spinal mobility, chest expansion and peripheral joint involvement. Imaging shows bone erosion and formation in affected areas.
- Treatment involves exercise, NSAIDs, and biologics targeting TNF. Surgery may be needed in advanced cases to correct deformities.
- Stabilizes shoulders
- Asks patient to rotate head to
maximum left and right
- Measures angle between chin and
sternum with goniometer
Normal: >60° each side
AS: <45°
1) Osteoarthritis is a progressive degenerative disease affecting synovial joints that results from stresses that damage joint tissues.
2) It is most common in people over 40 and prevalence increases with age, making it a major cause of disability in the elderly.
3) Treatment involves both non-pharmacologic options like exercise and weight loss as well as pharmacologic options like acetaminophen, NSAIDs, and opioids to manage pain.
Rib notching refers to deformities of the superior or inferior rib surfaces and can be caused by a variety of conditions. Superior rib notching is often seen in osteogenesis imperfecta, rheumatoid arthritis, and SLE due to abnormal bone formation or resorption. Inferior rib notching, also called Roesler's sign, indicates enlarged collateral vessels and is seen in coarctation of the aorta, interrupted aortic arch, subclavian artery obstruction, and Takayasu arteritis. Both superior and inferior rib notching can occur in hyperparathyroidism due to increased osteoclastic activity from elevated parathyroid hormone levels.
This document discusses seronegative spondyloarthropathies, which are characterized by negative rheumatoid factors, involvement of the axial skeleton, and association with HLA-B27. Key features include inflammation of the sacroiliac joints, spine, and peripheral joints. Extra-articular manifestations can include uveitis, inflammatory bowel disease, and genital ulcers. Major types are ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. Ankylosing spondylitis commonly causes back pain and stiffness and can result in fusion of the spine and loss of mobility over time. Management involves exercise, NSAIDs, TNF inhibitors, and sometimes surgery.
Ankylosing spondylitis clinical feature and diagnosisdattasrisaila
Ankylosing spondylitis is an inflammatory arthritis that primarily affects the spine and sacroiliac joints. It presents with inflammatory back pain and stiffness that improves with exercise. Diagnosis requires radiographic evidence of sacroiliitis along with limitations in spinal mobility. The disease progresses over time, leading to fusion of the vertebrae and loss of spinal movement. It is strongly associated with the HLA-B27 gene.
Vertebral column associated pathology and radiographic appearanceSwapnil Shetty
The document provides information on the basic anatomy of the vertebral column, common vertebral pathologies, and their radiographic appearances. It describes the basic structure and composition of vertebrae and how they vary by region. It then discusses several common pathologies like ankylosing spondylitis, fractures, herniated discs, kyphosis, lordosis, metastases, osteoarthritis, and others. For each condition, it provides a definition and descriptions of associated radiographic findings to aid in diagnosis. The goal is to help readers understand vertebral anatomy and some key pathologies that can be identified on imaging studies.
Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation of the spine and sacroiliac joints. It is characterized by pain and stiffness in the lower back and hips that worsens over time. The signs and symptoms often appear gradually between ages 20-30 and can include lower back pain and stiffness, pain in the hips or shoulders, and limited mobility in the spine. While the exact cause is unknown, genetics and environmental factors likely play a role. Diagnosis involves x-rays, CT scans, or MRIs to detect inflammation and damage to affected joints. There is no cure for AS, but treatments can help reduce symptoms, including medications, surgery, and physical therapy.
This document summarizes various joint diseases categorized into degenerative, inflammatory, and less common types. Degenerative joint disease (osteoarthritis) is described as a wearing down process common in weight-bearing joints. Rheumatoid arthritis is an inflammatory polyarthritis causing bone erosion and cartilage destruction seen symmetrically in small joints. Seronegative arthritides like ankylosing spondylitis predominantly involve the spine causing bony spurs (syndesmophytes) forming a "bamboo spine." Gout is caused by urate crystal deposition usually in the first MTP joint. Pseudogout produces chondrocalcinosis from calcium pyrophosphate crystal deposition commonly in the knee.
This document discusses degenerative spine diseases, including anatomy of the intervertebral disc, degenerative changes, symptoms, diagnosis, and management. The intervertebral disc has two main components - the annulus fibrosis and nucleus pulposus. Degenerative changes include decreases in water and proteoglycan content as well as tears in the annulus fibers. Common symptoms are back and leg pain, numbness, and weakness. Diagnosis involves physical exam, imaging like MRI, and ruling out other causes. Treatment options include conservative measures like medication and physical therapy as well as surgery for severe cases.
Transient synovitis, also known as irritable hip, is the most common cause of acute hip pain in children aged 3-8 years. It involves transient inflammation of the hip synovium that causes pain and limping. Symptoms include unilateral hip or groin pain and limping. Diagnosis is usually made after ruling out trauma and infection via x-rays and physical exam. Treatment focuses on rest, anti-inflammatory drugs, and recovery typically occurs within 2 weeks. Legg-Calvé-Perthes disease involves osteonecrosis of the femoral head and requires containment of the hip through bracing or surgery depending on the age and extent of involvement.
Congenital anomalies and degenerative conditions of vertebraBipulBorthakur
This document summarizes CT findings related to congenital anomalies, infections, and degenerative conditions of the spine. It describes common congenital anomalies such as spina bifida occulta, coronal cleft vertebra, and block vertebra. It also discusses spinal infections including bacterial spondylodiskitis caused by pathogens like Staphylococcus aureus and tuberculous spondylitis. Finally, it reviews degenerative changes in the spine seen with aging and conditions like ankylosing spondylitis. CT is useful for evaluating bony abnormalities, spinal infections, and the extent of fusion in diseases like ankylosing spondylitis.
This document provides an overview of low back pain (LBP), including prevalence, classifications, types, and key points regarding evaluation and management. Some key points:
- 60-80% of people experience LBP at some point, though 90% resolves within 6 weeks. Recurrence is common and LBP is a major cause of disability.
- LBP can be classified as mechanical, traumatic, infectious, neoplastic, and more. 97% are considered mechanical.
- Types include discogenic, radicular, facet joint, sacroiliac joint, muscular/myofascial, and others. Herniated discs can cause radicular symptoms.
- Evaluation involves detailed history and exam to identify
Low back ache is a common condition that can have many causes, including mechanical strains, herniated discs, and spinal stenosis. A thorough history, physical exam, and imaging tests are used to diagnose the underlying problem, with treatment depending on the specific cause but often involving rest, physical therapy, medications, or surgery. Radiculopathy and plexopathy can cause low back pain radiating into the legs.
Rheumatoid arthritis is a chronic autoimmune disorder that causes inflammation of the synovial tissue in joints, resulting in pain, stiffness, swelling and erosion of cartilage and bone. It affects around 1% of the population and is more common in women. The disease progresses through four stages, starting with swelling and pain and progressing to joint deformity and ankylosis. Treatment focuses on reducing inflammation and joint damage through medications like NSAIDs, DMARDs and corticosteroids, as well as joint protection, exercise and surgery. Nursing management addresses pain, impaired mobility, self-care needs and psychosocial impacts of the disease.
Spine.pptx and its functions with complete assesmentalishbasohail3
This document discusses various pathologies related to the management of spine and musculoskeletal disorders. It covers topics such as intervertebral disc herniation, protrusion, and extrusion. It also discusses prolonged flexion posture and its relationship to disc issues. Signs and symptoms of disc lesions are outlined. Additional pathologies covered include spondylosis, rheumatoid arthritis, ankylosing spondylitis, and Scheuermann's disease.
LOW BACK PAIN. Dr Haki Selaj Residency in Kosovo QKUKHakiSelaj1
back pain is a very widespread pathology in the world. There are health and socioeconomic consequences. widespread both in the young and in the old. The causes are different. The overwhelming majority is mechanical pain without a specific cause, while the others are pain from disc, infections, tumors, fractures, metabolic.
- Ankylosing spondylitis is an inflammatory disorder that primarily affects the axial skeleton including the spine and sacroiliac joints. It has a strong association with the HLA-B27 gene.
- The disease usually begins in young adults and presents as inflammatory back pain. Diagnosis requires radiographic evidence of sacroiliitis along with symptoms of back pain and stiffness.
- While the exact cause is unknown, it is thought to be immune-mediated potentially triggered by intestinal bacteria in genetically susceptible individuals with HLA-B27. Tumor necrosis factor inhibitors can provide relief of symptoms.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
This document provides an overview of the radiographic features seen in various rheumatic diseases. It describes the early and late manifestations seen in rheumatoid arthritis on x-rays, including periarticular osteopenia, erosions, and bone deformities. Features of psoriatic arthritis include asymmetric joint involvement and enthesophyte formation. Ankylosing spondylitis is characterized by sacroiliac joint fusion and syndesmophyte formation leading to a "bamboo spine." Gout typically causes well-defined erosions, often with overhanging edges. Calcium pyrophosphate disease results in chondrocalcinosis. Diffuse idiopathic skeletal hyperostosis is identified by flowing
Spondylolisthesis is a condition where one vertebra slips over the vertebra below it. It can be caused by defects in the bone (congenital or acquired) or degeneration. Imaging like x-rays, CT, and MRI are used to classify and evaluate the spondylolisthesis. Patients experience back pain that worsens with activity and improves with rest. Treatment depends on the severity and cause of the spondylolisthesis.
There are three types of chest films: anteroposterior (AP), posteroanterior (PA), and lateral. The ideal timing is at the end of inspiration when the patient holds their breath and the x-ray tube is 180cm away. Image quality is assessed using the "RIPE" mnemonic of rotation, inspiration, position, and exposure to ensure visibility of key structures like the heart and vertebrae. Interpretation follows the "ABCDEF" schema of checking the airways, bones, cardiac, diaphragm, extrathoracic tissues, and fields and fissures for any abnormalities.
This document discusses the diagnosis and treatment of acute asthma exacerbations. It defines acute asthma as progressive breathlessness, chest tightness, decreased peak flow, and lack of improvement with short-acting beta agonists. Triggers include viral infections, allergens, pollution, and poor adherence to inhaled corticosteroids. Treatment involves repeated doses of inhaled short-acting beta agonists, controlled oxygen therapy, and a 5-7 day course of oral corticosteroids. Patients should be discharged with maintenance inhaled corticosteroid-containing medications and reliever medications.
More Related Content
Similar to Spondyloarthropathies By Dr Rekha Vankwani.pptx
Rib notching refers to deformities of the superior or inferior rib surfaces and can be caused by a variety of conditions. Superior rib notching is often seen in osteogenesis imperfecta, rheumatoid arthritis, and SLE due to abnormal bone formation or resorption. Inferior rib notching, also called Roesler's sign, indicates enlarged collateral vessels and is seen in coarctation of the aorta, interrupted aortic arch, subclavian artery obstruction, and Takayasu arteritis. Both superior and inferior rib notching can occur in hyperparathyroidism due to increased osteoclastic activity from elevated parathyroid hormone levels.
This document discusses seronegative spondyloarthropathies, which are characterized by negative rheumatoid factors, involvement of the axial skeleton, and association with HLA-B27. Key features include inflammation of the sacroiliac joints, spine, and peripheral joints. Extra-articular manifestations can include uveitis, inflammatory bowel disease, and genital ulcers. Major types are ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. Ankylosing spondylitis commonly causes back pain and stiffness and can result in fusion of the spine and loss of mobility over time. Management involves exercise, NSAIDs, TNF inhibitors, and sometimes surgery.
Ankylosing spondylitis clinical feature and diagnosisdattasrisaila
Ankylosing spondylitis is an inflammatory arthritis that primarily affects the spine and sacroiliac joints. It presents with inflammatory back pain and stiffness that improves with exercise. Diagnosis requires radiographic evidence of sacroiliitis along with limitations in spinal mobility. The disease progresses over time, leading to fusion of the vertebrae and loss of spinal movement. It is strongly associated with the HLA-B27 gene.
Vertebral column associated pathology and radiographic appearanceSwapnil Shetty
The document provides information on the basic anatomy of the vertebral column, common vertebral pathologies, and their radiographic appearances. It describes the basic structure and composition of vertebrae and how they vary by region. It then discusses several common pathologies like ankylosing spondylitis, fractures, herniated discs, kyphosis, lordosis, metastases, osteoarthritis, and others. For each condition, it provides a definition and descriptions of associated radiographic findings to aid in diagnosis. The goal is to help readers understand vertebral anatomy and some key pathologies that can be identified on imaging studies.
Ankylosing spondylitis (AS) is a type of arthritis that causes inflammation of the spine and sacroiliac joints. It is characterized by pain and stiffness in the lower back and hips that worsens over time. The signs and symptoms often appear gradually between ages 20-30 and can include lower back pain and stiffness, pain in the hips or shoulders, and limited mobility in the spine. While the exact cause is unknown, genetics and environmental factors likely play a role. Diagnosis involves x-rays, CT scans, or MRIs to detect inflammation and damage to affected joints. There is no cure for AS, but treatments can help reduce symptoms, including medications, surgery, and physical therapy.
This document summarizes various joint diseases categorized into degenerative, inflammatory, and less common types. Degenerative joint disease (osteoarthritis) is described as a wearing down process common in weight-bearing joints. Rheumatoid arthritis is an inflammatory polyarthritis causing bone erosion and cartilage destruction seen symmetrically in small joints. Seronegative arthritides like ankylosing spondylitis predominantly involve the spine causing bony spurs (syndesmophytes) forming a "bamboo spine." Gout is caused by urate crystal deposition usually in the first MTP joint. Pseudogout produces chondrocalcinosis from calcium pyrophosphate crystal deposition commonly in the knee.
This document discusses degenerative spine diseases, including anatomy of the intervertebral disc, degenerative changes, symptoms, diagnosis, and management. The intervertebral disc has two main components - the annulus fibrosis and nucleus pulposus. Degenerative changes include decreases in water and proteoglycan content as well as tears in the annulus fibers. Common symptoms are back and leg pain, numbness, and weakness. Diagnosis involves physical exam, imaging like MRI, and ruling out other causes. Treatment options include conservative measures like medication and physical therapy as well as surgery for severe cases.
Transient synovitis, also known as irritable hip, is the most common cause of acute hip pain in children aged 3-8 years. It involves transient inflammation of the hip synovium that causes pain and limping. Symptoms include unilateral hip or groin pain and limping. Diagnosis is usually made after ruling out trauma and infection via x-rays and physical exam. Treatment focuses on rest, anti-inflammatory drugs, and recovery typically occurs within 2 weeks. Legg-Calvé-Perthes disease involves osteonecrosis of the femoral head and requires containment of the hip through bracing or surgery depending on the age and extent of involvement.
Congenital anomalies and degenerative conditions of vertebraBipulBorthakur
This document summarizes CT findings related to congenital anomalies, infections, and degenerative conditions of the spine. It describes common congenital anomalies such as spina bifida occulta, coronal cleft vertebra, and block vertebra. It also discusses spinal infections including bacterial spondylodiskitis caused by pathogens like Staphylococcus aureus and tuberculous spondylitis. Finally, it reviews degenerative changes in the spine seen with aging and conditions like ankylosing spondylitis. CT is useful for evaluating bony abnormalities, spinal infections, and the extent of fusion in diseases like ankylosing spondylitis.
This document provides an overview of low back pain (LBP), including prevalence, classifications, types, and key points regarding evaluation and management. Some key points:
- 60-80% of people experience LBP at some point, though 90% resolves within 6 weeks. Recurrence is common and LBP is a major cause of disability.
- LBP can be classified as mechanical, traumatic, infectious, neoplastic, and more. 97% are considered mechanical.
- Types include discogenic, radicular, facet joint, sacroiliac joint, muscular/myofascial, and others. Herniated discs can cause radicular symptoms.
- Evaluation involves detailed history and exam to identify
Low back ache is a common condition that can have many causes, including mechanical strains, herniated discs, and spinal stenosis. A thorough history, physical exam, and imaging tests are used to diagnose the underlying problem, with treatment depending on the specific cause but often involving rest, physical therapy, medications, or surgery. Radiculopathy and plexopathy can cause low back pain radiating into the legs.
Rheumatoid arthritis is a chronic autoimmune disorder that causes inflammation of the synovial tissue in joints, resulting in pain, stiffness, swelling and erosion of cartilage and bone. It affects around 1% of the population and is more common in women. The disease progresses through four stages, starting with swelling and pain and progressing to joint deformity and ankylosis. Treatment focuses on reducing inflammation and joint damage through medications like NSAIDs, DMARDs and corticosteroids, as well as joint protection, exercise and surgery. Nursing management addresses pain, impaired mobility, self-care needs and psychosocial impacts of the disease.
Spine.pptx and its functions with complete assesmentalishbasohail3
This document discusses various pathologies related to the management of spine and musculoskeletal disorders. It covers topics such as intervertebral disc herniation, protrusion, and extrusion. It also discusses prolonged flexion posture and its relationship to disc issues. Signs and symptoms of disc lesions are outlined. Additional pathologies covered include spondylosis, rheumatoid arthritis, ankylosing spondylitis, and Scheuermann's disease.
LOW BACK PAIN. Dr Haki Selaj Residency in Kosovo QKUKHakiSelaj1
back pain is a very widespread pathology in the world. There are health and socioeconomic consequences. widespread both in the young and in the old. The causes are different. The overwhelming majority is mechanical pain without a specific cause, while the others are pain from disc, infections, tumors, fractures, metabolic.
- Ankylosing spondylitis is an inflammatory disorder that primarily affects the axial skeleton including the spine and sacroiliac joints. It has a strong association with the HLA-B27 gene.
- The disease usually begins in young adults and presents as inflammatory back pain. Diagnosis requires radiographic evidence of sacroiliitis along with symptoms of back pain and stiffness.
- While the exact cause is unknown, it is thought to be immune-mediated potentially triggered by intestinal bacteria in genetically susceptible individuals with HLA-B27. Tumor necrosis factor inhibitors can provide relief of symptoms.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
This document provides an overview of the radiographic features seen in various rheumatic diseases. It describes the early and late manifestations seen in rheumatoid arthritis on x-rays, including periarticular osteopenia, erosions, and bone deformities. Features of psoriatic arthritis include asymmetric joint involvement and enthesophyte formation. Ankylosing spondylitis is characterized by sacroiliac joint fusion and syndesmophyte formation leading to a "bamboo spine." Gout typically causes well-defined erosions, often with overhanging edges. Calcium pyrophosphate disease results in chondrocalcinosis. Diffuse idiopathic skeletal hyperostosis is identified by flowing
Spondylolisthesis is a condition where one vertebra slips over the vertebra below it. It can be caused by defects in the bone (congenital or acquired) or degeneration. Imaging like x-rays, CT, and MRI are used to classify and evaluate the spondylolisthesis. Patients experience back pain that worsens with activity and improves with rest. Treatment depends on the severity and cause of the spondylolisthesis.
Similar to Spondyloarthropathies By Dr Rekha Vankwani.pptx (20)
There are three types of chest films: anteroposterior (AP), posteroanterior (PA), and lateral. The ideal timing is at the end of inspiration when the patient holds their breath and the x-ray tube is 180cm away. Image quality is assessed using the "RIPE" mnemonic of rotation, inspiration, position, and exposure to ensure visibility of key structures like the heart and vertebrae. Interpretation follows the "ABCDEF" schema of checking the airways, bones, cardiac, diaphragm, extrathoracic tissues, and fields and fissures for any abnormalities.
This document discusses the diagnosis and treatment of acute asthma exacerbations. It defines acute asthma as progressive breathlessness, chest tightness, decreased peak flow, and lack of improvement with short-acting beta agonists. Triggers include viral infections, allergens, pollution, and poor adherence to inhaled corticosteroids. Treatment involves repeated doses of inhaled short-acting beta agonists, controlled oxygen therapy, and a 5-7 day course of oral corticosteroids. Patients should be discharged with maintenance inhaled corticosteroid-containing medications and reliever medications.
This document outlines a lecture series on managing diabetic foot complications. It introduces the "Limbs for Life" program which aims to prevent amputations by addressing foot ulcers and infections. The series covers topics like the types and burden of diabetes, foot anatomy, ulcer identification and classification, neuropathy, infection, offloading devices, and footwear recommendations. It provides an overview of 17 planned lectures and on-site workshops on examining the diabetic foot and managing associated conditions like Charcot foot and peripheral artery disease. The overall goal is to educate on the standard of care for the diabetic foot through lectures and hands-on training.
A 61-year-old male presented to the emergency department with swelling, tenderness, and severe pain in his wrist after falling on an outstretched hand. On examination, he had swelling and a "dinner-fork" deformity of the wrist. X-rays showed a distal radius fracture. The fracture was reduced closed by an orthopedic resident and splinted. Distal radius fractures can be reduced in the emergency department if Colles or Smith fractures but Barton fractures require immediate orthopedic referral. Patients can be discharged if they have appropriate reduction, immobilization, follow-up arranged, and understand cast care instructions.
Obesity is an abnormal increase in body fat that occurs primarily in visceral and subcutaneous tissues. It is the second leading cause of preventable death and third leading reason for liver transplantation. Body mass index (BMI), waist circumference, and waist-to-hip ratio are used to measure obesity, with increased health risks for those above certain measurements. Genetic, environmental, and psychological factors all contribute to obesity, which increases mortality and decreases quality of life as it becomes more severe. Weight loss through diet and exercise can help reduce obesity-related health issues.
This document provides information about cerebrovascular accidents (strokes), including definitions, types, pathophysiology, signs and symptoms, investigations, treatment, and secondary prevention. It defines strokes as rapidly developed neurological deficits lasting over 24 hours caused by vascular issues. The main types are ischemic (87% of cases), caused by blockages, and hemorrhagic. Investigations include CT/MRI scans, ultrasound, and blood tests. Treatment focuses on thrombolysis with tPA within 3-4.5 hours and mechanical thrombectomy within 24 hours. Secondary prevention consists of antiplatelet therapy like aspirin long-term and carotid revascularization for severe stenosis.
This document discusses hypertensive urgencies and emergencies. It defines them as very high blood pressure with minimal or no symptoms for urgencies versus life-threatening symptoms and organ damage for emergencies. It covers causes, pathophysiology involving vascular injury and ischemia, common presentations like stroke and heart failure, diagnosis, and goals of rapidly lowering blood pressure to prevent further organ damage for emergencies. It recommends intravenous drugs like labetalol to slowly reduce pressure at first followed by oral medications.
approachtomuscleweakness modified- By Sir Ghani.pptxZOHAIB57
1) The document discusses differentiating between true muscle weakness and fatigue, and provides an algorithmic approach to evaluating the cause of weakness.
2) Key points include differentiating acute vs. chronic onset, unilateral vs. bilateral involvement, and determining if signs are upper or lower motor neuron.
3) Common causes discussed include stroke, spinal cord lesions, peripheral neuropathies, myasthenia gravis, and myopathies. The algorithm provides guidance on determining the localization and cause based on history and exam findings.
1) Spondyloarthritis (SpA) is a group of inflammatory diseases that includes ankylosing spondylitis (AS) and affects the spine and joints.
2) AS is a chronic inflammatory disorder that primarily affects the axial skeleton and peripheral joints. It is strongly associated with the HLA-B27 gene.
3) The main clinical manifestations of AS include low back pain, impaired spinal mobility, butt pain indicating sacroiliac joint involvement, and enthesitis or inflammation at tendon attachments sites. Extra-articular features can include uveitis and cardiovascular or pulmonary involvement.
Mixed Connective Tissue Disease (MCTD) is an autoimmune disease with features of systemic lupus erythematosus (SLE), scleroderma, polymyositis, and rheumatoid arthritis. It is characterized by the presence of anti-U1 RNP antibodies. Common manifestations include Raynaud's phenomenon, arthritis, myositis, and lung or kidney involvement. Treatment focuses on symptoms and may include corticosteroids, immunosuppressants, and vasodilators. Prognosis is generally good, but pulmonary hypertension and interstitial lung disease can be serious complications.
This document discusses key aspects of an electrocardiogram (ECG or EKG), including that it graphs the heart's electrical activity over time. It notes that an ECG can be used to examine the heart rate, presence of QRS complexes, and characteristics of the P, QRS, and T waves like shape, duration and direction. Abnormal findings on an ECG can provide information about conditions like atrioventricular block or left ventricular hypertrophy.
This document discusses dyspnea, or shortness of breath, as a medical emergency. It defines dyspnea and lists various causes including cardiac, pulmonary, cardiopulmonary, and non-cardiopulmonary conditions. Signs and symptoms, timing, positioning, precipitating/relieving factors, and approach to examination and initial management are described for evaluation of a patient presenting with dyspnea.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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3. Sero-Negative Arthritis
• Negative to RHEUMATOID FACTOR or other
autoantibody serologic abnormalities .
SPONDYLOARTHROPATHIES
Definition:
A group of inflammatory arthropathies
that share distinctive clinical, radiographic and
genetic features. These diagnoses include:
1.ANKYLOSING SPONDYLITIS (AS)
1.REACTIVE ARTHRITIS(ReA)
2.PSORIATIC ARTHRITIS
3.ENTEROPATHIC ARTHRITIS
5. • Seronegative (i.e. Rheumatoid Factor Is Absent).
• Rheumatoid nodules are absent.
• Frequent association of HLA-B27.
• A tendency to occur in same family(familial
aggregation).
• Inflammatory axial arthritis, generally Sacroiliitis and
Spondylitis.
• Oligoarthritis generally with asymmetrical presentation.
• Enthesitis (inflammation of the entheses, the sites
where tendons or ligaments insert into the bone) e.g.
Plantar fasciitis, Achilles tendonitis, costochondritis.
• Extra-articular features, such as involvement of eyes
(anterior uveitis), skin, genitourinary tract.
common features
6. Associations with HLA-B27
Rheumatic diseases
• Ankylosing spondylitis
• Reiter’s syndrome/
Reactive arthritis
• IBD related arthritis
• Psoriatic arthritis
Degree of Associations
>90%
>80%
~75%
~50%
7. 1.ANKYLOSING SPONDYLITIS (AS)
• It is an Chonic inflammatory disorder of unknown
cause that primarily affects the Axial
skeleton,peripheral joints and extraarticular
structures.
90% of patients are HLA-B27 positive .
Incidence - Men:women 3:1
Age of onset typically between 20 and 40 years.
More commonly involves the axial skeleton,
although peripheral joints may also be affected.
8. Pathology
• Sacroiliitis is the earliest manifestation of AS.
• Synovitis, Pannus, Myxoid marrow,
subchondral granulation tissue and marrow
edema are found.
• In Spine, there is inflammatory granulation
tissue at the junction of annulus fibrosis and
vertebral bone.
• The outer annular fibers are eroded and
replaced by bone, forming a syndesmophyte.
9.
10. HistoPathology
• Inflammatory cells in ligamentous and periosteal
area
• Subchondral marrow oedema
• Pannus and new bone formation
• Bony erosion
• Fibrocartilagenous regeneration
and ossification
11. • The pathogenesis of AS is thought to be
immunemediated,but there is no direct
evidence for autoimmunity. There is
uncertainty regarding the primary site of
disease initiation.
• Squaring of the vertebral bodies”
• One of the early radiographic signs of
enthesitis.
caused by erosions of the superior and inferior
margins of vertebral bodies, resulting in loss of
the normal concave contour of the anterior
surface.
12. • “ Bamboo spine”
Thin and slender syndesmophytes are generally
evident, representing ossification of the outer
layer of the annulus fibrosis.
• On AP lumbar spine radiographs the
syndesmophytes thicken, become continuous
giving knobbly appearance.
13. • “ Bamboo spine”
Thin and slender syndesmophytes are generally
evident, representing ossification of the outer layer
of the annulus fibrosis.
On AP lumbar spine radiographs the
syndesmophytes thicken,become continuous giving
knobbly appearance.
14.
15. Clinical Manifestations
• The symptoms of the disease are usually first noticed in late
adolescence or early adulthood median age being 23.
• The initial presentation of AS generally occurs in the SI(sacro
iliac joint); involvement of the SI joints is required to
establish the diagnosis.
• SI joint involvement is followed by involvement of the
diskovertebral, apophyseal, costovertebral, and
costotransverse joints.
16. • The initial symptom is usually dull aching pain,
Insidious in onset, felt deep in the lower lumbar or
gluteal region, accompanied by low-back morning
stiffness of up to a few hours duration that
improves with activity and returns following
inactivity.
• Arthritis in the hips and shoulders occurs in
25–35% of patients.
• Arthritis of peripheral joints other than the hips
and shoulders, usually asymmetric , occurs in
another30% of patients.
18. • Neck pain and stiffness from involvement of the
cervical spine are late manifestations.
• Chest expansion is measured as the difference
between maximal inspiration and maximal forced
expiration in the fourth intercostal space. Normal
chest expansion is ≥5 cm
19. Restriction of lumbar movement
Shober’s test – mark the patient’s back at the level of the
posterior iliac spine.
Place one finger 5 cm below this mark and a 2nd finger 10 cm
above this mark. Patient is instructed to touch his toes. If the
distance between finegrs increases < 5 cm, lumbar flexion is
limited.
20. • Peripheral musculoskeletal involvement
occurs in 30-50% of all patients.
• The following are common:
1. Achilles tendinitis.
2. Plantar fasciitis.
3. At the tibial tuberosity.
4. Superior and inferior poles of the patella.
5. Iliac crests.
21. Extra-articular manifestations
1. Uveitis
Uveitis (also called iritis or iridocyclitis) is the
most common extra-articular manifestation of AS,
occurring in 20-30% of patients.
• Usually acute,unilateral and non granulomatous.
•Acute eye pain,Increased lacrimation, Photophobia
& Blurred vision
1.Cardiovascular disease
Aortitis of the ascending aorta resulting in aortic valve
insufficiency.
• Mitral valve insufficiency .
• Atrioventricular block.
.
22. 1. Pulmonary disease
• Restrictive lung disease.
• Bilateral apical pulmonary fibrosis.
4.Renal disease
• Amyloidosis is a very rare complication of AS in
patients with severe, active, and long-standing
disease.
5.GI disease
• Asymptomatic inflammation of the proximal
colon and terminal ileum has been observed.
23. Laboratory Findings
• No laboratory test is Diagnostic of AS.
• HLA-B27 is present in 90% of patients.
• Erythrocyte sedimentation rate (ESR) and C-reactive
protein (CRP) are elevated.
• Mild anemia may be present.
• Patients with severe disease may show an elevated
alkaline phosphatase level.
• Elevated serum IgA levels are common.
• Rheumatoid factor(RA factor ) ,Anti-Cyclic
Citrullinated peptide (CCP), and Antinuclear
Antibodies (ANAs) are ABSENT.
24. Radiographic Findings
• The earliest signs can be detected by 3-6
months after the onset.
• SacroIliac Joints-Early patchy osteoporosis
develop around the distal third of both the
bones. Joint margins become illdefined and
the joint intervals become widened.
Subchondral erosions start and when multiple
produce a rosary effect.
31. .
• Lumbar Spine-
• The earliest change is
squaring of the anterior
portion of the vertebral
bodies.The anterior
concavity of the body is
lost.
• This is found initially at
the upper lumbar and
lower thoracic regions.
• There will be loss of
lumbar lordosis
32. Paravertebral ossification develops beneath the anterior
longitudinal ligaments within the annulus at each level.The
ossification develops vertically in contrast to those developed in
the OA. Finally the appearance is of Bamboo spine.
33. • Cervical Spine-
Extreme bony bridging extends along the
anterior aspect of the vertebral bodies.
There will be loss of lordosis and apophyseal
joints become ankylosed.
• Hips-
Severe Osteoporosis occurs in both sides of
the joints.Erosions develop and the joint space
becomes reduced.
34.
35. • To qualify as the criterion
for inflammatory back pain of axial SpA the
chronic ( 3 months) back pain should have
four or more of these characteristic features
(1) age of onset below 40 years.
(2) insidious onset.
(3) improvement with exercise.
(4) no improvement with rest and
(5)pain at night with improvement upon getting
up.
36. Treatment
General measures
• Patients are encouraged to remain active and
follow their normal pursuits as far as possible.
• They should be taught to maintain satisfactory
posture and to perform spinal extension exercises
every day.
• Swimming, dancing and gymnastics are ideal
forms of recreation.
• Rest and immobilization are contraindicated
because they tend to increase the general feeling
of stiffness.
37. Non-steroidal anti-inflammatory drugs ( NSAIDS)
• NSAIDs improve spinal pain, peripheral joint pain,
and function over a short period of time (6
weeks).
• They dont prevent or retard the progress to
ankylosis.
TNF inhibitors
• Etanercept,Infliximab,Adalimumab,
Golimumab,and Certolizumab pegol have all been
approved by the US Food and Drug
Administration (FDA) as therapies for AS and are
indicated after NSAID therapy has failed.
38. • Infliximab(Remicade) -Adult dosage-5 mg/kg
IV at 0, 2, and 6 weeks, then every 6 weeks.
• Etanercept (Enbrel)-Adult dosage- 50 mg SC
once weekly or 25 mg SC twice weekly;
if twice weekly, doses should be given on
same day or 3-4 days apart.
• Adalimumab(Humira)-40 mg SC q2wk.
These therapies are generally reserved for
individuals who have failed to be controlled
with non-steroidal anti-inflammatory drugs.
39. JOINT REPLACEMENT
• Patients with significant involvement of the
hips may benefit from Total Hip Arthroplasty.
• Heterotopic bone formation may occur after
total joint replacement, especially around the
hip.
• Heterotopic bone formation can be reduced
by giving NSAIDs (eg, indomethacin) or
employing radiation therapy postoperatively.
40.
41. 2.REACTIVE ARTHRITIS
• It refers to acute non-purulent arthritis
complicated by an infection elsewhere in the
body.
• • Syndrome was described by Hans Reiter in 1916
and known as Reiter’s Disease.
• A clinical triad of urethritis, arthritis and
• conjunctivitis occurring some weeks after
dysentery or genitourinary infection.
• TRIAD: arthritis + urethritis (vaginitis) +
conjunctivitis (classic triad found in < one-third
of pts)
42. Etiology
• GIT pathogens include Shigella flexneri/shg sonnei ,
Salmonella, Campylobacter species and Yersinia
enterocolitica.
• Lymphogranuloma venereum and Chlamydia
trachomatis have been implicated as sexually
transmitted infections.
• Post-venereal onset: more common Sex 5:1 M:F
• Post-dysenteric: less, equal M=F
• Course: self limiting (< 6 months), chronic,
intermittent.
43. Pathology
• The pathological changes are essentially the
same as those in ankylosing spondylitis, with the
emphasis on large-joint synovitis and a chronic
disease course tending towards Sacroiliitis and
Spondylitis.
44. • Synovial histology - is
similar to that of
other SpA
• Enthesitis - increased
vascularity
• Macrophage
infiltration of
fibrocartilage
• Histopathology
evidence of
inflammation has
occasionally been
noted in the colon
and ileum
45. Bacterias
• produce lipopolysaccharide (LPS)
• capacity to attack mucosal surfaces,
• survive intracellularly
• HLA-B27 - prolongs the intracellular survival
• Trafficking of infected leukocytes from the site of
primary infection to joints, where an innate and
adaptive immune response to persistent bacterial
antigens promote arthritis.
Synovial T cells that specifically responded to antigens of
the inciting organism were reported and characterized
as predominantly CD4+ with a TH2 or T regulatory
phenotype. More recent work has documented high
levels of IL-17
46. Clinical features
• The most common
age group is 18–40 years.
• Can occur in children
over 5 years of age
and in older adults.
•Men are affected
more often than
women (the ratio is
about 10:1).
47. • The acute phase of the disease is marked by
an asymmetrical inflammatory arthritis of the
lower limb joints.
• Knee, Ankle, Subtalar, Metatarsophalangeal,
and toe interphalangeal joints, are most
commonly involved, but the wrist and fingers
can be involved as well.
• Dactylitis, or "sausage digit," a diffuse swelling
of a solitary finger or toe, is a distinctive
feature of ReA.
48.
49. • Tendo Achilles tendinitis and Plantar fasciitis are common.
• In Men: Mild dysuria, Mucopurulent urethral discharge,May
present as prostatitis or epididymitis
• In Women : Dysuria and Purulent vaginitis or cervicitis with
vaginal discharge
• Ocular disease is common, ranging from asymptomatic
conjunctivitis to an aggressive anterior uveitis.
• The characteristic skin lesions, are keratoderma blenorrhagica.
A papulosquamous skin rash, Comprises vesicles that become
hyperkeratotic, forming and crusts before disappearing
The chronic phase is
more characteristic of a
spondyloarthropathy,wi
th features resembling
those of ankylosing
spondylitis.
50.
51.
52. Laboratory Findings
• Tests for HLA-B27 are positive in 75 per cent of
patients with sacroiliitis.
• ESR may be high in the active phase of the
disease.
53. Radiographic Findings
• In early or mild disease, radiographic changes may be
confined to juxtaarticular osteoporosis.
• With long-standing persistent disease, marginal erosions
and loss of joint space can be seen in affected joints.
• Sacroiliitis and spondylitis may be seen as late sequelae.
• Sacroiliitis is more commonly asymmetric than in AS, and
spondylitis, can begin anywhere along the lumbar spine.
• The syndesmophytes may be asymmetric, coarse and
nonmarginal.
54. Treatment
• Most patients with ReA benefit to some degree from high-
dose NSAIDs.
• Indomethacin, 75–150 mg/d in divided doses, is the initial
treatment of choice, but other NSAIDs may be tried.
• Majority of patients with chronic ReA due to Chlamydia
benefited significantly from a 6-month course of
RIFAMPICIN 300 mg daily + AZITHROMYCIN 500 mg daily for 5
days then twice weekly,
or
RIFAMPICIN 300 mg daily 6 months + DOXYCYCLINE 100 mg
twice daily.
55. • Tendinitis and other enthesitic lesions may
benefit from intralesional glucocorticoids.
• Topical steroids may be used for uveitis.
• TNF inhibitors like Infliximab may be used in
refractory cases.
56. 3.PSORIATIC ARTHRITIS
• Psoriatic arthritis (PsA) refers to an
inflammatory arthritis that characteristically
occurs in individuals with Psoriasis.
• 60 % of those with psoriatic spondylitis or
sacroiliitis have HLA-B27.
58. Pathology
• The inflamed synovium in PsA resembles that
of RA, although with somewhat less
hyperplasia and cellularity than in RA, and
greater vascularity.
• Unlike RA, PsA shows prominent enthesitis,
with histology similar to that of the other
spondyloarthritides.
59. shares pathogenic mechanisms with psoriasis
immune-mediated
Infiltration with T cells, B cells, macrophages, and NK
receptor–expressing cells
Resembles that of RA - less hyperplasia and cellularity
than in RA, & greater vascularity
Synovial overexpression of proinflammatory cytokines
• Interleukin 2
• Interferon
• TNF
marked increase in osteoclastic precursors in
peripheral blood and upregulation of
Receptor Activator Of Nuclear Factor Ligand (RANKL)
in the synovial lining layer.
60. .
Clinical Features
• In 60–70% of
cases, psoriasis
precedes joint
disease ( primary )
• In 15–20% of
cases, the two
manifestations
appear within 1
year of each other.
• In about 15–20%
of cases, the
arthritis precedes
the onset of
psoriasis ( secondary)
61.
62. • The spectrum of arthropathy associated with
psoriasis is broad.
• Five patterns are described
(1) arthritis of the DIP joints.
(2) asymmetric oligoarthritis.
(3) symmetric polyarthritis similar to RA.
(4)axial involvement (spine and sacroiliac
joints).
(5)arthritis mutilans, a highly destructive form
of disease.
63. Nail changes-Pitting of the fingers or toes occur in 90%of patients with
PsA. Widespread shortening of digits (“Telescoping").
• Eye involvement, either
conjunctivitis or uveitis, is reported in 7–33% of PsA patients.
64. • Nail Changes :
6 types Occur in 90% of patients with PsA
1. Pitting ,
2. Horizontal ridging,
3. Onycholysis,
4. Yellowish discoloration of the nail margins,
5. Dystrophic hyperkeratosis &
6. Combinations .
65. 6 types of nail pattern in psoriatic arthritis
66.
67. Laboratory Findings
• ESR and CRP are elevated.
• • About 10% of patients have anti-CCP
antibodies.
• • Uric acid may be elevated in the presence of
extensive
• psoriasis.
• • HLA-B27 is found in 50–70% of patients with
axial
• disease, but 20% in patients with only peripheral
• joint involvement.
69. Marginal proliferative
erosions.
• Small-joint ankylosis.
• Osteolysis of
phalangeal and
metacarpal bone, with
Telescoping of digits.
• Periostitis and
proliferative new bone
at sites of enthesitis
70. Characteristics of
axial PsA include
Asymmetric
sacroiliitis;
compared with
idiopathic AS, less
apophyseal joint
arthritis, fewer and
less symmetric and
coarse
syndesmophytes.
71.
72. Treatment
• In mild disease no more than topical preparations to control
the skin disease and NSAIDs for the arthritis are needed.
• In resistant forms of arthritis, immunosuppressive agents
(Methotrexate) and TNF inhibitors (Infliximab,
Etanercept and Adalimumab) have are effective.
• ETANERCEPT- 50 mg SC once weekly or 25 mg SC twice
weekly; if twice weekly, doses should be given on same day or 3-
4 days apart.
• ADALIMUMAB- 40 mg SC q2wk.
• INFLIXIMAB- 5 mg/kg IV at 0, 2, and 6 weeks, then every 8
weeks.
74. 4 . ENTEROPATHIC ARTHRITIS
• Both forms of IBD, Ulcerative Colitis
(UC) and Crohn's disease (CD) are
associated with SpA.
• Two types of involvement.
1.Peripheral Arthritis.
2.Sacroiliitis and Spondylitis.
Pyoderma gangrenosum
75. 1.Peripheral arthritis
• Peripheral arthritis occurs in about 15 per cent
of patients with inflammatory bowel disease.
• Typically larger joints are involved in
asymmetric fashion.
• Synovitis and joint erosion can occur.
• Men and women are affected with equal
frequency and there is no particular
association with HLAB27
76. 1. Sacroiliitis and Spondylitis
• This pattern is seen in about 10 per cent of
patients with inflammatory bowel disease,.
• HLA-B27 is positive in 60 per cent and there is
an increased incidence of ankylosing
spondylitis in close relatives.
• Unlike the peripheral arthritis, sacroiliitis
shows no temporal relationship to
gastrointestinal inflammation and its course is
unaffected by treatment of the bowel disease.
78. Laboratory Findings
• Of patients with AS and IBD, 30–70% carry the
HLA-B27 gene.
Radiographic Findings
• Radiographic changes in the axial skeleton are
the same as in uncomplicated AS.
79. Treatment
• INFLIXIMAB & ADALIMUMAB are effective for
induction and maintenance of clinical
remission in CD and UC.
• Treatment for IBD, including Sulfasalazine and
related drugs, systemic Glucocorticoids, and
Immunosuppressive drugs, are also usually of
benefit for associated peripheral arthritis.
80. 5.UNDIFFERENTIATED AND
JUVENILEONSET SPONDYLOARTHRITIS
• Patients who do not meet the classification criteria
are included in this.
• Approximately one-half of the patients with
undifferentiated SpA are HLA-B27-positive.
• In familial cases, which are much more frequently
B27-positive, there is often eventual progression to
classical AS.
• Juvenile-onset SpA, begins between ages 7 and 16,
most commonly in boys (60–80%).
• An asymmetric, predominantly lower-extremity
oligoarthritis and enthesitis occurs.
• Extraarticular features are absent.
81. • The prevalence of B27 in this condition,is
approximately 80%.
• Many of these patients go on to develop AS in
late adolescence or adulthood.
• Management of undifferentiated SpA is similar
to that of the other spondyloarthritides.