Tuesday, September 10, 2013

Spondyloarthropathies - Symptoms and Diagnosis

Spondylo-arthropathies are a group of diseases that all share inflammation of spine and other joints. Each disease has some characteristic signs that make it different from other spondyloarthropathies.

One of these diseases is Reiter's Syndrome. It's a type of reactive arthritis that occur after infection with salmonella, shigella or non gonococcal urethritis (venereal infection).


It mainly affects the joints of the lower limbs in the form of inflammation and joint pain.

The Rheumatoid factor is negative in these cases and is treated by NSAIDs and steroids.

Another form of spondylo-arthritis is Ankylosing Spondylitis (AS) which usually affects men. It affects the spine and lower back.

Symptoms are : lower back pain, stiffness, kyphosis and joint pain (arthralgia).

It's also associated with extra-articular manifestaions such as prostatitis, irits, myocarditis and lung fibrosis.

The diagnosis of ankylosing spondylitis depends mainly on X-ray. The sacro-iliac joint shows obliteration and narrowing while the vertebrae show the characteristic "square shaped" sign then the spine becomes "Bamboo-shaped". If the X-ray shows these signs with one of the following citeria, it's diagnosed as ankylosing spondylitis:

1-Lower back pain.

2-Limitation of chest movement.

3-Limited lumbar motion.

These are associated with the symptoms of the causing bacterial infection, i.e. genital infection or Symptoms of Salmonella poisoning.

Steroid are contraindicated in these cases. Instead, NSAIDs and salazopyrine can be used and may be surgery.

Both Reiter's syndrome and AS share the presence of the HLA B27 gene in blood sample examination.

Behcet's disease:

This disease affects the following systems:

-Eye: uveitis and iritis.

-Oro-genital ulcers.

-Skin rash and pigmentation.

-Neuropathy and cardiomyopathy.

As an autoimmune disease, it is treated using steroids, colchicine or immuno-suppressive drugs.

In some patients, te symptoms are not confined to one disease and are vague (specially in early stages of the disease). These patients are usually diagnosed with Undifferentiated Spondyloarthritis (USpA). This term is used to describe cases that suffer from Spondilitis but can't be classified into one of the known spondyloarthropathies.

Other Spondylo-arthropathies also include Psoriatic arthropathy, Whipples disease and arthrirtis associated with Crohn's disease.

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