3Case 1 A 34-year-old secretary 3 months painful swelling of her right 2nd and 4th fingers2 weeks later tenderness and swelling in the 2nd MCPs and the 3rd and 5th right PIPs, diffuse painful swelling of the 3rd toe of her left foot.
8Case 3 21-year-old male student low back pain of 6 months' duration. Relevant questions?
9Case 3 The onset insidious over the course of the previous 6 months. worse in the morning, improves with activitywakes up in the middle of the night with back pain that goes away after he walks around.pain is located in the low back and intermittently goes down the back of one leg or the other to the knee.He has an uncle, age 50, who has "always" had a stiff back.painful red eye 6 months ago, which was treated by anophthalmologist for 2 months at university.
14Demography AS Prevalence AS 0.05-0.23%, 3-4X male UHCW catchment area – AS pts
15Burden of AS SMR 1.5 10% less labour participation 15% constraints at workPoor quality of life cf worse than RA
16AetiologyAS has been closely associated with the expression of the HLA-B27 geneThe response to the therapeutic blockade of TNFalpha indicates that this cytokine plays a central role in ASExamination of inflamed SI joints in AS patients has demonstrated high levels of CD4+ and CD8+ T cells and macrophages.The overlapping features with reactive arthritis and IBD (SpAs) suggests a possible role for intestinal bacteria in the pathogenesis of AS.
18Diagnostic criteria – Modified New York criteria Radiologic criteria : sacroiliitis - grade 2 bilaterally or grade 3-4 unilaterallyClinical criteria : LBP and stiffness > 3 months improved with exercise and not relieved by rest, limitation of L/spine motion in frontal and sagittal planes, limitation of chest expansion relative to normal values correlated with age and sexDiagnosis : radiologic criteria and at least one clinical
44Reactive arthritis Young adults, equal sex Incidence of 30-40/100,000 Post urethritis/cervicitis or infectious diarrhoea eg campylobacter, salmonella, shigella, yersinia,chlamydia – 1-6 weeksSero-ve features + conjunctivitis, balanitis, oral ulcers, pustular psoriasis