Spondyloarthritis Khusrow Khidri 1039

Spondyloarthritis (or spondyloarthropathy) is the name for a family of inflammatory rheumatic diseases that cause arthritis. This group of disorders includes several clinical entities, of which ankylosing spondylitis is the prototype. Others include Reiter syndrome, psoriatic arthritis, spondylitis associated with inflammatory bowel diseases, and reactive arthropathies after infections

Spondyloarthritis differs from other types of arthritis in that it involves the “entheses.” These sites are where ligaments and tendons attach to bones. Symptoms present in two main ways. The first is inflammation causing pain and stiffness, most often of the spine. Some forms can affect the hands and feet or arms and legs. The second type is bone destruction causing deformities of the spine and poor function of the shoulders and hips.

The spondyloarthropathies are characterized by the following: Pathologic changes that begin in the ligamentous attachments to bone rather than in the synovium Involvement of the sacroiliac joints, with or without arthritis in other peripheral joints Absence of rheumatoid factor Association with HLA-B27

Causes Ankylosing spondylitis is hereditary. Many genes can cause it. Up to 30 of these genes have been found. The major gene that causes this disease is HLA-B27. Almost all white people with ankylosing spondylitis are carriers of HLA-B27.

complications Altered spinal biomechanics Combined with the brittle quality of the osteoporotic bone Increase susceptibility to vertebral column factures, and Spinal Cord injury, even after minor, often trivial, trauma Significantly impaired mobility and peripheral joint arthritis

Treatment Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) offer symptom relief for most patients by reducing pain and swelling. Other medicines called anti-TNF drugs or TNF blockers are effective in patients who do not respond enough to NSAIDs physiotherapy

Background: A 32-year-old white man presented with features of inflammatory back pain, including awakening at night and morning stiffness. He had acute back pain 4 years earlier as a result of a herniated lumbar disc. Investigations: The orthopedic consultation included tests for neurologic deficits; a Lasègue test; a finger-to-floor distance test; X-rays of the lumbar spine; and MRI of the lumbar spine. The rheumatologic consultation included recordal of clinical history and family history; physical examination, including a Schober's test, lateral spine flexion, chest expansion, cervical rotation, and tragus-to-wall distance; blood tests, including genotyping for human leukocyte antigen B27 positivity, and measurements of C-reactive protein level and erythrocyte sedimentation rate; MRI of the sacroiliac joints with use of short tau inversion recovery sequences; and measurement of the Bath Ankylosing Spondylitis Disease Activity Index and the Bath Ankylosing Spondylitis Functional Index. Diagnosis: Axial undifferentiated spondyloarthritis. Management: NSAIDs and physiotherapy.

references Gorlick R, Khanna C: Osteosarcoma. J Bone Miner Res 25:6831, [Current overview of the underlying genetic and pathologic basis for osteosarcoma.] professionals-and-students/reports/hands-on/hands- on-spring-2010.aspx nts/Diseases_And_Conditions/Spondylarthritis_(Spond ylarthropathy)/