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Spondyloarthritis (TREATMENT (Flares of uveitis: Topical or intraocular…

- - - - cardinal: infl spine pain
        spine involvement ascends from sacroiliac joints to involve all levels of spine
        ankylosis of vertebral column & apophyseal joints--> progressive loss of motion
        Costovertebral involvement--> decr chest expansion + restrictive lung physiology
      - Loss of mobility & secondary osteoporosis of vertebral
        bodies--> incr risk of traumatic spine fracture
        Axial involvement of shoulders & hips common and a. w/ a worse prognosis.
        Peripheral oligoarthritis, enthesitis, and dactylitis more common in fs.
        Dx: demonstration of radiographic sacroiliitis (SIJ erosions, sclerosis, ankylosis).
        Ant uveitis common.
        Aortitis, upper lobe pulmonary fibrosis, cauda equina syndrome, and amyloidosis less common, seen in late disease.
    - - urethritis, conjunctivitis, certain dermatologic problems
        urethritis: chlamydial infection triggering disease OR a sterile infl discharge seen in diarrhea-associated disease.
        Conjunctivitis: mild in reactive arthritis, distinct from uveitis
      - Keratoderma blennorrhagicum: a distinct papulosquamous
        rash u. found on palms or soles
        Circinate balanitis: a rash that may appear on penile glans or shaft of men w/ reactive arthritis
        Nonpitting nail thickening & oral ulcers may also occur, can be confused w/ similar findings in psoriasis and IBD, respectively.
      - Most cases self-limited
        Chronic or relapsing arthritis and chronic spondylitis a. w/ HLA-B27 and Chlamydia infection
    - - Five identifiable clinical patterns:
        DIP joint involvement w/ nail pitting;
        asymmetrical oligoarthropathy of large & small joints;
        arthritis mutilans, a severe, destructive arthritis;
        symmetrical polyarthritis, identical to RA;
        predominately axial disease
        (patterns are not exclusive, clinical overlap significant)
      - Spondylitis or sacroiliitis may occur
        prevalence of HLA-B27 increased among spondylitis or sacroiliitis but not other patterns
        Psoriatic skin or nail disease predates arthritis in most
    - - Crohn’s disease and UC frequently a. w/ infl spine disease and peripheral arthritis
        peripheral arthritis typically nonerosive, oligoarticular, episodic, and degree of joint involvement fluctuates w/ gut activity.
        A more chronic, symmetrical polyarthritis may occur in Crohn’s disease