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Seronegative spondyloarthropathies - Coggle Diagram
Seronegative spondyloarthropathies
Ankylosing spondylitis (axial)
Reactive arthropathies (peripheral)
Psoriatic arthritis (peripheral)
Multi-system inflammatory disorders that primarily affect:
Axial skeleton (particularly the spine)
Begins at sites where
tendon and ligament insert into bone
(rather than in the synovium)
Absence of RF = seronegative spondylo-arthropathies
Ankylosing spondylitis
Chronic
Systemic inflammatory disease of joints of vertebral column and sacroiliac joints
Manifested by pain and progressive stiffening of the spine
Bamboo spine
It affects 2-8% of HLA-B27 positive white people
Less severe in women
Etiology
Genetic
Environemental factors
90% of patients have the
HLA-B27 antigen
Clinical manifestations
Low back pain
= worst when resting in bed
Muscle spasm
Loss of lumbar lordosis
as the disease progress =>
kyphosis of the thoracic spine and extension of the neck
A spine fused in the flexed position is the end result in severe AS
The heart and lungs get compressed and the abnormal body weight support may destroy the hips
Diagnosis:
Based on history
Physical examination
XR
Early and precise diagnosis of AS is closely related to favorable prognosis
Tx:
Controlling pain
Maintaining mobility by suppressing inflammation
Proper posture and therapeutic exercises (swimming)
Reactive arthropathies (Reiter’s syndrome)
Etiology
Infectious microorganisms that reach the joint
Be caused by foreign substances inside the joint (implants, industrial gases or oils)
Most common type of inflammatory polyarthritis in
young men
HLA-B27
genotype is a predisposing factor in over 2/3 of patients with reactive arthritis
Most frequently follows genitourinary infection with Chlamydia trachomatis
Reactive arthritis may also follow enteric infections with some strains of Salmonella or Shigella (antibiotics not effective)
Reactive arthritis should always be considered in young men who present with polyarthritis
Clinical manifestations
Self-limited course
Recurrent episodes of arthritis
Reactive arthritis related with:
nongonococcal urethritis
asymmetric oligoarthritis
and
conjunctivitis
=>
Reiter arthritis
Diagnosis
History and physical examination
Tx
High doses of potent nonsteroidal anti-inflammatory drugs
Intra-articular corticosteroid injection
for patients that have with large-joint involvement
Psoriatic arthritis
Seronegative inflammatory arthropathy that occurs in
7% of people with psoriasis
Etiology
Unknow
Tissue type HLA-B27
(
genetic factor
)
Environemental
Immunologic factor
Clinical manifestations
20%
of patients with psoriatic arthritis have an
elevated serum level of uric acid
Diagnosis
Skin psoriasis and serum level of uric acid
Positive HLA-B27
Tx:
Management to reduce pain, stiffness and swelling, maintain mobility
It classical involves:
DIP joints of the hands and feet
Can lead to sausage fingers or toes