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Spondyloarthropathies Notes

This is a sample of our (approximately) 6 page long Spondyloarthropathies notes, which we sell as part of the Rheumatology Notes collection, a MBChB (hons) (1st) package written at University Of Leicester in 2014 that contains (approximately) 20 pages of notes across 6 different documents.

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Spondyloarthropathies Revision

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Sero-negative inflammatory arthritis (Spondyloarthropathies) A group of inflammatory conditions, which typically affect the spine and enthesis (tendon and ligament insertions) Associated with HLA-B27 gene Distinct from RA because
- Seronegative (no RF)
- Males> Females
- Younger patients Includes
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis

Ankylosing Spondilitis A chronic inflammatory disorder with eventually leads to ankylosis (fusion). Mainly affects the spine but can invade proximal joints of limbs Pathogenesis
- Chronic inflammation of synovium, articular cartilage and ligaments
- Leads to ossification of joints
- After 10-15 years inflammation stops and disease process halts Diagnostic criteria 1) Limitation of movement of lumbar spine in all 3 planes 2) Hx of pain in lumbar spine or at the dorso-lumbar junction 3) Limited chest expansion to <2.5cm measured at 4th ICS 4) Sacroilitis - must have this +/- other symptoms Clinical features Early symptoms
- LBP (worse at night, gradual onset)
- Stiffness relieved by exercise
- Pain may progress up the back, SIJ, hips and down legs Examination
- Limited lumbar spine movement
- Decreased chest expansion (ankylosis of costovertebral joints)
- Enthesis - usually Achilles tendon or plantar fascia Schobar test for lumbar flexion
- Pt stands erect. Make mark over spinous process of L5 - make another mark 10cm above it and ask pt to bend forward. Distance normally exceeds 15cm Wall test for cervical flexion deformity
- Pt stands erect with heels and buttocks against wall
- Instruct pt to extend neck maximally in attempt to touch wall with the occiput. Distance between occiput and wall measures degree of deformity Extra-articular features Eyes - Uveitis Heart - Aortitis, cardiomegaly Lungs - Apical pulmonary fibrosis Renal - IgA nephropathy, amyloidosis GI - Inflammatory bowel disease Limbs - Neuropathy

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