- Chronic and progressive form of seronegative arthritis.
- Inflammatory disorder of articular and para-articular entheses (where ligaments tendons and capsule meet bone)
- Axial skeleton, particularly sacroiliac joints (SIJ) and facet joints of vertebrae
- May involve greater trochanter, patella, calcaneum, iritis/uveitis and pulmonary involvement.
- M : F = 5:1, 15 - 35 yo, 90% have HLA-B27
- Back pain/stiffness (morning pain > 30 min), sciatica, wt loss, and low-grade pyrexia
- Neck and costochondral stiffness later
- Early signs
- loss lateral flexion lumbar spine, SIJ tenderness
- no loss of lumbar lordosis in lumbar flexion
- Check for cardiovascular (aortic incompetence/pancarditis) and pulmonary fibrosis
- Associated inflam. bowel disease
- Associated uveitis (20%), prostatitis, conjunctivitis
- Later: Bamboo spine, Amyloidosis
- Psoriasis, Reiter's disease, enteropathic arthropathy, hyperparathyroidism, rheumatoid arthritis, gout.
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Similar x-ray appearance but DISH age group is older, SIJ not involved in DISH
- Raised ESR, positive HLA-B27, anaemia of chronic disease, rheumatoid F negative
- NSAIDS, sulfasalazine, physiotherapy to maintain flexibility.
- Infliximab / Etanercepts (anti-TNF) agentsvery effective and disease modifying especially if used early
Content by Dr. Íomhar O' Sullivan 05/06/2009. Last reviewed ÍOS 3/08/12.