Inflammatory Spondyloarthropathy

Inflammatory spondyloarthritis is a family of conditions with 3 common features:

• Inflammation, pain and stiffness in spine and pelvic joints

• Enthesitis – Inflammation at the insertion point of a ligament/tendon

• HLA-B27 gene

The most common condition here is Ankylosing Spondylitis, but other types include Psoriatic arthritis, Reactive arthritis, Enteropathic arthritis (related to IBD), and Bechet’s disease.

Ankylosing Spondylitis

This causes progressive stiffness and pain in spine and pelvis due to inflammation. It presents with:

• Lower back pain – Often early morning stiffness (worse with rest, better with movement), with tenderness of sacroiliac joints

• Peripheral enthesitis can occur in 1/3 patients – e.g. Achilles tendonitis, Plantar fasciitis

N.B. "Ankylosis" means fused bones or hard tissue due to injury or disease. "Spondylitis" means inflammation in vertebrae.

A key complication here is Vertebral fracture.

Extra-articular complications:

• Anterior uveitis

• Aortitis – Can lead to AR

• Upper lobe PF – Reduced chest expansion

Investigations:

• Bloods - CRP/ESR

• O/E - Schober’s test (assess for any restricted lumbar movement) will show lots of restriction

• Lumbar XR - Vertebral bodies may become squared, with bony bridges (syndesmophytes) forming between them, and ossification of spinal ligaments. In late disease, there may be complete fusion of the vertebral column = Bamboo spine.

Management:

• NSAIDs, Steroids, Physio, Exercise, Stop smoking, Treat complications

• Steroid injections as an adjunct