Continuing Medical Education: Spondyloarthropathies.

Resources

Bibliography

1. Schumacher HR, Klippel JH, Robinson DR (eds): Primer on the Rheumatic Diseases, Tenth Edition. Arthritis Foundation, Atlanta, Georgia, 1993.

   Excellent source for quick information on the rheumatic diseases. Generally more detailed than medicine textbooks.

2. Kahn MA (ed): Ankylosing spondylitis and related spondyloarthropathies. Spine. State of the Art Reviews 1990;4:497-688.

   A more detailed source of information on this subject.

3. Kahn MA, van der Linden SM: A wider spectrum of spondyloarthropathies. Semin Arthritis Rheum 1990; 20:107-113.

   Discusses the continuum of disease associated with the HLA-B27 antigen.

4. Kahn MA, van der Linden SM, Kushner I, et al: Spondylitic disease without radiologic evidence of sacroilitis in relatives of HLA-B27 positive ankylosing spondylitis patients. Arthritis Rheum 1985; 28:40-43.


5. Calabrese LH: Human immunodeficiency virus infection and arthritis. Rheum Dis Clin N Am 1993; 19:477-489.


6. Blocha KLN, Sibley JT: Undiagnosed chronic monoarthritis. Arthritis Rheum 1987; 30:1357-1361.

   Discusses the etiology of chronic inflammatory monoarthritis on long term follow-up. Sixty-five percent were still undiagnosed at 2 years but approximately 15% ended up with the diagnosis of spondyloarthropathy and 8% with rheumatoid arthritis.

Review questions

1. A 27 year old male with severe ankylosing spondylitis was involved in a minor car accident. He complains about neck pain but routine films demonstrate only changes of the spondylitis including ankylosis of multiple cervical segments. A likely cause of this patients neck pain is: (one best answer)
   1. Muscle strain from the accident.
   2. Flare of the ankylosing spondylitis from the trauma.
   3. Fracture through an ankylosed cervical disc space.
   4. Insufficiency fracture through a cervical vertebrae.
   5. Desire for large insurance settlement.
2. A 38 year old male comes to your office with a 3 week history of swelling and pain in the right ankle as well as several the toes of both feet. In addition, the left heel is very painful. Associated with these is a history of a urethral discharge and frequent loose stools. Diagnostic considerations include: (may be more than one right answer)
   1. Whipple's disease
   2. Reiter's syndrome
   3. HIV infection
   4. Inflammatory bowel disease
   5. Early rheumatoid arthritis
3. A 24 year old female comes to the office with a 3 month history of low back pain particularly bad in the morning and better with activity. There is tenderness over both sacroiliac joints. X-rays of the pelvis show a question of right sided sacroilitis. The next choice for diagnostic testing to evaluate the possibility of ankylosing spondylitis might be: (one best answer)
   1. HLA-B27 antigen
   2. Sedimentation rate
   3. CT scan of sacroiliac joints
   4. X-rays of the lumbar spine
   5. Repeat AP pelvis in 6 months
4. Radiographic features of ankylosing spondylitis include all of the following except: (one best answer)
   1. Syndesmophytes
   2. Facet joint fusion
   3. Reactive periostitis
   4. Disc space narrowing
   5. Sacroilitis

Surgery for arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

Disclaimer

This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.

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