Continuing Medical Education: Spondyloarthropathies.
Edited By: Gregory C. Gardner, M.D.
Last updated Friday, January 07, 2005
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Other types of spondyloarthropathiesWhat is juvenile ankylosing spondylitis? This entity is characterized by pauciarticular lower extremity
arthritis usually in boys and often with a family history of
spondyloarthropathy. Most are B27 positive. The peripheral arthritis
usually begins first followed later by the axial skeletal involvement.What is late onset peripheral spondyloarthropathy? At the other end of life, a syndrome of pauciarticular joint
involvement with marked lower extremity swelling which later evolves
into more typical ankylosing spondylitis has been described. It has
been reported to occur in the sixth and seventh decades of life and
does not respond well to NSAIDs as do other spondyloarthropathies.
Patients may have marked elevation of the ESR and constitutional
symptoms as well.What is enteropathic spondylitis? - Inflammatory Bowel Disease
- Peripheral arthritis: Both Crohn's disease and
ulcerative colitis can be associated with a peripheral arthritis in
about 20% of patients. The large joints of the lower extremities are
typically affected and the arthritis waxes and wanes with the activity
of the bowel disease. The peripheral arthritis is not a HLA B27
associated process.
- Spondylitis: About 20% of patients
may have evidence of sacroilitis and some 20% of these patients may
progress on to actual ankylosing spondylitis. Only 50% of patients with
sacroilitis carry the HLA B27 haplotype. The course of the spondylitis
does not correlate with the bowel activity.
- Whipple's Disease
Arthritis is the presenting complaint in 60% and occurs at some time
in 90% of patients with Whipple's disease. The arthritis is a migratory
oligoarthritis. Patients also have an increased prevalence of
sacroilitis and ankylosing spondylitis. Diagnosis is made by the
history of persistent diarrhea and possibly protean other
manifestations, along with PAS positive material in the lamina propria
of the gut on biopsy. Treatment is with prolonged antibiotics. - Bowel Bypass Arthritis-Dermatitis Syndrome
Intestinal bypass for obesity has been associated with a interesting
syndrome of arthritis and dermatitis occurring in 8-36% of patients.
The arthritis in typically oligoarticular in nature and very painful.
The etiology is felt to be due to immune complexes containing bacterial
products from the gut. Dermatitis is also present in up to 80%.
Treatment is with NSAIDs, antibiotics to reduce bacterial load, or
reanastomosis of the bowel.
What is undifferentiated spondyloarthropathy? This category is used to include those patients who do not fit any
particular category of disease or may have a combination of features.
Many of these patients may have a chronic inflammatory monoarthritis in
the setting of B27 haplotype, heel pain caused by calcaneal
periosititis, or recurrent dactylitis (sausage digits).
Uveitis is a feature of almost all of the spondyloarthropathies to
one degree or another. Any young male who presents to an
ophthalmologist with uveitis should be evaluated for a
spondyloarthropathy. Surgery for arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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