Spondyloarthropathy ??????

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Spondyloarthropathy ??????
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Spondyloarthropathy (SAE)

• Spondyloarthropathy Enthesopathy
• Spondylopathy????
• Arthropathy????
• Enthesopathy?????
• ?? Seronegative arthritis enthesitis
• Seronegative(????)???????
• Arthritis
• Enthesitis

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Common Features Enthesitis ?????

• Sausage dactylitis

• Periarthritis

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Common Features Heel Pain ???
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(No Transcript)
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Common Features Spondylopathy

• Sacroiliitis ?????
• ????
• Buttock pain

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Common Features Syndesmophytes

• Syndesmophytes
• ??????????????
• ?SAE?????
• ????enthesitis osteitis ???

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Marginal/Non-MarginalSyndesmophytes

• Focus on conners of vertebral body

Non-Marginal Reiter, Psoriatic arthritis
Marginal AS, IBD
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Uveitis ???

• Acute stage???
• Chronic stage???
• ????????glaucoma

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Spondyloarthropathy (SAE)

• Ankylosing spondylitis ??????
• Psoriatic arthritis ??????
• Reactive arthritis ??????
• Enteropathic arthritis ????????
• Crohns disease
• Ulcerative colitis
• Juvenile ankylosing spondylitis ??????
• Undifferentiated spondylarthropathies

Behcets disease ???? HIV-related arthropathy
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?????????

• ??????(Ankylosing Spondylitis),???????????????,
• ????????????????????51?
• ????????????????0.5 1?

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????

• ???????????,?1984?Dr. van der Linden?????????????
  
• Modified New York criteria, 1984
• 1. ??????,?????????3?????
• 2. ?????????
• 3. ???????
• X???????,
• ??2????3????
• ?????????4?,??13??????,??????????????

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??????????

• ????
• ????
• ?????
• X???

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??????????

• ????
• 40?????
• Insidious onset
• Duration ?????
• ????????????????????
• ?????????
• ?????????????????
• ????
• ????????

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?????????

• ?????????????????????????????????,???????????????
• ?????????????,?????????
• ???????????????????????????????????????,??????????
  ??????????
• Cough pain/Sneezing pain
• T spine involvement
• Neck lateral bending limitation
• C-spine involvement
• ???????????????????????????????????????

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Spondylarthropathies ?????

• ????????
• ???(Sausage digits)
• ?????(Enthesopathy)
• Achilles Tenosynovitis
• Plantar fasciitis
• Costochondritis
• 25???????????/??????????(Acute anterior
  uveitis/iridocyclitis)

• 15 AS ????? IgA nephropathy?????????,????????????
  
• ????????AR(???????),????????
• ???????????????,????????????????
• (Apical pulmonary fibrosis)

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??????????

• ????
• ????
• ?????
• X???

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??????????

• ????
• Lateral flexion
• Schobers tests (for L-spine)
• C-spin (occipital-wall distance)
• Tests for SI joints -- SI stressing tests-- SI
  compression tests

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Ankylosis of Lumbar Spine
Limited spine motion
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Schober???

• ?????,???????(dimples of Venus)
• (?????)
• ???????????????,?????????10
• ??????????
• ???????,?????????,??????15???
• ??????????????(lt4CM)?????AS????

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Occiput-to-wall Test

• ??????,???????,???????,????0??

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Tests for SI Joints
SI compression tests
SI stressing tests
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??????????

• ????
• ????
• ?????
• X???

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??????????

• ?????
• ??????(?CRP?ESR)?????????????????????????(???A???
  ???)
• ??????????,B27????????(HLA-B27)????????,??????????

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??????????

• X???
• X??????????,???????????????X???????,??????????????
  ?????
• CT of SI joints??????bony erosion???
• MRI?enthesitis, discitis??????bony erosion??CT??
• ??????(bone scan)
• ??????????????,????????????????,????????????

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??????????

• NSAID
• ??????,?????????(NSAID),??????,???????????????
  ???????????COX-2 ?????(Syndesmophyte)??????
• COX-2-specific inhibitor
• ???????????????
• Steroid
• ??????
• ??Acute uveitis, refractory spondylitis, active
  peripheral arthritis, ??????extra-articular
  manifestations

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??????????

• DMARADs
• Salazopyrine ???DMARD
• MTX ????????
• Sulfasalazine ?Methotrexate ?????????????,????????
  ????
• ??????Biphosphates Palmidromate
• ??????????????????
• Thalidomide

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?????????????

• ?????????(Anti-TNF,?Enbrel ??),????????,???????

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Juvenile Ankylosing Spondylitis

• Onset before 14 y/o
• Usually from mono or oligo- lower extremities
  arthritis
• Poor prognosis
• Early involvement of hip/shoulder joints and
  C-spine

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Reiters Syndrome??????

• Arthropathy enthesopathy
• Peripheral arthritis
• Sausage dactylitis
• Enthesopathy
• Mucocutaneous lesions
• Oral ulcer
• Genital ulcer
• Skin change
• Conjunctivitis

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Genital Ulcers

• Balanitis Circinata (?????) Usually shallow,
  non-painful ulcer on glan of penis

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Skin Lesions

• Keratoderma blenorrhagica(??????)

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Bacteria Associated with Reactive Arthritis

• Reiters syndrome
• Chlamydia trachomatis
• Salmonella
• Shigella flexneri
• Yersini enterocolitica
• Campylobater jejuni
• Lyme disease
• Borrelia burdoferi

• Neisseria gonorrhea
• Gonococcal arthritis

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Psoriatic Arthritis??????

• ??????
• Classical type DIP type
• Oligoasymmertrical arthritis with dactylitis
• Polysymmertrical arthritis (RA-like)
• Arthritis multilans ?????
• Psoriatic spondyloarthropathy
• With or without peripheral arthritis

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Skin Change Arthritis

• Psoriasis skin lesions
• 1/3 before arthritis, 1/3 during arthritis, 1/3
  after arthritis
• Nail change
• Pitting nail
• Onychodystrophy
• Onycholysis

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Inflammatory Bowel Disease-Related
SAE????????????

• Ulcerative colitis
• Crohns disease
• ????Ankylosing spondylitis ??

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Behcets Disease

• Recurrent aphthus ulcer
• Oral ulcer
• Genital ulcers
• Skin lesions
• Erythema nodosum
• Folliculitis
• Uveitis panuveitis or post uveitis
• ?????

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Behcets disease

• HLA association HLA B51
• ????????test Pathergy reaction
• ????N.S. 48-72?????Non-septic pustules
• ??thromboembolism
• ????NSAID,low dose steroid, Colchicine??, ?low
  dose aspirin??thromboembolism

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HIV-related arthropathy

• ?Reiters-like syndrome ????
• ???Psoriasis??
• Systemic symptoms ??????

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HLA-B27 ???
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• 90?AS??? HLA-B27??????
• ??????AS??,?50??????????HLA-B27???
• ?B27 ??,??AS?????10?
• ?B27??,??AS????20?
• ???????AS??,??AS?????5?
• ????????5.5?B27,?2-10??????AS?

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HLA-B27 disease associations

• Ankylosing spondylitis gt 90 (white
  males)
• with uveitis or aortitis
  100
• Reactive arthritis 50-80
• with sacroiliitis or uveitis
  90
• Juvenile spondylarthropathy 80
• Inflammatory bowel disease
• Peripheral
  Not increased
• Axial
• Crohns disease
  50
• Ulcerative colitis
  70
• Psoriasis
• Peripheral
  Not increased
• Axial
  50

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HLA correlation

• HLA B7( B27, B60..) SAE, Uveitis
• HLA-B51 Behcets disease
• HLA DR3 SLE, Sjogren syndrome
• HLA DR4 RA ,Pemphigus vulgaris , IDDM Type I
• HLA DR5 Pauciarticular juvenile chronic
  arthritis, Hashimotos thyroiditis
• HLA DR7 Congenital adrenal hyperplasia
• HLA DR8 Palidromic rheumatism (PMRA)
• HLA DQ 3.2 IDDM (type I)