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Ebook ABC Rheumatology (4/E): Part 2

Part 2 book “ABC Rheumatology” has contents: Spondyloarthritides, juvenile idiopathic arthritis, musculoskeletal disorders in children and adolescents, polymyalgia rheumatica and giant cell arteritis, systemic lupus erythematosus and lupus-like syndromes, raynaud’s phenomenon and scleroderma, refl ex sympathetic dystrophy, vasculitis and related rashes, and other contents. | CHAPTER 14 Spondyloarthritides Andrew Keat1 and Robert Inman2 1 Northwick Park Hospital, Harrow, UK Toronto Hospital Western Division, Toronto, Canada 2 OVER VI EW • Spondyloarthritides as a group occur with a similar prevalence to rheumatoid arthritis. • The various spondyloarthritic syndromes share common clinical lesions, especially enthesitis, oligoarthritis, sacroiliitis, iritis, psoriasiform skin and mucosal lesions and overt or covert inflammatory bowel disease. • Inheritance of HLA-B27 and other genes is common to all spondyloarthritides, the prevalence of these disorders varying with the local prevalence of HLA-B27. • Diagnosis of ankylosing spondylitis is often long delayed; identification of inflammatory back pain is a key determinant in making the diagnosis early. • Use of anti-tumour necrosis factor biologic drugs has revolutionized the treatment of severe ankylosing spondylitis. The spondyloarthritides (SpA) comprise a group of syndromes that are distinct from rheumatoid arthritis and are characterized by inflammation of the spine in many, but not all, cases. Other key features include asymmetric oligoarthritis, enthesitis, psoriatic skin and mucous membrane lesions, and eye and bowel inflammation. Tests for rheumatoid factor, anti-cyclic citrullinated peptide antibody and other autoantibodies are negative, but there is a strong association with the human leukocyte antigen (HLA) B27. Spondyloarthritides occur in both adults and children, although spinal involvement is rare in children. A working definition has been provided by the European Spondyloarthritis Study Group (Box 14.1). A diagnosis of SpA requires one or two of the entry criteria plus one other. Skin, eye and bowel disease may become apparent only with the passage of time. The classical forms of spondyloarthritis (also called “spondyloarthropathies”) and the key physical features are listed in Table 14.1. ABC of Rheumatology, 4th edn. Edited by Ade Adebajo. ©2010 Blackwell Publishing