Spondyloarthritides

Chronic, immune system mediated inflammatory mediated inflammation of the ligamentous and tendinous junctions of vertebral bodies, SI joints, chest wall, generally occurring in young to middle age men and women often leading to extreme spinal rigidity, possibly associated with RA like inflammation of diarthrodial joints, tendonitis, inflammatory eye disorders, inflammatory bowel disorders, psoriasis, GI/GU infections.

RF negative

History

• Pain at cervical, thoracic, lumbar, SI?
• How long has pain been present?
• More spinal pain during sleep and the early morning hours after awakening? Or later in the day after activities?
• Family h/o spinal disorders, ankylosing spondylitis?
• h/o of underlying disorder that could predispose to spondylarthritis? i.e. psoriasis, crohn’s, UC, bacterial dysentery, STD
• h/o inflammatory peripheral arthritis, Achilles tendonitis, plantar fasciitis, dactylitis?
• h/o uveitis, iritis, pars planitis, conjunctivitis?
• h/o oral mucosa or anal mucosa ulcers?
• Rashes of genitalia or soles of the feet
• Prior rheum eval?
• Prior imaging?
• NSAIDS? Corticosteroids? DMARDS?

Exam

• All spine
• All peripheral joints for ROM, TTP, synovitis, Achilles tendonitis, plantar fasciitis, dactylitis
• ROM for cervical flexion, extenstion, lateral flexion and rotation
• Lumbar flexion an dextension
• Does patient revers the normal lumbar lordosis when bending forward?
• Modified Schober’s test
• e/o psoriasis of scalp, extremities, trunk, perianal region, nails?