Spondyloarthropathy

 

1- Reactive arthritis:

* These are mono or trace aseptic arthritis following an episode of infection or genital tract which they are separated by 3 weeks to 1 month

* The germs are usually responsible: Yersinia enterocolitica, Shigella flexneri, Salmonella enteritidis, Campylobacter jejuni (digestive front door); Chlamydia trachomatis and Ureaplasma urealyticum in case of genital gateway.

* The HLA B27 antigen was found in 70% of cases. The closest connection is with the AR associated with Yersinia.

* A few weeks after the infectious episode appear successively conjunctivitis, arthritis and sometimes palmoplantar keratoderma and balanitis.

Most often the picture is incomplete, only joint phenomena are present (this is called reactive arthritis)

* The Fiessenger Reiter syndrome is characterized by eye-urethrovaginal synovial triad.

* Biological inflammatory syndrome often age; inflammatory synovial fluid is rich in neutrophils and aseptic.

* Sometimes, evolution becomes chronic -> asymmetric arthritis, sometimes destructive; the tenosynovial and joint damage fingers carries the characteristic sausage fingers (real spondylitis devices!)

* In most cases, joint symptoms gives a few weeks NSAID; evolution is punctuated by frequent recurrences.

* Antibiotics (cyclins) would be likely to reduce the incidence of such recurrences in post-venereal forms.

* The combination with axial involvement is suggestive (but … ???)

Spondyloarthropathy

Spondyloarthropathy

2- Psoriatic arthritis:

* The frequency of articular manifestations in carriers of psoriasis patients is 40%.

* Binding to HLA-B27 phenotype is only 20% (or 50%?).

* Trace arthritis frequently reaching the IPD (very specific); more or less symmetrical arthritis; combination with axial disease, pelvic and spinal very close to the SPA.

* Joint involvement may precede psoriasis.

* The radiological lesions associated destructive images and ossifying enthesopathy.

* The treatment is sufficiently close to that of PR; methotrexate (DMARD) for the benefit of acting also on the skin condition.

3- Rheumatism of bowel:

* They are observed in 10-20% of patients with Crohn’s disease or ulcerative colitis.

* This is often a little destructive mono or oligoarthritis preferentially affecting large joints. Axial may be associated with it (isolated sacroiliitis …).

* Sulfasalazine (outside NSAIDs) is the treatment of choice.

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