Arthropathies

Psoriatic Arthritis

Clinical features   Can mimic rheumatoid arthritis or ankylosing spondylitis Asymmetrical oligoarthritis Psoriatic rashes - scaly lesions on scalp & extensor surfaces Nail changes Investigations   FBE - mild, normochromic, normocytic anaemia of chronic disease ESR & CRP - moderately elevated X-Ray - assymetrical, affecting terminal interphalangeal joints, with little or no periarticular osteopaenia Treatment   NSAIDs Sulphasalazine Methotrexate

Ankylosing Spondylitis

Clinical features   Subacute, low back or neck pain Progressive stiffening & ankylosis of axial skeleton Limited range of movement in axial joints - back, neck, chest wall & shoulders Uveitis Investigations   FBE - normochromic normocytic anaemia of chronic disease, thrombocythaemia ESR & CRP - moderately elevated HLA-B27 assay - positive in 90% of patients X-Ray - sacroiliac joints & spine     Sacroiliac joint sclerosis & ankylosis Syndesmophytes - osteophytes in the ligaments Squaring of vertebrae - Bamboo spine Treatment   Education Regular exerecise NSAIDs Sulphasalazine Methotrexate Steroids

Reiter's Disease

Clinical features   Follows episode of infective gastroenteritis (Salmonella, Shigella, Campylobacter), or STD exposure Triad   Non ghonococcal urethritis Iritis / Conjunctivitis Reactive arthritis Large joint polyarthritis (ankles, knees, hips) Investigations   FBE - normochromic normocytic anaemia of chronic disease ESR & CRP - moderately elevated HLA-B27 assay - positive in 70% of patients Treatment   STD education Antibiotics for urethritis or conjunctivitis NSAIDs