Spondyloarthritis Flashcards
AS clinical criteria and Hallmark sign
Clinical criteria:
- Low back pain and stiffness > 3 mo
- improve with exercise
- not relieved by resting
Hallmark feature:
Sacroiliitis–>Deep dull pain in buttocks due to inflamed SIJ
AS other S/S
- Low back pain due to inflammation
- Syndesmophytes: bony growth within ligaments on either side of a joint–>fusion & rigidity
- Onset before 40, M>F
- Postural deformities: Tx kyphosis, Dec. lumbar lordosis, poking chin
- Chest expansion limitation–>restrictive
- Fatigue due to disease progression
- Others: inflammation of bowels, lungs, heart
Common feature
- Inflammation of the spine
- unilateral peripheral joint synovitis
- Enthesitis
- Extra-articular feature, Involvement of eyes (uveitis), skin, GI
- No rheumatoid factor (seronegative
- Associate with HLA-B27
AS PT Rx consideration
- Improve trunk flexibility & joint mobility
- Increase muscle endurance & strength
- Increase respiratory function & deep inhalation
** no high impact/high loading cardio exercise (e.g. running)**
AS Postural Assessment Overview
- Tragus to wall
- Lateral trunk flexion
- Trunk flexion (Modified Schober’s)
- Trunk extension (Smythe test)
- Trunk rotation
- Chest expansion
- Cervical mobility
Tragus to wall
Patient Position:
- stands with heels, buttocks, and shoulder blades against the wall
- as erect as possible+chin tuck
Measurement:
- distance between tragus to wall
ensure both sides are the same/rotated head
Lateral trunk flexion
Patient Position:
- stands with heels, buttocks, and shoulder blades against the wall
- Feet: shoulder width, record the width
Initial Measurement:
- Distance between the ground and the tip of 3rd finger
Patient Action:
Repetitively Side flex with contacting the wall
Final Measurement:
- on the 4th repetition
Trunk flexion (Modified Schober’s)
Patient Position:
- stands erect
Initial Measurement:
- Mark between PSIS & S2
- Mark 2 more points:
1st: 10 cm above S2
2nd: 5 cm below S2
Patient Action:
Bend down
Final Measurement:
- Distance between the later 2 markings
Trunk extension (Smythe test)
Patient Position:
- stands erect
Initial Measurement:
- Mark between PSIS & S2
- Patient bend down
- Mark 3 consecutive 10cm segments above S2
Patient Action:
- Prone
- Extension by arm extended
Final Measurement:
- Measure each segments
Trunk rotation
Patient Position:
- stands erect
Initial Measurement:
- Place a tape between Xiphisternum & PSIS
Patient Action:
- Twist to contralateral side
Final Measurement:
- Change in measurement
Chest expansion
Patient Position:
- stands erect
Initial Measurement:
- Place a tape around the trunk at Xiphisternum
Patient Action:
- Full inhale+full exhale
Final Measurement:
- change in circumference in two actions
Cervical mobility
Check:
-Flexion/Extesion
-Rotation
-Side flexion
with a tape measure/ goniometer
Psoriatic arthritis
Etiology:
- M=F
- 30-50 yo, but can start in childhood
Presentation:
*digits, large joints of axial skeleton, back and SI joints:
Chronic, erosive, inflammation
*Dactylitis: sausage-like fingers due to swelling
*Enthesitis: usually in heels and back
Enteropathic spondylitis
Etiology:
- Associated with inflammatory bowel disease
1. Ulcerative colitis (lower 1/2 of bowel)
2. Crohn’s disease (whole digestive system)
Pathophysiology:
- long standing inflammation–>bacteria enter damaged bowel wall+circulate through the blood
Presentation:
- Flare up–>subside after six weeks–>common re-occurence
- Peripheral joint more affected–> can affect spine
Reactive arthritis
Etiology:
- Reaction to an infection by certain bacteria in bowel/GI tract
Presentation:
-Short-lasting but can become chronic
-Hot swollen joint in knee & ankle
-Persistent LBP–>worse at night/morning
