Spondyloarthropathies

Introduction

• Spondyloarthropathy (Spondloarthritis)– Term for a group of

chronic diseases– Affecting the joints of the

spine– Ankylosing spondylitis,

Reiters syndrome, psoriatic arthritis, juvenile idiopathic arthritis

– Different to Rheumatoid Arthritis

• All have the following symptoms– Inflammatory low back

pain– Sacroilitis– Uveitis– Inflammatory Bowel

Disease– Skin Rashes– Enthesisitis

Pathophysiology (Ankylosing Spondylitis)

• Not well known• HLA B27 Receptor gene

predisposition• Immune response• Inflammation of joints,

intervertebral and facet• Causes syndesmophyte

formation• Vertebrae fuse

Mechanism Of Injury

• Insidious

Associated Pathologies

• IBS• Inflammatory Bowel Disease• Depression

Subjective

• Insidious onset• Low back Pain (often other joints painful)• Age < 40• Morning stiffness > 30 mins• Duration longer than 3 months• Waking 2nd half of the night only• Improvement with Exercise• Worse with rest• Fatigue• Eye symptoms, Bowel symptoms, SIJ Symptoms

Objective

• Reduce lumbar lordosis• Increase thoracic

kyphosis• Reduced ROM in all

directions• Tenderness and heat

palpation• Limited chest wall

expansion

Special Tests

• Schober’s test

Further Investigations

• Diagnosis often takes many months to years

• Specialist/Rheumatologist investigations– Laboratory Testing– Radiographic evaluation– Subjective and physical

examination

General Management

• Medical and Rheumatologically managed• No cure• Physiotherapy used to MAINTAIN strength and

range of movement• Scripting should reflect this• Manual Therapy should be used with extreme

care and only in a non inflammatory stage

Conservative - Management

• Pain Relief– Medication advise, soft tissue massage

• Maintain ROM– Thoracic ROM, Lumbar ROM, Chest and Ribs, Hip– Stretching, soft tissue massage, joint mobilisations,

hydrotherapy• Maintain Strength– Whole Body

• Maintain VO2 Capacity– Aerobic exercise

Plan B - Management

• Medical management• Will be in regular contact with rheumatologist

who will guide and manage client