The spondyloarthropathies are another category of
systemic in-flammatory disorders of the skeleton. The spondyloarthropathies
include ankylosing spondylitis, reactive arthritis (Reiter’s syn-drome), and
psoriatic arthritis. Spondyloarthritis is also associ-ated with inflammatory
bowel diseases such as regional enteritis (Crohn’s disease) and ulcerative
These rheumatic diseases share several clinical features. The in-flammation tends to occur peripherally at the sites of attachment— at tendons, joint capsules, and ligaments. Periosteal inflammation may be present. Many patients have arthritis of the sacroiliac joints. Onset tends to occur during young adulthood, with the disease affecting men more often than women. There is a strong tendency for these conditions to occur in families. Frequently, the HLA-B27 genetic marker is found.
Ankylosing spondylitis affects the cartilaginous
joints of the spine and surrounding tissues. Occasionally, the large synovial
joints, such as hips, knees, or shoulders, may be involved. Ankylosing
spondylitis is usually diagnosed in the second or third decade of life. The
disease is not usually as severe in females as in males, in whom the disease is
more prevalent and likely to include signifi-cant systemic involvement. Back
pain is the characteristic feature. As the disease progresses, ankylosis of the
entire spine may occur, leading to respiratory compromise and complications.
disease process is called reactive because the arthritis occurs following an
infection. It affects young adult males and is char-acterized primarily by
urethritis, arthritis, and conjunctivitis. Dermatitis and ulcerations of the
mouth and penis may also be present. Low back pain is common.
arthritis is characterized by synovitis, polyarthritis, and spondylitis. Both
psoriasis and arthritis are common conditions, and one theory suggests that the
overlap of the two conditions is a chance occurrence. However, epidemiologic
data suggest that the prevalence of arthritis in patients with psoriasis is 7%
to 42%, exceeding the rate in the general population. Similarly, the
preva-lence of psoriasis in persons with arthritis is 2.6% to 7.0%, com-pared
with 0.1% to 2.8% in the general population, supporting the theory that these
two processes occur together in a unique dis-ease process (Ruddy et al., 2001).
management of spondyloarthropathies focuses on treat-ing pain and maintaining
mobility by suppressing inflammation. For the patient with ankylosing
spondylitis, good body position-ing and posture are essential, so that if ankylosis (fixation) does occur, the
patient is in the most functional position. Maintaining range of motion with a
regular exercise and muscle-strengthening program is especially important.
NSAIDs, and corticosteroids often produce marked improvement in back, skin, and
joint symptoms. Methotrexate is also used to control psoriasis as well as joint
management may include total hip replacement.
nursing interventions in the spondyloarthropathies are re-lated to symptom
management and maintaining optimal func-tioning. This population is unique in
rheumatology, because patients are primarily young men. Their major concerns
are often related to prognosis and job modification, especially among those who
perform physical work.