Spondyloarthropathies

Spondyloarthropathies

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 colitis.

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

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.

REACTIVE ARTHRITIS (REITER’S SYNDROME)

This 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.

PSORIATIC ARTHRITIS

Psoriatic 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).

Medical Management of Spondyloarthropathies

Medical 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.

PHARMACOLOGIC THERAPY

Salicylates, NSAIDs, and corticosteroids often produce marked improvement in back, skin, and joint symptoms. Methotrexate is also used to control psoriasis as well as joint inflammation.

SURGICAL MANAGEMENT

Surgical management may include total hip replacement.

Nursing Management of Spondyloarthropathies

Major 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.