Inflammatory back pain

Inflammatory back pain

5% of those with chronic low back pain
the pain is due to inflammation in the
spine.
It is important to be able to distinguish
inflammatory pain from mechanical pain,
as the treatment is very different.
 Inflammatory back pain
These were:
(1) improvement with exercise
(2) pain at night
(3) insidious onset
(4) age at onset <40 years
(5) no improvement with rest
If at least four out of these five parameters
were fulfilled, the criteria had a sensitivity
of 77.0% and specificity of 91.7%
Ann Rheum Dis. New criteria for inflammatory back pain in patients with chronic back pain: a
real patient exercise by experts from the Assessment of SpondyloArthritis international Society
.(ASAS). 2009 Jun;68(6):784-8. Epub 2009 Jan 15
Inflammatory back pain
is the main symptom of a group of
conditions called the” seronegative
spondyloarthritis” (SpA)”
 seronegative= blood serum >> -RF
spondyloarthritis= inlfammation of spine
and joints.
seronegative spondyloarthritis
The group includes:

 ankylosing spondylitis
reactive arthritis (Reiter's syndrome)
 psoriatic arthritis
enteropathic arthritis (spondylitis/arthritis
associated with inflammatory bowel
disease),
 seronegative spondyloarthritis
 variety of symptoms and signs ,but they also share many features;

 inflammatory arthritis of the spine, sacroiliac and limb joints.

 enthesopathy, which is an inflammation where the ligaments attach to the bone

 nonarticular sites are also affected(e.g., gut, skin, and eye).

 Most types of SpA begin around the ages of 20-30. (<40)

 Men are more likely to get SpA. (Psoriatic arthritis, which affects men and women
equally, is the exception)

 occur in more than one family member

 They are not associated with rheumatoid factor but have a strong association with HLA-
B27.
 Ankylosing Spondylitis
ankylos, bent;
spondylos, vertebrae.
Complete fusion
results in a complete
rigidity of the spine,
a condition known as
bamboo spine
! Question mark posture
Reiter Syndrome
Classic triad :
Arthritis
 conjunctivitis
Urethritis

Reactive arthritis occurs within

1 month of a genitourinary
(Chlamydia trachomatis) or
enteral (Shigella, Salmonella,
Yersinia, Campylobacter)
infection.

.
 Radiographic syndesmophyte (arrows). Fine symmetrical
marginal syndesmophytes typical of ankylosing spondylitis.
Coarse, asymmetrical non-marginal syndesmophytes typical of
psoriatic/Reiter's spondylitis
Psoriatic Arthritis & Intestinal
Arthritis
Psoriatic arthritis is an
inflammatory arthritis
seen in up to 40% of
patients with psoriasis.
 Nail involvement
(pitting, dystrophy, or
onycholysis) is a clue
to the diagnosis.
 The arthritis occurs
before psoriasis is seen
in 15% of patients.