Inflammatory Arthopathies



No pathognomonic signs for gout

- identification of negative birefringent crystals under polarising light 

- trial of indomethacin if suspected


Inflammatory Bowel Disease / Enteropathic


Crohn's & Ulcerative Colitis

- spinal manifestation similar to Ankylosing Spondylitis

- 15-60% of IBD


Two different forms

- mild & asymptomatic

- HLA B27 positive with progressive & aggressive disease


Colectomy does not improve spondylosis




20% develop spondylitis


Reiter's Spondylitis


Men more common

- 3rd decade

- post infectious reactive arthritis


Back pain &/or Sacroiliitis

- 20-30%

- usually unilateral compared with Ankylosing Spondylitis



- see juxta-articular osteoporosis

- joint space narrowing & erosive changes


Behcet's Syndrome


Rare seronegative disease involving many systems

- oral & genital ulcers

- uveitis

- CNS involvement

- + arthritis, thrombophlebitis & skin lesions



- ? viral ? immunolgical

- endemic in parts east Europe and Asian



- asymmetric appendicular arthritis especially knee

- sacroiliitis & spondylitis may occur


Alkaptonuria & Ochronosis


Inborn error of metabolism in which homogentisic acid can not be oxidised


A form of HA 

- black deposit in tissues 

- deposited in connective tissue containing hyaline & fibrocartilage


Most common spinal problem is spondylosis

- deposits in disc with ossification & marginal syndesmophytes

- SIJ usually unaffected


Neuropathic Spondyloarthropathy



- tabes dorsalis

- syrinx in cervical spine



- deformity, instability, crepitation & hyper-mobility