1. Spondyloarthropathies

2. 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

3. Pathophysiology (Ankylosing Spondylitis) Not well known HLA B27 Receptor gene predisposition Immune response Inflammation of joints, intervertebral and facet Causes syndesmophyte formation Vertebrae fuse

4. Mechanism Of Injury Insidious

5. Associated Pathologies IBS Inflammatory Bowel Disease Depression

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

7. Objective Reduce lumbar lordosis Increase thoracic kyphosis Reduced ROM in all directions Tenderness and heat palpation Limited chest wall expansion

8. Special Tests Schober’s test

9. Further Investigations Diagnosis often takes many months to years Specialist/Rheumatologi st investigations – Laboratory Testing – Radiographic evaluation – Subjective and physical examination

10. 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

11. 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

12. Plan B - Management Medical management Will be in regular contact with rheumatologist who will guide and manage client