Atlantoaxial Subluxation in Undifferentiated Spondyloarthropathy: A case report

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system.

Clinical verification of classified standards for undifferentiated spondyloarthropathy / 中华风湿病学杂志

0 05).Conclusion The standards of Amor and ESSG have higher sensitivity and specificity to diagnose spondyloarthropathy in China.The two standards have no difference in statistics.

Clinical Features of Undifferentiated Spondyloarthropathy: Comparison with Ankylosing Spondylitis / 대한내과학회지

OBJECTIVES:To investigate the clinical features of undifferentiated spondyloarthropathy among the HLA-B27 positive arthralgic patients and to compare with those of ankylosing spondylitis. METHODS: Two hundred and three HLA-B27 positive subjects among patients with arthralgia in various joints were classified according to the standard diagnostic criteria. The onset age, disease duration, numbers of involved joint, X-ray and bone scan findings were compared between patients with undifferentiated spondyloarthropathy(uSpA) and ankylosing spondylitis(AS). RESULTS: 1) The patients diseases were classified as ankylosing spondylitis(46%), undifferentiated spondyloarthropathy(29%), juvenile spondyloarthropathy(4%), reactive arthritis(3%), psoriatic spondyloarthropathy(1%) and unclassified(17%). 2) In undifferentiated spondyloarthropathy, the durations of the symptoms were shorter than ankylosing spondylitis and the male predominance is less prominent(5: 1 as compared to 17:1 in ankylosing spondylitis). 3) The numbers of involved peripheral joints and the frequency of peripheral joint inflammation were more frequent in undifferentiated spondyloarthropathy while the spinal joint symptoms including sacroiliac joint and the radiological severity grade of sacroiliitis were higher in ankylosing spondylitis. 4) There were no significant differences in bone scan uptake and ESR between undifferentiated spondyloarthropathy and ankylosing spondylitis. CONCLUSION: The prevalence of undifferentiated spondyloarthropathy was notable high in HLA-B27 posicive arthralgic patients when a new classification criteria was applied, Attention should be paid on the diagnosis and progression of this elusive and challenging clinical entity.