Spondyloarthropathies

The spondyloarthropathies include ankylosing spondylitis and psoriatic arthritis. The hallmark clinical features are inflammatory spinal disease, dactylitis, and enthesitis, together with an asymmetrical oligoarthritis, often of the lower limbs. Psoriaform skin and nail changes are also frequently seen, and, less commonly, but characteristically, a mutilating arthritis with severe deformity of the toes. These unique features often allow a diagnosis to be made purely on clinical examination of the lower limbs. However, these features also provide challenges for local treatments as skin disease may complicate the use of orthoses and percutaneous steroid injections. However, the importance of mechanical factors in the pathogenesis of these disorders almost mandates a combined mechanical and pharmacological approach to treatment.