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HLA-B27 associated spondyloarthropathy
typically males (5:1 M:F)  20-30yrs

''Features''
    young man, lower back pain and stiffness, insidious onset
    stiffness worse in morning and improves with exercise
    pain at night which improves on getting up

''Signs''
reduced chest expansion    
reduced lateral flexion
reduced forward flexion - Schober's test - (draw lines 10 cm above and 5 cm below back dimples (dimples of Venus). distance between the two lines should increase by >5 cm when patient bends forwards
   
''Other features - the 'A's''
    Apical fibrosis
    Anterior uveitis
    Aortic regurgitation
    Achilles tendonitis
    AV node block
    Amyloidosis
    and cauda equina syndrome
    peripheral arthritis (25%, more common if female)

''LS/SI joint Xray'' - may be normal early on
    sacroilitis: subchondral erosions, sclerosis
    squaring of lumbar vertebrae
    'bamboo spine' (late & uncommon)
    syndesmophytes: due to ossification of outer fibers of annulus fibrosus
    chest x-ray: apical fibrosis

''Spirometry'' - restrictive defect due to a combination of pulmonary fibrosis, kyphosis and ankylosis of the costovertebral joints.

''Management''
    encourage regular exercise such as swimming
    physiotherapy
    NSAIDs are the first-line treatment
DMARD used for RA (eg sulphasalazine) only useful with peripheral joint involvement
    Anti-TNF therapy if persistently high disease activity ?? in early disease - research awaited