Patient Care

• Learn the approach in evaluation of patients with axial or oligoarticular complaints through specific history, family information and physical exam details (aside from peripheral joint exam, review the back exam with Schober’s testing and other maneuvers)
• Distinguish characteristic features of inflammatory back pain; from mechanical back pain
  
• Distinguish the symptoms and physical findings of spondyloarthritis patients from other inflammatory joint diseases or connective tissue disorders
  
• Learn the appropriate approach for evaluation of the spondyloarthritis patient, including laboratory studies, imaging modalities and the utility of HLA B27 testing
  
• Determine the need for further subspecialty evaluations with gastroenterology, dermatology or ophthalmology
  
• Discuss the need for physical and occupational therapy (1) (2) and explore the impact of the specific diagnosis on the patient’s professional and personal lifestyle
  
• Review the risks and benefits of various treatment modalities for each of the spondyloarthropathies and their limitations.
  
• Understand the potential complications [L4]  of the various spondylarthropathies

Medical Knowledge

• Characterize the classification of spondyloarthropathy based on history, physical exam, laboratory and radiographic findings (see links above in case discussion)
• Differentiate the various forms of psoriatic arthritis (PsA) on physical exam: isolated DIP disease; dactylitis; symmetrical polyarthritis; arthritis mutilans; asymmetrical sacroiliitis. Compare the different radiographic features of psoriatic arthritis: erosions similar to RA; joint ankylosis; arthritis mutilans with pencil-in-cup changes
• Identify the common infectious organisms associated with reactive arthritis (ReA) and their role in pathogenesis
• Compare the frequency and characteristics of axial versus peripheral arthritis associated with inflammatory bowel disease (IBD)
• Review the extra-articular manifestations of ankylosing spondylitis (AS), ReA, PsA and Inflammatory Bowel Disease (IBD) associated arthropathies (as discussed above) but also: onycholysis; nail pitting; conjunctivitis; keratoderma blennorrhagica; palatal or oral ulcers; circinate balanitis; rare neurologic features
• Understand the role of HLA B27 in pathogenesis and the practical use of this genetic testing in patients with back pain or uveitis
• Review the currently available drugs for treatment of AS, PsA, and IBD arthropathy and understand their mechanism of action, potential benefits, limitations and risks

• Discuss the course of the specific spondyloarthropathies with the patient and designated family members and provide information from rheumatology resources and national organizations
• Explain the potential complications of the arthritis and rationale for routine monitoring for disease status and drug toxicities
• Discuss the importance of daily exercise and life style adaptations in patients with spondylitis and provide resources for the patient
• Provide information to specialists or other providers regarding the reason for the consult/referral

• Recognize the importance of patient privacy, informed consent and equal care
• Respect the patient’s decisions and opinions even when they are divergent with the standard of care
• Recognize and address the patient’s concerns and fears when a diagnosis is uncertain or when the diagnosis is established

• Recognize the current classification of spondyloarthritis
• Apply the information from the patient’s history, physical exam, laboratory and radiographic findings to make informed approach in further management of patients with different spondyloarthropathies
• Set learning goals in comparing and contrasting the types of treatment and expected outcomes reported/recommended in the current literature for each of the spondyloarthropathies
• Recognize current assessment tools for monitoring disease activity in AS and psoriatic arthritis

• Demonstrate the ability to work with consultants (dermatology, gastroenterology, ophthalmology, and orthopedics) and allied health professionals in the management of patients with inflammatory back disease or peripheral arthritis
• Provide supporting information for patient’s health plan or employers when issues concerning medications, work accommodations or disability arise
• Demonstrate an awareness of the impact of diagnostic and pharmacologic recommendations on the health care system, including insurance companies, physician and patient
• Identify barriers to the delivery of optimal patient care for patients with spondyloarthritis and offer improved ideas for delivering care