004. Spondyloarthritides Flashcards
What are the spondyloarthritidies?
Give some examples of the different conditions?
Group of related chronic inflammatory conditions that typically affect the axial (midline) skeleton. They are linked by common features
Ankylosing spondylitits
Enteric arthropathy
Psoriatic arthritis
Reactive arthritis
What are the shared features the spondyloarthritidies exhibit?
Seronegativity (Rf-ve)
HLA B27 associations
Axial arthritis (sacroiliac and spine)
Asymmetrical large joint osteoarthritis (<5 joints)
Enthesitis (inflammation of insertion point e.g. plantar fascitis)
Dactilytis- inflammation of an entire digit
Extra-articular diseases e.g.g uveitis, oral ulcers, IBD
What is ankylosing spondylitis?
Chronic inflammatory disease of the spine and sacroiliac joints with unknown aetiology
How does ankylosing spondylitis typically present
Typical patient is a man under 30 with lower back pain that has a gradual onset.
Worse during the night with with spinal stiffness relieved by exercise
Pain radiates from sacroiliac joint to hips/buttocks and usually improves towards the end of the day.
Progressive loss of spinal movement
What features may ankylosing sponylitits progress to?
Kyphosis
Neck hyperextension
Spino-cranial ankylosis
What other features are associated with AS?
Enthesitis (achilles tendonitis, plantar fascitis)
Anterior mechanical chest pain
Fatigue
Anterior iririts
Osteoperosis, aortic valve incompetance, pulmonary apicla fibrosis (rare)
What investigations are undertaken when AS is suspected?
Clinical assessment
MRI scan to see active inflammation and destructive changes
Bloods (ESR, FBC, normocytic anaemia, CRP)
HLA B27
How is ankylosing spondylitits managed?
Exercise for back ache and physio
NSAIDS
TNF a blockers
Local steroid injections
Surgery ? hip replacement if severe hip involvement
What is enteric arthropathy?
Joint inflammations associated with IBD, GI bypass and Whiplle’s disease
Arthropathy usually improves with treatment of bowelsymptoms (beware NSAIDS)
Psoriatic arthritis can present in between 10 and 40% of people with arthritis. What are the patters of the disease?
Symmetricla polyarthritis
DIP joint involvement
Asymetricla oligoarthritis
Spinal involvment (similar to AS)
What radiological feature would you expect to see with psoriatic arthritis?
Pencil in cup deformity
What other symptoms are classic with psoriacic arhtritis
Nail changes
Acneifrom rashes
Palmo-plantar pustulosis
What is the management of psoriatic arhtritis?
NSAIDS
Sulfasalazine, methotrexate
Anti TNF may also be effective
What is reactive arthritis?
Condition in which arthritis and other clincial manifestations occur as an autoimmune response to infection
Aside form the shared features that occur in spondyloarthritides, what features occur in reactive arthritis?
(all occur outside joints)
Iritis
Keratoderma blenorrhagica (raised bits on the soles and palms)
Circinate balantis (penis ulceration)
Mouth ulcers
