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Rheumatology > 2: Inflammatory Spondyloarthropathies > Flashcards

2: Inflammatory Spondyloarthropathies Flashcards

1
Q

What is an inflammatory spondyloarthropathy

A

chronic inflammatory arthritis disease that often affects joints and enthesis (where tendons + ligaments attach tot bone).

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2
Q

Name 4 inflammatory spondyloarthropathies

A
  1. Ankylosing spondylitis
  2. Enteropathic arthritis
  3. Reactive arthritis
  4. Psoriatic arthritis
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3
Q

what are 4 over-arching features of inflammatory spondyloarthopathies

A
  • Affect 20-40y
  • More common in males
  • Genetic association HLAB27
  • often unilateral
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4
Q

What a mnemonic to remember conditions associated with HLAB27

A

A PAIR

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5
Q

What conditions are typically associated with HLAB27

A 
Acute anterior uveitis 
Psoriatic arthritis 
Ankylosing spondylitis 
Inflammatory bowel disease 
Reactive arthritis
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6
Q

What is ankylosing spondylitis

A

Chronic inflammatory disease of the axial skeleton that leads to partial or complete fusion of the spine

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7
Q

In which gender is ankylosing spondylitis more common

A

Male

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8
Q

What age does ankylosing spondylitis most commonly onset

A

20-30

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9
Q

What do 95% of individuals with ankylosing spondylitis have

A

HLAB27

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10
Q

Explain how ankylosing spondylitis may present

A
  • Gradual onset back and spine pain
  • Morning stiffness that improves with activity
  • Night pain
  • Tenderness over SI joints
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11
Q

How can the extra-articular manifestations of ankylosing spondylitis be remembered

A

A’s

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12
Q

What are the 8 extra-articular manifestations of ankylosing spondylitis

A 
Anterior uveitis 
Apical fibrosis 
Aortic regurgitation 
AV node block 
Achille's tendonitis 
Amyloidosis 
Peripheral Arthritis 
And cauda equina
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13
Q

How else may AS present

A

Malaise
Fever
Fatigue
Chronic IBD

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14
Q

What is the most common extra-articular manifestation of AS

A

Anterior uveitis (25%)

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15
Q

What are the signs of ankylosing spondylitis

A
  • Tenderness over SI joint
  • Limited spinal flexion (+ve schober’s test)
  • Reduced chest expansion
  • Dactylitis
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16
Q

What 3 signs may be positive in AS

A
  • Mennell
  • FABER
  • Schober
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17
Q

What is mennell sign

A

Pain on palpation over SI joint

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18
Q

What is FABER test

A

Pain on abduction, flexion and external rotation

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19
Q

What is schober’s test

A

Increase in less than 5cm on spinal flexion

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20
Q

What 4 investigations are used for ankylosing spondylitis

A
  1. Clinical
  2. CRP, ESR
  3. X-ray
  4. MRI
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21
Q

What is the criteria for referral the a rheumatologist for spondyloarthritis assessment

A

If an individual is under age 45, has had back pain for 3m and has 4 or more the the following criteria

  1. Lower back pain before age 35
  2. Symptoms that wake them up during second 1/2 of the night
  3. Buttock pain
  4. Improvement when walking
  5. Improve in 48h of NSAIDs
  6. Spondyloarthrosis in first-degree relative
  7. Current/previous arthritis
  8. Current/previous enthuses
  9. Current/past psoriasis
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22
Q

If an individual is positive on the clinical screen what should be done

A

HLAB27

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23
Q

If an individual is positive on HLA B27 what should be done

A

Refer to rheumatologist of spondylarthopathy screen

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24
Q

If ankylosing spondylitis is suspected but they do not meet the clinical criteria, what should be done

A

Advise individual to return if they develop new symptoms

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25
Q

What may the rheumatologist do

A

X-Ray

CRP, ESR

26
Q

How will CRP/ESR present in ankylosing spondylitis

A

May be raised. But if not, ankylosing spondylitis should not be excluded

27
Q

Is an x-ray required for the diagnosis of AS

A

No

28
Q

What is an x-ray in AS useful for

A

Assess severity

29
Q

What may be seen on x-ray in AS

A
  • Sacroillitis
  • Sclerosis
  • Partial/totoal fusion
  • Loss of lordosis
  • Sclerosis of vertebral ligaments
  • Syndesmophytes
30
Q

What is a late stage of ankylosing spondylitis

A

syndesmophytes resulting in a bamboo spine

31
Q

What is the best method for early detection of ankylosing spondylitis

A

MRI

32
Q

When is MRI performed

A

If suspicion of sacroillitis but cannot be seen on x-ray

33
Q

What is first-line management for ankylosing spondylitis

A

Exercise and stretching therapy

34
Q

What is second line management for ankylosing spondylitis

A

Oral analgesia (NSAIDs, or paracetamol)

35
Q

What is 3rd line management for ankylosing spondylitis

A

anti-TNFa

36
Q

Name 3 anti-TNFa inhibitors

A
  • Entarnercept
  • Adalimumab
  • Infliximab
37
Q

Who is infliximab, etarnercept and adalimumab reserved for

A

Those with high disease activity despite conventional treatment

38
Q

When may sulfasalazine be given in ankylosing spondylitis

A

If peripheral joint involvement

39
Q

If suspect an individual has anterior uveitis what should be done

A

Same day referral to opthalmology

40
Q

What are 4 complications of ankylosing spondylitis

A
  • Increase risk stroke
  • Increase risk CVD
  • Reduced spinal mobility
  • Reduced chest expansion causing respiratory difficulties
  • Increased risk of osteoporotic fractures
41
Q

What is reiter’s syndrome also referred to as

A

Reactive arthritis

42
Q

What is reactive arthritis

A

Arthritis that occurs following UTI, STI or gastroenteritis

43
Q

What classification of arthritis is reactive arthritis and why

A

Spondyloarthopathy due to its association with HLA B27

44
Q

What demographic is typically affected by reactive arthritis

A

Young Males

45
Q

What are the two causes of reactive arthritis

A

Post-urethritis

Post-dysentry

46
Q

What bacteria causes reiter’s syndrome post-urethritis

A

Chlamydia

47
Q

What 4 organisms cause reactive arthritis following gastroenteritis

A
  • Salmonella
  • Yersinia
  • Shigella
  • Campylobacter
48
Q

What are two risk factors for reactive arthritis

A
  • HIV

- HLAB27

49
Q

What is the typical latency period for reactive arthritis

A

2-4W

50
Q

What is the triad seen in Reiter’s syndrome

A

Urethritis
Conjunctivits
Arthritis

(Can’t see, pee or climb a tree)

51
Q

What proportion of patients have the triad associated with Reiter’s syndrome

A

1/3

52
Q

How does arthritis in reactive arthritis present

A
  • acute onset asymmetrical polyarthritis
  • predominantly affects lower extremities
  • sacroillitis
  • dactylitis
53
Q

How does reactive arthritis present if associated with gonococcal infection

A

migratory character

54
Q

What are possible other features of reactive arthritis

A
  • Oral ulcers
  • Balantitis circinate = ring shaped lesions on the penis
  • Keratoderma blenorrhagia = hyperkeritinsation of palms and soles
55
Q

How is reactive arthritis often diagnosed

A

Clinically

56
Q

What investigations could be ordered for reactive arthritis

A
  • ESR, CRP

- HLAB27

57
Q

What is used to manage reactive arthritis

A

NSAIDs

Antibiotics

58
Q

What is typical prognosis of reactive arthritis

A

6m

59
Q

What percentage of reactive arthritis may become chronic

A

20-30%

60
Q

What are two complications of reactive arthritis

A

Aortic insufficiency

Arrythmias

Rheumatology (10 decks)

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