2 - spondyloarthropathies Flashcards
what are spondyloarthropathies?
group of conditions that have similar clinical features (back pain, arthritis, inflammation etc)
what are spondyloarthropathy conditions?
- Psoriatic Arthritis
- Enteropathic Arthritis
- Axial Spondyloarthropathies
- Reactive Arthritis
(PEAR)
what is HLA-B27?
it’s a major histocompatibility complex and is used by body to distinguish between self & non self antigens. it’s a class I antigen that presents antigens to T cells
what is the difference between mechanical and inflammatory pain?
mechanical = worse by activity, improved with rest, any age
inflammatory = improves with activity, prolonged morning stiffness, responds to NSAIDs, onset young
what is enthesitis?
inflammation of entheses (where tendon/ligaments joins to bone)
- it’s a hallmark & shared feature of spondyloarthropathies
what is dactylitis?
entire digit swells (due to inflammation of tendons, ligaments & soft tissue)
- it’s a hallmark & shared feature of spondyloarthopathies
what is axial spondyloarthritis?
type of chronic inflammatory arthritis that affects axial skeletal joints (spine & sacroiliac)
how does axial spondyloarthritis present?
chronic back pain, stiffness, reduced spinal mobility (eventually leading to joint damage)
- onset late teenage or early adult
what are 2 subtypes of axial spondyloarthritis?
- radiographic axial spondyloarthritis (ankylosing spondylitis)
- non-radiographic axial spondyloarthritis
what are clinical features of axial spondyloarthritis?
- chronic back pain
- chest wall pain
- enthesitis
- extra articular features (anterior uveitis, cardio, pulmonary fibrosis, amyloidosis)
what are the list of symptoms for axial spondyloarthritis that mean it’s called A disease?
axial arthritis
anterior uveitis
aortic regurgitation
apical fibrosis
amyloidosis
achilles tendinitis
plantar fascitis
what is change to spine that occurs with ankylosing spondylitis?
syndesmophytes = fusion of vertebrae making more straightened spine
what is occiput to wall test for axial spondyloarthritis?
it’s when stand with back to wall and try put neck back to wall, if can’t move neck then due to changes in spine so positive result
what is schobers test?
one done in clinical skills, where put tape measure 10cm above sacroiliac joint and then get patient to bend forward and should go above 15cm (it is used to test lumbar spine flexibility - for conditions like ankylosing spondlyarthritis)
what is seen on x-ray for ankylosing spondylitis?
- Syndesmophytes (fused spine)
- Marginal Ossification
- Bamboo spine = later stage
- Shiny corners
- Sacroiliac joint erosions
- Sacroiliac joint fusion
what are complications of ankylosing spondylitis?
- osteoporosis
- ventilatory impairment
- aortic regurgitation
- heart block
- amyloidosis
what is psoriatic arthritis?
= seronegative inflammatory arthritis in patients with psoriasis, usually in 30s
- peripheral joint involvement
*seronegative = absence of specific autoantibodies that are commonly found in other types of inflammatory arthritis, particularly rheumatoid arthritis (just means its a different type of inflammatory arthritis)
what are 5 subtypes of psoriatic arthritis? (i think just get basic understanding)
- confined to distal interphalangeal joints of hands & feet
- symmetric polyarthritis
- spondylitis (spine involvement)
- asymmetrical oligoarthritis with dactylitis (sausage fingers)
- arthritis mutilans (severe in hands & feet)
what are clinical features of psoriatic arthritis?
- nail involvement (pitting, onycholysis)
- dactylitis →swelling of entire digit due to enthesitis or tenosynovitis
- enthesitis (inflammation of tissue - especially achilles tendon, plantar fasciitis)
- extra articular like eye or psoriasis
what is reactive arthritis?
when you get arthritis in joint 1-4 weeks after infection (remember not infection in joint itself!)
what are clinical features of reactive arthritis?
- general symptoms of infection like fever, fatigue, malaise
- asymmetrical monoarthritis or oligoarthritis
- enthesitis (achilles or plantar fasciitis)
- mucocutaneous lesions (certain skin stuff like oral ulcers, hyperkeratotic nails)
- ocular lesions (conjuctivitis iritis)
- cardio lesions
- mild renal disease
what is enteropathic arthritis?
arthritis associated with inflammatory bowel disease (mostly in knees, ankles, elbows, wrists)
= usually gets worse as bowel symptoms worsen
what is management of enteropathic arthritis?
- non pharmacological = physio & occupational therapy
- pharmacological = NSAIDs, corticosteroid injections until DMARDs kick in. topical steroid eyedrops
when would you not use hydroxychloroquine DMARD?
worsens psoriasis so would avoid for psoriatic arthritis
what is septic arthritis? what causes?
intra-articular infection at joint - bacterial infection of joint itself, can be spread there either traumatic (inoculation like trauma, surgery) or through blood (haematogenous, from within body)
*NOT common but clinically important as can destroy cartilage and joint so ortho emergency
what are common organisms causing septic arthritis?
staph aureus or strep or e.coli
what is typical presentation of septic arthritis?
- raised white blood cell count & inflammatory markers
- fever
- reduced range of motion and swelling (if joint moves well then problem around the joint but if don’t want to move joint since pain then problem of joint itself)
what is kocher’s criteria for septic arthritis?
- fever
- refusal to bear weight
- ESR 40mm/hr
- serum WBC
what is treatment of septic arthritis?
- surgical washout
- antibiotics = staph aureus
manage →aspirate or urgent open/arthroscopic washout
