6. Spondyloarthritis Flashcards
What are seronegative aponsyloarthropathies
Psoriatic arthritis,
Axial spondyloarthropathy
Ank spond
Reactive arthritis
Enteropathic arthritis
Diff between axspon and ankspon
ax spon is inflammatory back pain with sacroileitis on MRI , but NO XR changes unlike ankspond
Peak incidence of PsA, what assoc
25-50 yo, assoc with met sx, obesity, high alcohol intake and obv psoriasis
What IL are involved in PSA and what cells
Increased production of IL-23, activation of th17 cells and increased IL-17 and TNF production
Which joints are affected in PsA
PIPJ and DIPJ of hands
Large joints
Sacroileitis
Sx of PsA
May have psoriasis, nail pitting and dystrophy, sx of enthesistis- pain in heel where achilles tendon goes into caclcaneus, inflammatory back pain and Uveitis
Dactylitis in hands and feet
Synovitis in large joints
Is RF negativity is positive or negative point for PsA
Positive
What are the imagiing findings for PsA
Juxta-articular new bone
Erosive arthritis on XR
Sacroileitis on XR or MRI
Synovitis, tenosynovitis on MRI or USS
How to mx PsA
Methotrexate, leflunomide. sulfsalazine or ciclosporin as single agent, only combine if poor response
NSAID for sx control
biologics and tsDMARD if resistant
What drug is contraindicated in PsA
STEROIDS- can cause psoriasis flare
When are biologics indicated in PsA
If active disease has responded inadequately to DMARD- 3 or more swollen and tender joints
What are risk factors for PsA
Obesity, smoking and alcohol
What is axial sponyloarthritis
Chronic inflm disease affecting mainly spine and SI joints
Possible MHx in AxSpA
PsA, IBD
Are men or women more commonly affected by AxSpA
Men
What are the clinical fx of AxSpA
Inflm back pain esp at night and morning stiffness
IMPROVED by exercise
good response to NSAID
Large joint arthritis, uveitis, osteoporosis and vert fractures
What are lung and heart fx in AxSpA
Aortic regurgitation
Upper lobe fibrosis
Physical exam in AxSpA
Limited range of back movements in all direction, abnormal schrober’s test
Reduced chest expansion
Uveitis
Fixed flexion deformity in advanced disease
How to image AxSpA
Xray- will show sacroileitis, syndesmophytes, vert #
MRI for marrow oedema
DEXA may show osteoporosis
What do bloods in AxSpA show
Raised ESR and CRP possible
What abs are +ve in AxSpA
none
How to mx AxSpa
Trial at least two NSAIDs for 2-4 weeks
Biologic is response inaqdequate
Physio very impt in AxSpA, need back exercises to prevent flexion deformity
When are IST and CST used for AxSPA
Only for peripheral synovitis, NOT for axial
Are men or women more commonly affected by reactive arthritis
Men
