9: Spondyloarthropathies

Question 1

What is the difference between arthritis and spondyloarthritis?

Answer 1

Spondyloarthritis affects the joint, tendon/ligament AND the enthesis (where the tendon/ligament attaches to the bone)

Question 2

What are the four types of arthritis covered by the term by spondyloarthritis?

Answer 2

Ankylosing spondylitis

Reactive arthritis

Psoriatic arthritis

Enteropathic arthritis

Question 3

Which gene mutation predisposes you to develop spondyloarthritis?

Answer 3

HLA B27

Question 4

Which joints tend to be involved in spondyloarthritis?

Answer 4

Spine

Usual joints

Question 5

Describe mechanical and inflammatory joint pain.

Answer 5

Mechanical pain - worse during activity, better at rest, worst at the end of the day

Inflammatory - worse with rest, better with activity, worst in the morning and lasts > 30 mins

Question 6

Which joints are affected in all spondyloarthropathies?

Answer 6

Spinal joints

Sacroiliac joint

+ Upper and lower limb joints

Question 7

Name an enthesis which is commonly affected by spondyloarthritis.

Answer 7

Achilles tendon enthesis

Question 8

What is dactylitis?

What does it look like?

Answer 8

Inflammation of an entire digit

Sausage fingers!

Question 9

What is the most common spondyloarthritis which primarily affects the spine?

Answer 9

Ankylosing spondylitis

Question 10

What is the main symptom of ankylosing spondylitis?

Answer 10

Back pain

Question 11

What are some extra-articular features of ankylosing spondylitis?

Answer 11

Uveitis

Aortic valve disease

Pulmonary fibrosis

Question 12

What are syndesmophytes?

Answer 12

Intervertebral discs fuse with bone, making spinal joints less mobile

Question 13

How is ankylosing spondylitis treated?

Answer 13

Physio / OT

NSAIDs

DMARDs

Biologic agents

Question 14

Which derm condition has an arthritis associated with it?

Answer 14

Psoriasis

(Psoriatic arthritis)

Question 15

What nail pathology is seen in psoriatic arthritis?

Answer 15

Nail pitting

Question 16

Are patients with psoriatic arthritis positive for rheumatoid factor?

Answer 16

No

RF isn’t raised in psoriatic arthritis

Question 17

What is the difference between septic arthritis and reactive arthritis?

Answer 17

Septic arthritis caused by ongoing infection of the joint

Reactive arthritis is an autoimmune response following an general infection

Question 18

How long after infection can reactive arthritis present?

Answer 18

1 - 4 weeks

Question 19

Which infections most commonly cause reactive arthritis?

Answer 19

Urogenital - e.g chlamydia

Entergenic - e.g salmonella, shigella

Question 20

What is Reiter’s syndrome?

Answer 20

A form of reactive arthritis with a triad of presentations:

Urethritis

Ocular inflammation (conjunctivitis/uveitis/iritis)

Arthritis

Question 21

What are the clinical features of reactive arthritis?

Answer 21

General inflammation symptoms (fever, fatigue, malaise)

Asymmetrical arthritis

Mucosal lesions

Question 22

Some people develop an arthritis associated with which GI diseases?

Answer 22

Inflammatory bowel disease

(Crohn’s, UC)

Question 23

When does enteropathic arthritis flare up?

Answer 23

During flare ups of the inflammatory bowel disease

Question 24

Which skin condition, associated with IBD, can also appear in enteropathic arthritis?

Answer 24

Pyoderma gangrenosum

Question 25

What drug, usually used to treat arthritis, is not a good choice for people with enteropathic arthritis?

Answer 25

**NSAIDs** cause GI side effects like oesophagitis and peptic ulcers

Question 26

What should be given instead of NSAIDs to patients with enteropathic arthritis?

Answer 26

**Normal analgesia** - paracetamol, co-codamol

Question 27

Which gene are spondyloarthopathies associated with?

Answer 27

**HLA B27**