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MSK > Ankylosing spondylitis > Flashcards

Ankylosing spondylitis Flashcards

1
Q

Where does ankylosing spondylitis affect?

A

Spine and sacro-iliac joints.

Can lead to fusion of these joints.

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2
Q

Which sex is more commonly affected?

A

Males

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3
Q

At what age is this usually diagnosed

?

A

20-40

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4
Q

What are the usual symptoms?

A

Spinal pain
Stiffness - especially in the morning which improves with exercise
Knee or hip arthritis

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5
Q

What spinal changes can occur over time?

A

Loss of lumbar lordosis
Increased thoracic kyphosis
“question mark spine”
Hunching over and loss of neck

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6
Q

How is lumbar spine flexion measured?

A

Schobers test.
10cm mark above posterior superior iliac crests and 5 cm below.
This space should increase to 20cm on flexion.

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7
Q

What might you seen on x-ray?

A

Sclerosis
Fusion of SI joints
Syndesmophytes- bony spurs from the vertebral bodies

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8
Q

Which immunological marker is positive in patients with spondyloarthropathies?

A

HLA- B27

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9
Q

What is the recommended treatment for AS?

A

Physiotherapy, exercise, NSAIDs and anti-TNF inhibitors.

No role for DMARDs

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10
Q

What are spondyloarthropathies?

A

Group of inflammatory arthritides which affect the spine and joints.

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11
Q

What is mechanical pain?

A

Worsened on activity, worst at end of day, better with rest.

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12
Q

What is enthesitis?

A

Inflammation at insertion of tendons into bones

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13
Q

What is dactylitis?

A

Inflammation of entire digits- swollen, erythematous

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14
Q

What extra-articular features do all spondyloarthopathies have?

A

Ocular inflammation

Mucocutaneous lesions

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15
Q

Why is ankylosing spondylitis known as the A disease?

A 
Axial arthritis
Anterior uveitis
Amyloidosis
Achilles tendinitis
Apical fibrosis
Aortic regurgitation
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16
Q

How common is psoriatic arthritis in patients with psoriasis?

A

Around 30%

17
Q

What is the pattern of this arthritis?

A

Asymmetrical oligoarthritis (1-4 joints).
Also affect the hands in a RA pattern.
Dactylitis
Enthesitis

18
Q

What nail changes commonly occur?

A

Pitting and onycholysis

19
Q

What treatment is recommended?

A

NSAIDs
Steroids
DMARDs- usually methotrexate

20
Q

What would you see on X-ray?

A

Marginal erosions and whiskering
Pencil in cup deformity
Osteolysis
Enthesitis

21
Q

What is Reiter’s syndrome?

A

TRIAD

Reactive arthritis PLUS urethritis and conjunctivitis or similar

22
Q

What is reactive arthritis?

A

Occurs in response to an infection in another part of the body- mostly GU or GI infections.

23
Q

What is usually responsible for reactive arthritis?

A

Chlamydia, salmonella, shigella

24
Q

What age group is most likely to develop reactive arthritis?

A

20-40 yr olds

M:F equal

25
Q

What are the clinical features of reactive arthritis?

A 
Constitutional symptoms
Asymmetrical monoarthritis 
Enthesitis 
Conjunctivitis
Mild renal disease
Oral ulcers
Hyperkeratotic nails
Keratodema blenorrhagica
26
Q

What is keratodema blenorrhagica?

A

Scaly patches/pustules, especially on the soles of feet and on hands

27
Q

What treatment would you give for reactive arthritis?

A

90% resolve within 6/12
NSAIDs
Steroids- intra-articular, oral and eye drops
Abx

28
Q

What is the arthritis called in patients who have an IBD?

A

Enteropathic arthritis

29
Q

How common is enteropathic arthritis?

A

10-20% of IBD sufferers also have this

Also common to have sacroilitis

30
Q

What is the presenting symptoms of enteropathic arthritis?

A 
Oligoarthritis. 
Knees, ankles, elbows and wrists. 
Diarrhoea with mucous and blood
Weight loss and fever
Pyoderma gangrenosum
Apthous ulcers
31
Q

What investigations would you do for enteropathic arthritis?

A

Upper and lower GI scope with biopsy

X-ray to show sacroilitis

32
Q

What is the treatment of enteropathic arthritis?

A

IBD must be managed and this will manage the arthritis.

Not NSAIDs.

MSK (30 decks)

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