Ankylosing spondylitis Flashcards
Where does ankylosing spondylitis affect?
Spine and sacro-iliac joints.
Can lead to fusion of these joints.
Which sex is more commonly affected?
Males
At what age is this usually diagnosed
?
20-40
What are the usual symptoms?
Spinal pain
Stiffness - especially in the morning which improves with exercise
Knee or hip arthritis
What spinal changes can occur over time?
Loss of lumbar lordosis
Increased thoracic kyphosis
“question mark spine”
Hunching over and loss of neck
How is lumbar spine flexion measured?
Schobers test.
10cm mark above posterior superior iliac crests and 5 cm below.
This space should increase to 20cm on flexion.
What might you seen on x-ray?
Sclerosis
Fusion of SI joints
Syndesmophytes- bony spurs from the vertebral bodies
Which immunological marker is positive in patients with spondyloarthropathies?
HLA- B27
What is the recommended treatment for AS?
Physiotherapy, exercise, NSAIDs and anti-TNF inhibitors.
No role for DMARDs
What are spondyloarthropathies?
Group of inflammatory arthritides which affect the spine and joints.
What is mechanical pain?
Worsened on activity, worst at end of day, better with rest.
What is enthesitis?
Inflammation at insertion of tendons into bones
What is dactylitis?
Inflammation of entire digits- swollen, erythematous
What extra-articular features do all spondyloarthopathies have?
Ocular inflammation
Mucocutaneous lesions
Why is ankylosing spondylitis known as the A disease?
Axial arthritis Anterior uveitis Amyloidosis Achilles tendinitis Apical fibrosis Aortic regurgitation
How common is psoriatic arthritis in patients with psoriasis?
Around 30%
What is the pattern of this arthritis?
Asymmetrical oligoarthritis (1-4 joints).
Also affect the hands in a RA pattern.
Dactylitis
Enthesitis
What nail changes commonly occur?
Pitting and onycholysis
What treatment is recommended?
NSAIDs
Steroids
DMARDs- usually methotrexate
What would you see on X-ray?
Marginal erosions and whiskering
Pencil in cup deformity
Osteolysis
Enthesitis
What is Reiter’s syndrome?
TRIAD
Reactive arthritis PLUS urethritis and conjunctivitis or similar
What is reactive arthritis?
Occurs in response to an infection in another part of the body- mostly GU or GI infections.
What is usually responsible for reactive arthritis?
Chlamydia, salmonella, shigella
What age group is most likely to develop reactive arthritis?
20-40 yr olds
M:F equal
What are the clinical features of reactive arthritis?
Constitutional symptoms Asymmetrical monoarthritis Enthesitis Conjunctivitis Mild renal disease Oral ulcers Hyperkeratotic nails Keratodema blenorrhagica
What is keratodema blenorrhagica?
Scaly patches/pustules, especially on the soles of feet and on hands
What treatment would you give for reactive arthritis?
90% resolve within 6/12
NSAIDs
Steroids- intra-articular, oral and eye drops
Abx
What is the arthritis called in patients who have an IBD?
Enteropathic arthritis
How common is enteropathic arthritis?
10-20% of IBD sufferers also have this
Also common to have sacroilitis
What is the presenting symptoms of enteropathic arthritis?
Oligoarthritis. Knees, ankles, elbows and wrists. Diarrhoea with mucous and blood Weight loss and fever Pyoderma gangrenosum Apthous ulcers
What investigations would you do for enteropathic arthritis?
Upper and lower GI scope with biopsy
X-ray to show sacroilitis
What is the treatment of enteropathic arthritis?
IBD must be managed and this will manage the arthritis.
Not NSAIDs.
