AS, EA, PsA, Reiter's Syndrome Flashcards
What is Ankylosing Spondylitis (AS)?
A chronic, progressive immune-mediated inflammatory disorder that results in ankylosis of the vertebral column and the sacroiliac joints
A seronegative spondyloarthropathy
Epidemiology:
- typically affects young patients aged 18 – 30 years old
- men > women (3:1 ratio)
Location:
- Most commonly affects the spine and the sacroiliac joints
- May affect large joints
Usual progression: SIT/LL/ST-spineC-spine
What are the causes of Ankylosing Spondylitis?
- Unknown
- May be genetic
What are the pathological features of Ankylosing Spondylitis?
Chronic spinal inflammation (spondylitis) can lead to fusion of vertebrae (Ankylosis)
What are the signs and symptoms of Ankylosing Spondylitis?
- mild to severe back and buttock pain
- pain may be unilateral or intermittent at first; but within a few months it generally becomes stiff & painful
- pain worse in the early morning hours (Morning stiffness) or after prolonged periods of inactivity
- pain usually gets better with activity or by a hot shower or exercise
- may simulate ‘sciatica’ although neuro exam normal
- inflammation: ligaments, tendons, joint capsules and spine
- reduced ROM due to fusion (ankylosis)
- sleep disturbance
- generalised fatigue
- Anorexia
- Malaise
- Low grade fever
- weight loss
What are the radiological features of Ankylosing Spondylitis?
- SI Joints - Sacroiliitis
- Spine- Stages:
Normal Spine > Inflammation > Syndesmophytes Formation >Fusion (Ankylosis)
- Romanus Lesion (Shiny Corner sign)
- Vertebral Body Squaring
- Bamboo Spine - fusion of the spine
- Dagger Spine
- Osteoporosis
What is squared vertebra?
Caused by a combination of corner erosions with resorption at the enthesis.
Best seen in the lumbar region, loss of anterior vertebral concavity and straightening of the anterior vertebral margin.
What is Dagger sign?
Posterior interspinous ligament ossification
Solid midline vertical density simulating a dagger
Preceded by the formation of syndesmophytes.
What is trolley track sign?
2 lines:
- central vertical line: ossification of supraspinous and interspinous ligaments
- two lateral vertical lines: ossification of the apophyseal joint capsules
What are the treatment options for Ankylosing Spondylitis?
- Medication: help manage symptoms of pain and stiffness
- Physiotherapy
- Surgical intervention
What are complications of Ankylosing Spondylitis?
-Carrot stick” Fx
- through ankylosed segment
- MC in lower C-spine and T/L junction
- may follow trivial trauma
- “Anderson Lesion”
- non union of Fx, forming pseudoarthrosis through the IVD
Carrot stick Fxs and Anderson lesions are highly unstable and can sever the spinal cord
- Atlantoaxial instability (2-15%)
- spinal stenosis & cauda equina syndrome
What is Enteropathic Arthritis (EA)?
A form of chronic, inflammatory arthritis associated with the occurrence of inflammatory bowel disease (IBD)
Classified as a form of seronegative spondyloarthropathy
Approximately 20% of people with Crohn disease or ulcerative colitis may develop EA
At least three forms of joint abnormalities are recognised in patients with IBD according to locations:
- peripheral joint arthritis
- sacroiliitis
- spondylitis identical to AS
What is Psoriatic Arthritis (PsA)?
A seronegative arthritis is patients with psoriasis
A Chronic disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis)
Affects both men and women equally
What ages are the onset of Psoriatic Arthritis (PsA)?
Between 20-50 yoa
What are the causes of Psoriatic Arthritis (PsA)?
Unknown
- genetics (HLA-B27 found in >50% of PsA patients)
- immune factors (stressors or changes in the immune system may affect the development or progression of the disease)
- environmental factors
What are the signs and symptoms of Psoriatic Arthritis (PsA)?
- Swollen, painful, hot, red joints - frequently in the knees, ankles and feet
- Swollen fingers or toes – “Sausage digits”
- Joint stiffness – worse in the morning
- Pitted nails, or nails separating from the nail bed
- Lower back pain
- Inflammation of the tendons
What are the clinical findings of Psoriatic Arthritis (PsA)?
- Confined to DIPS of hands and feet (Hands > Feet)
- Painful, hot, red joints
- Swollen fingers or toes – “Sausage digits”
- Joint stiffness – worse in the morning
- Almost always accompanies skin disease (e.g. psoriasis) and nail changes (e.g. pitted nails, or nails separating from the nail bed)
- Lower back pain
- Inflammation of the tendons
PSORIASIS: An immune-mediated skin disorder, causing skin cells to multiply up to 10 times faster than normal. This causes build-up of irregular red patches covered with white scales on the scalp, elbows, knees, and lower back.
What are the radiological findings of Psoriatic Arthritis (PsA)?
- Asymmetrical distribution
- Soft tissue Swelling
- the earliest and only radiographic sign
- fusiform
- may involve a single joint (spindle digit) or whole digit (Sausage digit)
- Bone density
- Normal - helpful in the DDX from RA
- Joint Space
- narrow or widened d/t fibrous tissue deposition
- ankylosis – later stage
- Erosions
- prominent finding
- starts at marginal bare areas of joints, progressing to the central areas
- May be extensive
- bones may appear gnawed away (“pencil in cup”)
- Tuftal resorption (tip of terminal phalanx)
- common finding
- DDX: Scleroderma, Hyperparathyroidism (HPTH), thermal injury
What is Reactive Arthritis (Reiters Syndrome)?
A painful form of inflammatory arthritis that develops in reaction to a bacterial or viral infection (e.g., genitourinary or gastrointestinal infections)
A Seronegative Spondyloarthropathy
CLINICAL TRIAD:
- Urethritis
- Arthritis
- Conjunctivitis
18 - 40 yrs
- Men>woman (50:1)
What causes Reactive Arthritis (Reiters Syndrome)?
- Bacterial or viral infection
- glandular fever
- food poisoning
- sexually acquired
What are the clinical findings of Reactive Arthritis (Reiters Syndrome)?
- Mild Anemia
- Markedly elevated ESR in most cases of acute reactive arthritis
- Elevated CRP at onset of disease
- Negative for RA factor
- May persist for years
What are the signs and symptoms of Reactive Arthritis (Reiters Syndrome)?
Urethritis - usually first complaint
- Dysuria (burning pain on urination) or increased frequency of urination - may be the only symptoms
- Fever, conjunctivitis & arthritis develop over few weeks
- Painful effusion
- Pain and swelling in large joints e.g., knees
- Heel pain and tenderness (“lover’s heels”)- common manifestation and should suggest DX in young male patients
What are the radiological findings of Reactive Arthritis (Reiters Syndrome)?
- Articular and periarticular soft tissue swelling
- Uniform loss of joint space
- Marginal erosions
What are the complications of Reactive Arthritis (Reiters Syndrome)?
Urinary tract obstruction
- Iritis, retrobulbar neuritis, corneal ulceration
- Initial illness typically resolves in 3-4 months
- 50% of patients experience transient recurrences of arthritis over a period of several years
