Axial Spondyloarthropathy Flashcards
What, epidemiology, aetiology, pathophysiology, diagnosis, clinical featuress, patient reported outcome measures
What is axial spondyloathropathy?
A chronic inflammatory disorder if the axial skeleton. Changes to the sacroiliac joints or spine seen on xray. Enthesis- inflammation of facet joint. These changes consist if sclerosis, erosions, new bone formation- osteocytes and/or ankylosis (abnormal stiffening and immobility due to fusion of bones).
What is non-radiographic axial spondyloarthropathy?
No changes on xray
Inflammation visible on MRI (7 in 10)
No visable imaging but sympotomatic (3 in 10)
Epidemiology of axial spondyloathropathy (2)
9-30/100,000
Higher in caucasians than african americans
Aetiology of axial spondyloathropathy. 5
- Genetic marker present in more than 90% of caucasians than african americans
- Family history
- Environment- exposure to toxins, pollutants
- Injury to the joint
- Lifestyle- smoking (worsens the severity of the disease)/ not exercises
Pathophysiology of axial spondyloathropathy
Arthritis- large joints, inflammation at insertion of tendons, ligaments or capsule into bone (enthesis). Results in wearing away if bone. Once resolves or reduces new bone develop. Resulting in movement restrictions. Due to bone repla ing elastic tissues i.e ligaments/tendons. Repetitionnif cycle= increase bone formation, fusing the vertebrae.
What are the patient outcome measures for axial spondyloathropathy?
BASMI- Bath AS metrology- movement object measures, keeo an eye on progression
BASFI- Functional index, ADL’S i.e putting socks on, high shelf
BASDI- inflammation
BAS-G- Global, different not just one specifc, i.e how been over last week, month etc
What is the diagnosis for axial spondyloathropathy?
Hard- 85% have the A27 gene, need more specific markers.
Not entirely know the specific pathology- think immune component resulting in bone growth.
Blood test- c reactive protein
Modified new york- low back pain, 3 months plus, better with exercise, not relieved by rest, limitation in movement , chest inflation, see on xray.
ASAS- back pain 3 months plus, les than 45 years when first onset, one or more spondyloathritis features.
What are the clinical features of axial spondyloathropathy?
S- skin, psoriasis, rash C- colitis, Crohn's R- Relative, family E- eyes, dry eyes, photosensitivity E- Early morning stiffness N- Nocturnal pattern, nail, number of joints E- Exercise response /effect M- Medication effect
Fatigue Low back pain 3 months plus Stiffness Buttock pain Arthritis Wake at night Symptoms respond to non-steriod anti-inflammatory drugs (NSAIDS) within 48 hrs. Better with exercise, worse at rest.
