Lecture: Spondyloarthropathies Flashcards
What are the seronegatives/spondyloarthropathies?
Predominant Axial SpA:
- Ankylosing spondylitis
- Non-radiographic axial SpA
Predominantly Peripheral SpA
- Reactive arthritis
- Psoriatic arthritis
- Enteropathic arthritis
- Undifferentiated SpA
What are the characteristic features of SpA?
- Seronegative
- Associated with HLA-B27
- Sacroiliitis
- Spondylitis
- Peripheral arthritis (asymmetrical, lower limbs, distal, dactylitis)
- Enthesitis
Non-articular:
- Psoriasiform skin and nail lesions
- Anterior uveitis
- Chronic GIT inflammation
- Chronic genitourinary inflammation
What are the characteristics of the peripheral arthritis of SpA?
ALDD
Asymmetrical
Distal joints
Lower limbs
Dactylitis
What is the ASAS classification criteria for Axial SpA?
In patients >3mo back pain + age of onset <45
- Have sacroiliitis on imaging and 1+ feature OR
- HLA-B27 positive and 2+ features
- Inflammatory back pain (IBP)
- Arthritis
- Enthesitis
- Uveitis
- Dactylitis
- Psoriasis
- Crohn’s/UC
- Good response to NSAIDs
- Family Hx of SpA
- HLA-B27
- Elevated CRP
What are the types of psoriatic arthritis?
- Oligoarticular (asymmetric)
- Polyarticular (symmetric)
- Spondyloarthropaty
- DIP predominant
- Arthritis mutilans
What is the clinical presentation of psoriatic arthritis?
Often a single joint so people mistake it for septic arthritis.
- Inflammatory arthritis
- Can be symmetrical or asymmetrical depending on type
Examination:
- Psoriatic plaques: extensor surfaces, scalp
- Dactylitis
- Telescoping
- Nail changes: pitting, riding, onycholysis, hyperkeratosis
What are the criteria for psoriatic arthritis?
> 3 out of 5
- Evidence of psoriasis
- Psoriatic nail dystrophy
- Negative RF
- Dactylitis
- Radiologic signs
What are the features on imaging of psoriatic arthritis?
X-Ray:
- Joint destruction and ankyloses
- Pencil in a cup deformity
- Spine: syndesmophytes, asymmetrical paravertebral ossification
How is psoriatic arthritis treated?
Mild: NSAIDs and steroids
Moderate to severe:
- DMARDs: MTX, leflunomide, sulfasalazine
- Biologics: Anti-TNF inhibitors
What is reactive arthritis?
Seronegative/SpA
A sterile joint inflammation that develops after a distant infection
What is the aetiology of reactive arthritis?
- HLA-B27 is associated with suspectibility and risk of chronicity
Genital: chlamydia trachomatis
Enteric: salmonella, yersinia, campylobacter, shigella
What is the presentation of reactive arthritis?
ASymmetric oligoarthritis
Classic triad: conjunctivitis, urethritis, arthritis
Urethritis, skin involvement, conjunctivitis, nephritis, gut inflammation, carditis
How do you treat reactive arthritis?
- Antibiotics if infection still present
- NSAIDs
- Glucocorticoids
- DMARDs if it becomes chronic
When are DMARDs used int reatemend of SpA?
When there is peripheral arthritis
Don’t help with axial arthritis
Do TNFalpha Inhibitors stop radiographic progression?
No- osteoproliferation is independent of TNFalpha so will still happen
