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Musculoskeletal > Rheumatology: Spondyloarthropathy > Flashcards

Rheumatology: Spondyloarthropathy Flashcards

1
Q

What is the HLA gene associated with spondyloarhropathies?

A

HLA B27

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2
Q

Where does Spondyloarthropathy affect?

A

The spine and joints

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3
Q

What are the disease subgroups?

A

Ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis

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4
Q

What is the difference between mechanical and inflammatory back pain?

A

Mechanical: worsened by activity and better with rest
Inflammatory: worse with rest, better with activity and there is early morning stiffness

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5
Q

What are the shared rheumatological features of the spondyloarthropathies?

A

Sacroiliac joints and spinal involvement
Enthesitis
Dactylitis

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6
Q

What is Enthesitis?

A

Inflammation of the epicondyles e.g. at the insertion of tendons into bones e.g. plantar fasciitis

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7
Q

What is Dactylitis?

A

“sausage” digits

-inflammation of the entire digit

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8
Q

What are the shared extra-articular features of the spondyloarthropathies?

A

No rheumatoid nodules, achilles tendonitis, “cocktail sausage” finger toes, occular inflammation (emergency)

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9
Q

What joints are typically affected first in ankylosing spondylitis?

A

Sacro-iliac joints

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10
Q

What is the hallmark of ankylosing spondylitis?

A

Sacroiliac joint involvement

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11
Q

When does ankylosing spondylitis typically present?

A

In the late teens- early 20s

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12
Q

What is the treatment for ankylosing spondylitis?

A

Home exercises to maintain core muscle strength, occupational therapy, corticosteriods/anti TNF

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13
Q

What are the clinical features of ankylosing spondylitis?

A

Sacroiliac back pain, enthesitis, peripheral arthritis

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14
Q

What are the extra-articular features of ankylosing spondylitis?

A

Neurological, pulmonary, CV involvement, anterior uveitis

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15
Q

Ankylosing spondylitis is often referred to as the “A” disease, what are some of the “A” features?

A

Atypical fibrosis, Anterior uveitis, Aortic Regurgitation, Achilles Tendonitis, Plantar Faciits, Amyloidosis, Axial (spine) arthritis

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16
Q

What are some of the examinations of ankylosing spondylitis?

A

Schober’s test

Occiput to wall test

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17
Q

How should ankylosing spondylitis be diagnosed?

A

Bloods: HLA B27
X ray
Examination

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18
Q

What should be seen on an x-ray in ankylosing spondylitis?

A

Sacroilitis, “bamboo” spine, syndesmophytes

19
Q

What is Psoriatic Arthritis?

A

Inflammatory arthritis associated with psoriasis, but 10-15% can have Psoriatic Arthritis without psoriasis

20
Q

What is the measure of Rheumatic factor in Psoriatic Arthritis?

A

None

21
Q

What are the clinical features of Psoriatic Arthritis?

A

Nail involvement: pitting and oncholysis
Sacroilitis: asymmetric
Enthesitis
Dacylitis

22
Q

What is the difference in distribution of Psoriatic Arthritis compared to RA in the fingers?

A

PA in the inter pharyngeal

RA in the MCP

23
Q

Are there rheumatoid nodules in Psoriatic Arthritis?

A

No

24
Q

How is Psoriatic Arthritis diagnosed?

A

History of psoriasis, FHx of skin problems, bloods show negative RF, x ray

25
Q

How should Psoriatic Arthritis look on an x-ray?

A

Marginal erosions and “whiskering”
“pencil in cup deformity”
Osteolysis
Enthesitis

26
Q

What is the medical and non medical treatments for Psoriatic Arthritis?

A

Medical: NSAIDs for pain relief, steroids for rescue, DMARs for long term to slow progression but not stop it, anti-TNG is severe

Non medical: OT, Physiotherapy

27
Q

What is Reactive Arthritis?

A

Infection Induced systemic illness characterised primary by an inflammatory synovitis from which viable organisms cannot be cultured

28
Q

Can micro-organisms be cultured in Reactive Arthritis?

A

No

29
Q

When do the onset of symptoms of Reactive Arthritis first tend to occur?

A

1-4 weeks after an infection

30
Q

What is Reiter’s syndrome?

A

Triad of reactive arthritis:

  • Urethritis
  • Arthritis
  • Conjunctivitis/Uveitis
31
Q

Who is usually affected by Reactive Arthritis?

A

Young adults 20-40

32
Q

What are the most common infections in Reactive Arthritis?

A

Urogenital, Chlamydia or Enterogenic: salmonella, shigella

33
Q

What are the clinical features of Reactive Arthritis?

A
  • Assymmetrical monoarthritis or oglioarthritis
  • Enthesitis
  • Mucocutaneous lesions
  • Occular lesions
34
Q

How is Reactive Arthritis diagnosed?

A

Joint fluid aspirate to exclude septic arthritis

35
Q

What is the treatment of Reactive Arthritis?

A

90% will resolve spontaneously within 6 months
Medical: steroid eye drops
Non medical: Physiotherapy, OT

36
Q

What is the prognosis for Reactive Arthritis?

A

Generally good, recurrence not common, only some develop chronic form

37
Q

What is Enteropathic Arthritis associated with?

A

10-20% with IBD

38
Q

What is the typical presentation of Enteropathic Arthritis?

A

Arthritis in several joints, especially the knees, ankles, elbow and wrists

39
Q

Why should a full GI history be taken in Enteropathic Arthritis?

A

Patient might not have been diagnosed with IBD yet and have had symptoms such as loose watery stools with mucus/blood

40
Q

What are the clinical symptoms in Enteropathic Arthritis?

A

GI symptoms, uveitis, pyoderma gangrenosum, Enthesitis: achilles tendonitis/plantar faciiitis/lateral epicondylitis, oral: apthous ulcers

41
Q

What investigations should be conducted to confirm Enteropathic Arthritis?

A
  • Upper and lower endoscopy with biopsy showing ulceration/colitis
  • No organisms or crystals in joint aspiration
  • sacroilitis
42
Q

What is the treatment in Enteropathic Arthritis?

A

Treat underlying IBD:

  • Steriod therapy in conjunction with gastroenterologists
  • Anti-TNF
43
Q

What drug shouldn’t be given in Enteropathic Arthritis/

A

NSAIDs

Musculoskeletal (13 decks)

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