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Year 3: Block 1: MSK system > Seronegative arthritis (spondyloarthirtis) > Flashcards

Seronegative arthritis (spondyloarthirtis) Flashcards

1
Q

What is it?
what can it be associated with?

involvement of?
more common in?

A
  • Negative rheumatoid factor
  • HLA- B27
  • axial skeleton (spine)
  • larger joints
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2
Q

what is Enthesitis

A

inflation of area where tendon r ligament attaches to bone - around elbow, Achilles

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3
Q

Extra-articular features- ? (3)

A

uveitis, inflammatory bowel disease, psoriasis

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4
Q

Clinical presentations

A
  • Ankylosing Spondylitis - back pain
  • Psoriatic arthritis
  • Bowel related arthritis (Crohn’s, UC)
  • Reactive arthritis
    Others
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5
Q

Age where sacroiliitis occurs?

A

late teens

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6
Q

Diagnosis of ankylosing spondylitis?

A

evidence of bilateral sacroiliitis

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7
Q

Ankylosing Spondylitis - prototype of?

Predilection for?

who is it more common in?

A

axial sponyloarthritis

axial skeleton and entheses

MALES

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8
Q

HLA b27 is not diagnostic of?

where is it positive in?

A

AS/SpA

80-95% of patients with AS

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9
Q

theories of HLA-B27 that may induce AS (3)

A
  • peptides from foreign antigens presented and trigger inflammatory process
  • mis folded - triggering of certain parts of the immune system
  • inability to fold into homodimers
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10
Q

Clinical aspects of AS - what do we look at (mobility)

A

spinal mobility - modified schober’s test

10cm mark - patient bends forward - anything less is abnormal

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11
Q

Clinical aspects of AS - what do we look at (laterally)

A

lateral spinal flexion

  • best of 2 tries on left and right are recorded
  • score is an average of both
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12
Q

Clinical aspects of AS - what do we look at (occiput)

A
  • occiput to wall and trigs to wall
  • ## measures the amount of thoracic kyphosis
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13
Q

Clinical aspects of AS - what do we look at (cervical rotation)

A
  • goniometer on top of the head
  • rotate head and records angle between sagital plane and new plane
  • average calculated
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14
Q

AS- Clinical features (NY criteria) (4)

A
  • Inflammatory back pain
  • Limitation of movements in antero-posterior as well as lateral planes at lumbar spine
  • Limitation of chest expansion
  • Bilateral sacroiliitis on X-rays
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15
Q

Grading of sacroiliitis goes from?

A

0-4

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16
Q

a fused spine also known as?
what is it?

in advanced AS the vertebrae are more?

A

bamboo spine
inflammation nat corner of vertebrae - shiny corners - calcification and ossification

  • squaring of the vertebrae
17
Q

Diffuse idiopathic skeletal hyperostosis (foresters disease) (3)

A

bony projections from vertebra

  • unilateral bridging spodylophytes
  • extensive calcification of the anterior spinal ligament
18
Q

radiographic means there are?

non radiographic means?

A

x ray changes

- picked up on MRI

19
Q

classification criteria for SpA

A

Sacroiliitis on imaging plus >1 SpA feature

or HLA-B27 plus >2 SpA features

20
Q

Name some SpA features

A
  • inflammatory back pain
  • arthritis
  • Enthesitis
    (heel)
  • uveitis
  • psoriasis
  • crohn’s
21
Q

Other features: systemic

A

Cardiac- Aortic incompetence, heart block, regurgitation

Pulmonary- restrictive disease, apical fibrosis

Osteoporosis and spinal fractures

Neurological- AAD & cauda equina syndrome

Renal- secondary amyloidosis

22
Q

management of AS (6/7)

A
  • Physiotherapy - posture and spine flexibility
  • NSAIDs- anti inflammatory, GI problems

DMARDs- Sulfasalazine

Anti-TNF

Anti-IL-17

  • Treatment of osteoporosis
  • Surgery- joint replacements and spinal surgery
23
Q

Patients with risk factors for radiographic spinal
progression eg…..?

what do these patients benefit most from?

A

syndesmophytes (bony changes) , elevated CRP

  • NSAID therapy
24
Q

hand features of psoriatic arthritis

A

distal inter-phalangeal involvement

-lifting of the nail bed, pitting

25
Q

most destructive type of psoriatic arthritis

A

arthritis mutilans

  • pencil cup deformity
26
Q

some joints involved in psoriatic arthritis

A

large joints more common

  • knees
  • toes
  • base of spine
  • hands
  • neck
27
Q

Psoriatic arthritis- clinical subtypes (6)

A
  • Arthritis with DIP joint involvement
  • Symmetric polyarthritis- similar to RA
  • Asymmetric oligoarticular arthritis (effect less than 5 joints)
  • Arthritis mutilans
  • Predominant spondylitis

Also characterized by dactylitis (sausage finger) & enthesitis (where tendon joints to bone)

Severity of joint disease does not correlate to extent of skin disease. Nail pitting seen

28
Q

Treatment of PA? (lots of examples)

A 
Sulfasalazine
Methotrexate
Leflunomide
Cyclosporine
Anti-TNF therapy
Anti- IL-17 and IL-23
Steroids
Physiotherapy and occupational therapy
Axial disease treated similar to AS
29
Q

Reactive arthritis triggers

A
  • Sterile synovitis after distant infection
  • Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia trachomatis or pneumoniae, Borrelia, Neisseria and streptococci
  • GI infections, throat infections
30
Q

Skin and mucous membrane involvement of reactive arthritis (psoriasis)

A
  • Keratoderma blenorrhagica
  • Circinate balanitis - chlamydia
  • Urethritis - chlamydia
  • Conjunctivitis
  • Iritis
31
Q

Reiter’s syndrome ? (3)

A

arthritis, urethritis and conjunctivitis

32
Q

Prognostic signs for chronicity?

A

Prognostic signs for chronicity
Hip/heel pain
High ESR
Family history and HLA-B27 +ve

33
Q

Treatment of reactive arthritis - acute

A

NSAID
Joint injection (if infection excluded)
antibiotics in chlamydia infection (contacts as well)

34
Q

Treatment of reactive arthritis - chronic

A

NSAID

DMARD (e.g. sulphasalazine, methotrexate)

35
Q

Enteropathic arthritis is commonly associated with?

it can be both?
what is commonly seen in this patient group?

A

Crohn’s or UC

peripheral and/or axial disease
Enthesopathy commonly seen

36
Q

Treatment of reactive arthritis?

what may alleviate peripheral disease?

A
  • NSAIDs difficult to use
  • Sulfasalazine
  • Steroids
  • Methotrexate
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease
37
Q

what in the history is key to pick up on?

A

inflammatory back pain

  • quality and quantity of early morning stiffness - tends to be more severe in inflammatory not mechanical
  • improvement of stiffness with activity
  • physical therapy is just as important as the drug therapy

Year 3: Block 1: MSK system (22 decks)

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