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Rheumatology > Seronegative spondylarthropathy > Flashcards

Seronegative spondylarthropathy Flashcards

1
Q

What are they?

A

Rheumatoid factor negative arthritis affecting the axial skeleton:

  1. Ank spond (axial spondylarthritis - AS)
  2. Reactive arthritis
  3. Psoriatic arthritis
  4. Enteropathic arthritis
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2
Q

What is the axial skeleton made up of?

A

the skull bones, the ossicles of the middle ear, the hyoid bone, the rib cage, sternum and the vertebral column.

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3
Q

What are the common features of the SPAs?

A
  1. Rh factor -ve
  2. HLA B27 associated
  3. Axial arthritis
  4. Asymmetrical large joint oligoarthritis (≥5) or monoarthritis
  5. Enthesitis
  6. Dactylitis
  7. Extra-articular manifestations
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4
Q

what is enthesitis? Give examples

A

inflammation at site of where tendon or ligament inserts into bone
e.g. plantar fasciitis, achilles tendonitis, costochondritis

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5
Q

What is dactylitis?

A

inflammation of entire digit due to soft tissue oedema + tendosynovial + joint inflammation

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6
Q

What are the signs nd sx of AS?

A
  1. Pain - gradual onset, lower, worse at night, can radiate to hips/buttocks
  2. Spinal morning stiffness relieved by exercise
  3. Progressive loss of spinal movement - reduced thoracic expansion
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7
Q

What are the extra articular features of AS?

A 
A's:
Anterior uveitis (iritis)
Apical fibrosis
Achilles tendonitis 
Aortic regurgitation
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8
Q

What can be found on examination in AS?

A

Reduced lateral + forward flexion (schobers)

Reduced chest expansion

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9
Q

who does AS tend to affect?

A

young men

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10
Q

What are the investigations for AS? what would you find?

A

Imaging:

  1. Spinal XR:
    i. sacroiliac - joint space narrowing/widening, sclerosis, erosions, ankylosis/fusion
    ii. Vertebral syndesmophytes
    iii. Bamboo spine
  2. CXR - apical fibrosis
  3. MRI - active inflammation, destructive changes (erosions, sclerosis, ankylosis)
  4. Bloods - FBC (normocytic), raised ESR, CRP
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11
Q

What are syndesmophytes?

A

bony proliferation due to enthesitis between ligaments and vertebrae, fuse w vertebral body above cause ankylosis

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12
Q

What is a bamboo spine/

A

calcification of ligaments w ankylosis ,result of the syndesmophytes

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13
Q

When does AS carry a worse prognosis?

A

ESR >30
Onset <16yrs
Early hip involvement
Poor response to NSAIDs

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14
Q

What is the conservative and pharmacological management of AS?What drugs are 1st line?

A
  1. exercise - intense exercise regimes
  2. 1st line NSAIDS
  3. TNF alpha blockers e.g. etanercept, adalimumab in severe active AS
  4. local steroid injections for temp relief
  5. bisphosphonates - increased risk of osteoporotic spinal fractures
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15
Q

What is the surgical management of AS and when is it indicated?

A

Hip replacement if increased pain and reduced mobility when hips are involved

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16
Q

What is enteropathic arthropathy associated w?

A

IBD
GI bypass
Coeliac
Whipples disease

17
Q

What is the rx of enteropathic arthropathy?

A

treat bowel sx, usually improves arthropathy
beware NSAIDS
DMARDs for resistant cases

18
Q

What % of pts w psoriasis does psoriatic arthritis occur?

A

10-40

19
Q

Do psoriasis and arthritis have to occur together for it to be PS?

A

no

20
Q

What are the different types of psoriatic athritis?

A
  • Rheumatoid like - symmetrical
  • DIP joints
  • Asymmetrical oligoarthritis - typically hands and feet
  • Spinal - like AS
  • psoriatic arthritis mutilans
21
Q

What are the associated features of psoriatic arthritis?

A
  • nail dystrophy
  • dactylitis
  • acneiform rashes
  • palmoplantar pustulosis
22
Q

What radiological changes can be seen in PS

A

erosive changes - pencil in cup deformity if severe

23
Q

What is the treatment of PS

A

NSAIDs
sulfasalazine
methotrexate
anti-tnfs

24
Q

What is reactive arthritis?

A

arthritis that develops following an infection where the organism cannot be recovered from the joint.

25
Q

How does reactive arthritis present/

A 
Reiters syndrome:
1. urethritis
2. arthritis
3. conjunctiviits
'cant see pee or climb a tree'
- circinate balanitis - painless penile ulcers secondary to chlamydia 
- keratoderma blenorrhagia - brown raised papule on soles and palms
- iritis
- mouth ulcers 
- enthesitis
usually lower limbs
26
Q

how long do sx generally last for in reactive arthritis? how soon after infection does it tend to develop[/

A

4-6months

4 weeks after inf

27
Q

What are the causative organisms in reactive arthritis?

A
  1. post dysenteric - shigella flexneri, salmonella, campylobacter,
  2. post STI - chlamydia trachomitis
28
Q

What tests would you do in RS?

A
  • ESR + CRP
  • Stool culture if diarrhoea
  • Infectious serology
  • Sexual health review
    XR -enthesitis w periosteal reaction
29
Q

What is the management of RS?

A

No specific cure
NSAIDs or local steroid inj
Splint affected joint
if >6m - sulphasalazine or methotrexate

Rheumatology (10 decks)

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