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MDD BAB > Seronegative Spondyloarthrides > Flashcards

Seronegative Spondyloarthrides Flashcards

1
Q

What do Seronegative spondylopathies all have in common ? (2)

A

They are rheumatoid factor negative and anti-CCP negative

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2
Q

What is the aetiological

factor for Seronegative spondylopathies ?

A

HLA B27

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3
Q

What is the mnemonic for the four types of Seronegative spondylopathies ?

A

PAIR

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4
Q

What are the 4 types of seronegative spondylopathies?

A

Psoriatic arthritis
Ankylosing spondylitis
IBD related arthropathy
Reactive Arthritis

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5
Q

What is the mnemonic for the features that the Seronegative spondylopathies have in common ? (5)

A

JED PA

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6
Q

What are the features that the Seronegative spondylopathies have in common ? (5)

A
  1. Joint ankylosing
  2. Enthesitis
  3. Davtylitis (sausage shaped finger common in psoriatic arthritis)
  4. Plantar fasciitis
  5. Achilles tendinitis
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7
Q

What … presents usually as episodic inflammation and stiffening of the sacroiliac joints in young adults (18-30) ?

A

Ankylosing spondylitis

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8
Q

What is the mnemonic for the symptoms of Ankylosing spondylitis?

A

GMP: God’s My Peace

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9
Q

What are the features of Ankylosing spondylitis? (3)

A
  1. Gradual onset of INTERMITTENT lower back/buttock pain which improves with exercise and is worse in the morning
  2. Morning stiffness lasting longer than one hour
  3. Pleuritic chest pain/ costochondritis
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10
Q

What are the signs on examination For ankylosing spondylitis with regards to the following:

  • Look (2)
  • feel (1)
  • move (2)
  • special tests (1)
A

Look: 1. Question mark posture during spinal flexion (early sign)
2. Paraspinal muscle wasting
Feel: 1. Tender sacroiliac joints
move: (2) limited lateral flexion and forward flexion of the spine
Special tests: shober’s test less than 5cm

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11
Q

What other joints may be involved ?

A
  1. Asymmetrical hip/shoulder joints

2. Other peripheral joints (rare)

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12
Q

What are the 4 extra-articulations manifestations of Ankylosing spondylitis? 😭

A

4A

  1. Anterior uvetis
  2. Apical pulmonary fibrosis
  3. Aortic regurgitation
  4. AV node block
  5. Amyloidosis
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13
Q

What investigations would you do for Ankylosing spondylitis with regards to the following:

  • Bloods (4)
  • Basic Imaging (2)
A

Bloods (4): FBC, ESR, CRP and HLA-B27
- Basic Imaging (2):
spinal x-Ray (2): 1. Squaring of vertebral bodies
2. Bamboo spine: Rigid spine due to formation syndesmophtyes: ossified ligaments
Pelvic X-Ray: bilateral sacroilitis: narrowing of joint space between the SIJs, eventually leading to fusion

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14
Q

What is the management for ankylosing spondylitis with regards to the following:

  • conservative
  • medical
  • surgical ?
A
  • conservative: exercise and physiotherapy
  • medical:
    full dose NSAIDs: first line
    2 NSAIDs: second line
    Biological therapy: etanercept; avoid infliximab
    -surgical: is affecting hip: THR
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15
Q

With regards to psoriatic arthritis, which occurs first the skin disease or arthritis

A

Skin disease can present prior/after arthritis

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16
Q

What are the 5 types of psoriatic arthritis?

A
  1. Symmetrical polyarthritis (similar to RA but affects DIPs) in the hands
  2. Asymmetrical oligoarthritis: Often one large joint and several small hand/foot joints
  3. DIP predominant disease:
    Nail charges: pitting, onycholosis, subungal hyperkeratosis
    - dactylitis: sausage finger
  4. Spondylitis: affecting spine with/without SIJs (often unilateral)
  5. Arthritis Motilans: marked joint deformity and telescoping of the digits
17
Q

What is the main investigation performed for psoariatic arthritis and explain the findings ?

A

X Ray changes: pencil in cup deformity due to central erosions

18
Q

What is the management for psoriatic arthritis with regards to the following:

  • one joint affected
  • multiple joint affectEd
A

one joint affected: oral NSAIDS + PPI with/without intra-articulations steroid injections
- multiple joint affected: Treat like RA: Oral NSAID (+PPI) + oral DMARD

19
Q

What … causes acute asymmetrical lower limb arthritis which usually occurs after 4-40 days following an infection usually GI/GU

A

Reactive arthritis causes acute asymmetrical lower limb arthritis which usually occurs after 4-40 days following an infection usually GI/GU

20
Q

What is the Classical triad of reactive arthritis ?

A

Can see, can’t pee or climb a tree

  1. Conjunctivitis/Iritis
  2. Dysuria due to urethritis and discharge
  3. Lower limb arthritis particularly in KNEE
21
Q

What must you not forget to ask about in a patient with reactive arthritis ?

A

Hx of unprotected sex/illness and Foreign travel

22
Q

What are the 3 extra-articulations manifestations of reactive arthritis ?

A
  1. May develop sacroilitis or spondylitis
  2. Enthesitis associated with plantar fasciitis and Achilles Tendinitis
  3. Skin changes: keratoderma and Balantitis
23
Q

What does the management of reactive arthritis Involve ?

A

NSAIDs with/without steroid injections: 1st line;

Sulphasalazine for more extensive disease

24
Q

What are the features of IBD associated arthropathy ? (2)

A
  1. Asymmetrical lower limb arthritis

2. May have sacroilitis or spondylitis

25
Q

What is the treatment of IBD related spondylopathy?

A

MDT approach:

  1. Treat IBD
  2. NSAIDs + intra-articular steroids for

MDD BAB (8 decks)

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