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CP3 @ UoN - Musculoskeletal & MDD > Seronegative Spondyloarthritis > Flashcards

Seronegative Spondyloarthritis Flashcards

1
Q

What are the Seronegative Spondyloarthritides?

A

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD-related arthropathy

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2
Q

What joints are involved in Seronegative Spondyloarthritides?

A

Spine
Proximal large joints
Joint involvement more limited than in RA

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3
Q

What deformities are more commonly seen in Seronegative Spondyloarthritides?

A

Joint ankylosis
Joint enthesitis
Dactylitis (sausage finger)

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4
Q

What is the aetiology of Seronegative Spondyloarthritides?

A 
All HLA B27 +
   -all RF neg
   -generally anti-CCP neg
Male preponderance 3:1
18-30yrs
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5
Q

How does Ankylosing Spondylitis present?

A

Episodic pain/stiffness in lower back/buttocks
-worse in morning, may wake from sleep
-relieved by exercise
-pain alternates b/w buttocks
Asymptomatic b/w episodes

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6
Q

What are the signs on examination of Ankylosing Spondylitis?

A

LOOK - question mark posture (early), paraspinal wasting (later)
FEEL - pain on pressure over SIJs
MOVE - limited lat/forward flexion of lumbar spine
Shober’s +ve

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7
Q

What causes a question mark posture in Ankylosing Spondylitis?

A

Retention of lumbar lordosis during spinal flexion

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8
Q

What is Shober’s test?

A

Line drawn along midline 10cm above & 5cm below L5

Distance b/w two lines should increase >5cm when pt bends forward

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9
Q

Which joints are commonly involved in Ankylosing Spondylitis?

A

Sacroiliac
Hip/shoulder (asymmetrically)
Peripheral joints
Chostocondral joints (chest pain)

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10
Q

What are the extra-articular manifestations of Ankylosing Spondylitis?

A 
Ant uveitis (20%)
Pulmonary (apical) fibrosis
AV node block
Aortitis
Amyloidosis
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11
Q

What investigations may be appropriate in suspected Ankylosing Spondylitis?

A 
ESR (normal in 50%)
Pelvis XR (bilat sacroilitis)
Spinal XR (bamboo spine)
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12
Q

What are the spinal XR findings of Ankylosing Spondylitis?

A

Vertebral bodies squared
Annulosus fibrosus/interspinous ligaments ossified
-leads to inflexible/rigid spine

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13
Q

What is a Syndesmophyte?

A

Ossified ligament

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14
Q

What is the management of Ankylosing Spondylitis?

A

Full dose NSAIDs (6wks)
Biologics
-started if no improvement on 2 diff NSAIDs

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15
Q

What is Psoriatic Arthritis?

A

Seronegative arthropathy seen in psoriasis

  • 8% of psoriasis pts
  • equal female/male incidence
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16
Q

What are the five subtypes of Psoriatic Arthritis?

A 
Symmetrical polyarthritis (40%)
Asymmetrical oligoarticulararthritis (30%)
DIPJ predominant disease (10%)
Spondylitis
Arthritis mutilans
17
Q

Describe Symmetrical Polyarthritis

A

Presents similarly to RA
DIPJ involvement
Less severe deformities

18
Q

Describe Asymmetrical Oligoarticulararthritis

A

<5 joints involved

-often one large joint plus several smaller hand/foot joints

19
Q

Describe DIPJ Predominant Disease

A

Associated w/ nail changes

  • pitting
  • onchylolysis
  • sausage finger
20
Q

Describe Spondylitis

A

Affects spine +/- SIJs as per AS

21
Q

Describe Arthritis Mutilans

A 
Severe form (5%)
Marked joint destruction/deformity
   -telescoping of digits
22
Q

What are the radiological signs of Psoriatic Arthritis?

A

Erosions similar to RA

  • minimal osteopenia
  • more central erosions (pencil in a cup)
23
Q

What joints are involved in Psoriatic Arthritis?

A

Sacroiliac (usually unilateral)

Early DIPJ involvement (specific to PA)

24
Q

What are the management options for Psoriatic Arthritis?

A 
If one joint involved
   -full dose NSAIDs +/- steroid injections
If multiple joints involved
   -treat as per RA, better prognosis
   -methotrexate also helps skin
   -DMARDs do not help spinal sx
25
Q

What is Reactive Arthritis (Reiter’s Syndrome)?

A

Acute, asymmetrical lower limb arthritis occurring 4-40 days following an infection (GI/GU)
-can then develop into chronic arthritis

26
Q

What are the common causative pathogens causing Reactive Arthritis?

A

Chlamydia
Salmonella
Campylobacter

27
Q

How does Reactive Arthritis present?

A 
Classical triad (can't see, pee or climb a tree)
   -conjunctivitis
   -dysuria
   -lower-limb oligoarthritis
Sacroilitis/spondylitis
Enthesitis
   -associated plantar fasciitis or Achilles tendonitis
Skin lesions
28
Q

What skin lesions are common in Reactive Arthritis?

A

Keratoderma blenorrhagica

Balantitis

29
Q

What causes Reactive Arthritis?

A

Disease process due to antigenic stimulation of inflammatory response

30
Q

What are the management options for Reactive Arthritis?

A

Full dose NSAIDs +/- steroid injections
Sulfasalazine 2nd line
-for more extensive disease

31
Q

How common is IBD-related arthropathy?

A

10-15% of those w/ IBD develop an arthropathy

32
Q

How does IBD-related arthropathy present?

A

Symmetrical arthritis affecting lower limb joints

-5% have spinal/SIJ involvement

33
Q

What are the management options for IBD-related arthropathy?

A

Remission of UC = remission of joint disease
Arthritis persists in well controlled Chron’s
MDT management w/ gastroenterologists

34
Q

In what arthritides are Anterior Uveitis common?

A

HLA B27 +

  • ankylosing spondylitis
  • psoriatic arthritis
35
Q

How does Anterior Uveitis present?

A

Acute pain & photophobia
Constricted pupil, poss irregular due to ant/post synechiae
Circumcorneal redness

36
Q

How is Anterior Uveitis managed?

A

Topical steroids

Dilating eye drop

37
Q

In what arthritides are Scleritis/Episcleritis common?

A

Rheumatoid Arthritis

38
Q

How does Scleritis/Episcleritis present?

A

Conjunctival congestion

  • w/ tenderness = episcleritis
  • w/ extreme pain = scleritis
39
Q

How are Scleritis/Episcleritis managed?

A

Anti-inflammatory eye drops

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

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