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Rheumatology > Seronegative spondyloarthropathy > Flashcards

Seronegative spondyloarthropathy Flashcards

1
Q

What is a spondyloarthropathy?

A

A chronic inflammatory condition, affecting usually the axial skeleton and have shared clinical features.

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2
Q

What are the four spondyloarthropathies?

A
  1. Ankylosing spondylitis
  2. Enteropathic arthritis (with IBD)
  3. Psoriatic arthritis
  4. Reactive arthritis
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3
Q

What are the shared clinical features of the spondyloarthropathies?

A
  1. Seronegative (no RhF)
  2. HLA B27 assocation
  3. Axial arthritis - pathology in spine and SI joints
  4. Asymmetric large joint oligoarthritis (<5) or monoarthritis
  5. Enthesitis (inflammation at tendon insertions)
  6. Dactlylitis
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4
Q

What is ankylosing spondylitis?

A

A chronic inflammatory disease of the spine and sacroiliac joints of unknown aetiology

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5
Q

What is the typical patient presentation in ankylosing spondylitis?

A
  • Young men (teens-mid thirties)
  • Gradual onset of lower back pain
  • Worse during the night with morning stiffness relieved by exercise
  • Pain radiates from SI joint to hips/buttocks
  • Improved towards the end of the day
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6
Q

What would examination show in a patient with ankylosing spondylitis?

A
  • Usually normal
  • Loss of lumbar lordosis
  • Exxagerated thoracic kyphosis
  • Neck hyperextension
  • Question mark posture
  • Reduced chest expansion
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7
Q

What is Shober’s test?

A
  • Mark skin 10cm above and 5cm below PSIS. Bend forward with straight legs.
  • Distance increase >20cm is normal
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8
Q

How do you diagnose AS?

A

Usually clinically

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9
Q

What imaging would you request for AS?

Why?

A

MRI -

  • Allows active detection of active inflammation
  • Destructive changes like erosions, erosions, fusions, ankylosis
  • Vertebral syndesmophytes
  • Bamboo spine in later stages
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10
Q

What bloods would you look for in AS?

A

FBC - Normocytic anaemia
Raised ESR and CRP
HLA B27 positive

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11
Q

What is the treatment for AS?

A
  • Exercise (intensive with a physio)
  • NSAID’s relieve symptoms within 48hrs
  • TNF inhibitors (adalimumab) if severe and acute
  • Local steroid injections can provide temporary relief
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12
Q

What is enteric arthropathy associated with?

A
  • IBD
  • GI bypass
  • Coeliac and Whipple’s disease
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13
Q

What treatment should you avoid using with enteric arthropathy?

A
  • NSAID’s

- Consider DMARD’s or TNF inhibitors

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14
Q

How does psoriatic arthritis present?

A
  • Symmetrical polyarthritis
  • Asymmetrical oligoarthritis
  • DIP joints
  • Spinal
  • Psoriatic arthritis mutilans
  • Dactylitis
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15
Q

What are the radiological changes in psoriatic arthritis?

A
  • Pencil in cup deformity due to erosive changes
  • Fuzzy appearance to bone around a joint due to proliferation
  • Dactylitis
  • Joint subluxation
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16
Q

What is the management for psoriatic arthritis?

A
  1. NSAID’s
  2. DMARD’S - Methotrexate, sulfalazine
  3. Anti-TNF agents
17
Q

What is reactive arthritis?

A

Sterile synovitis that develops after distant infection

  • Post dysentery (Salmonella,Shigella)
  • Following urethritis/cervicitis (Chlamydia)
18
Q

How does reactive arthritis present?

A
  • Few days to 2 weeks post infection

- Acute asymmetrical lower limb arthritis

19
Q

What are other clinical features that occur with reactive arthritis?

A
  • Skin (keratoderma blennorrhagica)
  • Eye (conjunctivitis, uveitis)
  • Enthesitis
20
Q

How do you investigate reactive arthritis?

A
  • Raised ESR and CRP
  • Culture stool if diarrhoea/sexual health review
  • Blood cultures
  • May need joint aspirate to rule out septic/crystal arthritis
21
Q

What is the treatment for reactive arthritis?

A
  • Treat the infection
  • NSAID’s and local steroid injections to improve symptoms
  • Most will resolve within 2 years, but may need DMARD’s
22
Q

What are the 5 A’s of anklosing spondylitis extra articular manifestations?

A
  1. Anterior uveitis
  2. Aortic incompetence
  3. AV Block
  4. Apical lung fibrosis
  5. Amyloidosis
23
Q

What are the features of inflammatory back pain? (IPAIN)

A 
I - Insidious onset 
P - Pain at night (improves upon getting up)
A - Age of onset <40
I - Improvement with exercise
N - No improvement with rest

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