spiondyloarthropathy and inflammatory mimic conditions Flashcards
What is spondyloarthritis relation with the antibodies anti-CCP and rheumatoid factor
It is negative for the rheumatoid arthritis antibodies
Is spondyloarthritis asymmetric or symmetrical
Asymmetric
What is enthesitis and what is it seen in
Inflammation where ligaments and tendons attach to bone - seen in spondyloarthritis
What are the extra-articular features of spondyloarthritis
Uveitis and inflammatory bowel disease
What is psoriatic arthritis caused by
psoriasis
What is reactive arthritis caused by
infection - typically GI or genito-urinary
In spondyloarthritis what is commonly seen in all of them
Sacroiliitis
What is ankylosing spondylitis
chronic inflammatory rheumatic disorder with a predilection for axial skeleton and entheses
specifically - increased number of osteoblasts which causes vertebrae to fuse in the spine
When does ankylosing spondylitis present
2nd to 3rd decade
Which gender is ankylosing spondylitis more common in
Males
How is spine mobility measured for spinal flexion and describe how it is done
Schober’s test - patient stands straight - mark a line from the two posterior iliac spines - place another mark 10cm above that - ask patient to bend forward as far as they can and then report the increase in cm - then take the best of two attempts
How is spinal mobility checked for lateral spinal flexion
Put heels and back and rest against wall - place mark on thigh and bend sidewards - then place another mark on the thigh and record the difference- the best of two tries on each side is done and then the mean is calculated between both times
What are the clinical features of spondyloarthritis
Inflammatory back pain
Limitations of movement in the lumbar spine
Limitation of chest expansion
Bilateral sacroiliitis on X-rays
Describe inflammatory back pain
Severe early morning stiffness - relieved by activity - night pain can be an issue - buttock pain can also be a symptom
What is the requirements to be diagnosed with axial spondyloarthritis (ankylosing spondyloarthritis)
Must have More than 3 months back pain with onset earlier than 45 years old with either:
HLA-B27 positive and more than or equal to 2 other spondyloarthritis features
OR
sacroiliitis on imaging and one or more spondyloarthritis feature
What are the spondyloarthritis features
Inflammatory back pain
arthritis
enthesitis
uveitis
dactylitis - inflammation of the digits
Chrons/UC
Psoriasis
Positive response to NSAIDS
family history positive
HLA-B27
Elevated CRP - inflammation marker
How is axial spondyloarthritis managed
Physiotherapy
NSAIDs - although have long term complications
Short term steroids
conventional synthetic DMARDs - sulfasalazine and methotrexate
Biologic DMARDs - first line - anti-TNF
Surgery - joint replacement and spinal surgery
Is psoriatic arthritis symmetrical
Yes like rheumatic arthritis
What is the most common presentation of psoritatic arthritis
Asymmetric oligoarticular arthritis - less than 4 joints affected
What is the treatment for psoriatic arthritis
First line - methotrexate
Second line - sulfasalazine
Third line - Biologic DMARDs - specifically - Anti-TNF - end in mab
What is cyclosporine and anti-inflammatory drugs not often combined
They combine to impact renal function
What infections commonly cause reactive arthritis
salmonella, shigella and campylobacter..
How many days after infection does reactive arthritis occur
10-14 days
How many joints does reactive arthritis affect
monoarthritis - one
or
oligoarthritis - less than 4
What is reiter’s syndrome
Arthritis, urethritis and conjunctivitis
What infection causes recurrent attacks in reactive arthritis
chlamydia
What are signs that the reactive arthritis will be long term
Hip/Heel pain
High ESR - inflammation marker
family history positive and positive HLA-B27
How is reactive arthritis treated acutely
NSAIDS
Joint injections
How is chronic reactive arthritis treated
NSAIDs and the usual conventional DMARDs - methotrexate and sulfasalazine
What is the treatment for enteropathic arthritis
NSAIDs difficult to use due to gut issues
conventional DMARDs - methotrexate and sulfasalazine
Biologics - Anti-TNF - end in mab
