spondlyarthropathies Flashcards
what are spondyloarthropathies?
inflammatory joint disorders of the spine
characterized by enthesitis and synovitis
negative RF (rheumatoid factor)
associated with HLAB27 gene
where does ankylosing spondylitis start?
sacroiliac join (SIJs)
what is ankylosing spondylitis?
sacroiliitis with pain, stiffness and new bone formation.
bony bridges across vertebrae
difficult to breathe in
epidemiology of ankylosing spondylitis?
3X more common in men.
teens and young adults.
what are the clinical features of spondyloarthorpathies
MSK - back pain
extraskeletal - eye redness and pain
inflammation of shoulders, hip, knee
axial skeleton more affected than peripheral joints
what investigation would you do for ankylosing spondylitis? and what would positive results be?
raised ESR
raised CRP
negative RF
what medication can be given for ankylosing spondylitis?
NSAIDs
biologics - anti-TNF
DMARDs - for peripheral joints only
Physio
what are the symptoms of psoriatic arthritis?
psoriasis
swollen, stiff, painful spine and peripheral joints
what does psoriatic arthritis increase your risk of?
CVD (cardiovascular disease)
epidemiology of psoriatic arthritis
effects men and women equally
20% develop psoriasis after arthritis
Less prevalent than RA
which joints does psoriatic arthritis commonly affect?
knees, ankles. hands (DIP), feet
what investigation do you do psoriatic arthritis? and what are the positive results?
raised ESR
raised CRP
negative RF
what medication is given for psoriatic arthritis?
NSAIDs
corticosteroids
DMARDs SZP, LFN, MTX, CyA, apremilast - NOT hydroxychloroquine
biologics - anti TNF, usekinumab
Physio/OT/education
what is enteropathic arthritis?
arthritis + IBD ( ulcerative colitis or chrone’s)
what meds are given for enteropathic arthritis?
corticosteroids
DMARDs- sulfasalazine, hydrocychloroquine, methotrexate, leflunomide
NSAIDs
what is a seronegative spondyloarthropathy?
inflammatory join disorders of lower spine with negative RF factor.
what is reactive arthritis?
sterile join inflammation that develops after a distant infection.
immune system attacks healthy tissue
Systemic
Triggering infections usually in throat, urogenital or GI tracts
symptoms of reactive arthritis
acute onset of stiffness, fatigue and fever, malaise
pain and swelling of weight-bearing joints, fingers and toes.
bilateral conjunctivitis
anterior uveitis
circinate balanitis
urethritis
what are the three symptoms of Reiter’s disease?
inflammation of joint spaces
inflammation of urethra lining
conjunctivitis
(cant see, pee or climb a tree)
what management is used to treat reactive arthritis?
paracetamol
NSAIDs
corticosteroid injections
DMARDs
antibiotics
Rest
Splinting
Rehab
Physio
what investigations are done for reactive arthritis and what are the positive results?
FBC
raised CRP
raised ESR
U&E
LFT
cervical, penile swab
mid-stream urine sample
stool sample
serological tests for salmonella and chlamydia
Epidemiology of reactive arthritis
Equal male to female
Age 20-40
More chronic nd severe if HLA-B27 +ve
What are the common infections for reactive arthritis
GI: salmonella, shigella, yersinia, campylobacter
Urogenital: chlamydia, neisseria
Others: meningococcal, streptococcal, borrelia, viruses
Joint and muscle symptoms of ReA
Arthralgia - disabling poly arthritis
Asymmetric
Mono/oligoarthritis
Large joints
Extra-articular MSK manifestations of ReA
Tenosynovitis
Enthesopathy
Plantar fasciitis
Achilles tendon it is
What are the symptoms of enteropatic arthritis
Crohns and ulcerative colitis
Dactylitis - inflammation of a digit
Inflammation of joints
