spondlyarthropathies

Question 1

what are spondyloarthropathies?

Answer 1

inflammatory joint disorders of the spine
characterized by enthesitis and synovitis
negative RF (rheumatoid factor)
associated with HLAB27 gene

Question 2

where does ankylosing spondylitis start?

Answer 2

sacroiliac join (SIJs)

Question 3

what is ankylosing spondylitis?

Answer 3

sacroiliitis with pain, stiffness and new bone formation.
bony bridges across vertebrae
difficult to breathe in

Question 4

epidemiology of ankylosing spondylitis?

Answer 4

3X more common in men.
teens and young adults.

Question 5

what are the clinical features of spondyloarthorpathies

Answer 5

MSK - back pain
extraskeletal - eye redness and pain
inflammation of shoulders, hip, knee
axial skeleton more affected than peripheral joints

Question 6

what investigation would you do for ankylosing spondylitis? and what would positive results be?

Answer 6

raised ESR
raised CRP
negative RF

Question 7

what medication can be given for ankylosing spondylitis?

Answer 7

NSAIDs
biologics - anti-TNF
DMARDs - for peripheral joints only
Physio

Question 8

what are the symptoms of psoriatic arthritis?

Answer 8

psoriasis
swollen, stiff, painful spine and peripheral joints

Question 9

what does psoriatic arthritis increase your risk of?

Answer 9

CVD (cardiovascular disease)

Question 10

epidemiology of psoriatic arthritis

Answer 10

effects men and women equally
20% develop psoriasis after arthritis
Less prevalent than RA

Question 11

which joints does psoriatic arthritis commonly affect?

Answer 11

knees, ankles. hands (DIP), feet

Question 12

what investigation do you do psoriatic arthritis? and what are the positive results?

Answer 12

raised ESR
raised CRP
negative RF

Question 13

what medication is given for psoriatic arthritis?

Answer 13

NSAIDs
corticosteroids
DMARDs SZP, LFN, MTX, CyA, apremilast - NOT hydroxychloroquine
biologics - anti TNF, usekinumab
Physio/OT/education

Question 14

what is enteropathic arthritis?

Answer 14

arthritis + IBD ( ulcerative colitis or chrone’s)

Question 15

what meds are given for enteropathic arthritis?

Answer 15

corticosteroids
DMARDs- sulfasalazine, hydrocychloroquine, methotrexate, leflunomide
NSAIDs

Question 16

what is a seronegative spondyloarthropathy?

Answer 16

inflammatory join disorders of lower spine with negative RF factor.

Question 17

what is reactive arthritis?

Answer 17

sterile join inflammation that develops after a distant infection.
immune system attacks healthy tissue
Systemic
Triggering infections usually in throat, urogenital or GI tracts

Question 18

symptoms of reactive arthritis

Answer 18

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

Question 19

what are the three symptoms of Reiter’s disease?

Answer 19

inflammation of joint spaces
inflammation of urethra lining
conjunctivitis
(cant see, pee or climb a tree)

Question 20

what management is used to treat reactive arthritis?

Answer 20

paracetamol
NSAIDs
corticosteroid injections
DMARDs
antibiotics
Rest
Splinting
Rehab
Physio

Question 21

what investigations are done for reactive arthritis and what are the positive results?

Answer 21

FBC
raised CRP
raised ESR
U&E
LFT
cervical, penile swab
mid-stream urine sample
stool sample
serological tests for salmonella and chlamydia

Question 22

Epidemiology of reactive arthritis

Answer 22

Equal male to female
Age 20-40
More chronic nd severe if HLA-B27 +ve

Question 23

What are the common infections for reactive arthritis

Answer 23

GI: salmonella, shigella, yersinia, campylobacter
Urogenital: chlamydia, neisseria
Others: meningococcal, streptococcal, borrelia, viruses

Question 24

Joint and muscle symptoms of ReA

Answer 24

Arthralgia - disabling poly arthritis
Asymmetric
Mono/oligoarthritis
Large joints

Question 25

Extra-articular MSK manifestations of ReA

Answer 25

Tenosynovitis
Enthesopathy
Plantar fasciitis
Achilles tendon it is

Question 26

What are the symptoms of enteropatic arthritis

Answer 26

Crohns and ulcerative colitis
Dactylitis - inflammation of a digit
Inflammation of joints