Spondylarthropathies Flashcards
What are Spondylarthropathies?
Asymmetrical seronegative (RF -ve) arthritis associated with HLA B27
An MHC1 serotype (interacts with Tc) - Inflammatory
What 4 arthritises are spondylathropathies?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
+ IBD associated arthritis
General features of spondylarthropathies?
acronym
SPINEACHE
What does SPINEACHE stand for?
Sausage fingers (dactylitis)
Psoriasis
Inflammation/back ache
NSAIDs - good response
Enthesitis (plantar fasciitis, inflamed heel tendon)
Arthritis
Crohns or collitis
HLA B27
Eyes - uveitis
What is ankylosing spondylitis?
Abnormal stiffening of the joints (sacroiliac + vertebral) due to new bony formation
Who does it affect?
Young male
HLA B27 +ve
Pathology of AS?
Syndesmophytes (vertical abnormal bony growths) replace spinal bone damage by inflammation + make spine less mobile
Sx of AS?
Young make with progressively worsening back stiffness, worse at night/morning, better with exercise
Where is inflammation also caused?
Tendons, eyes, fingers
Anterior uveitis
Enthesitis (inflam of achilles tendon)
Dactylitis
Lumbar pathology
1. low natural lumbar lordosis
2. Schober test shows low lumbar flexion (<20cm)
more kyphosis
Dx of AS?
X ray (spine/pelvis) = bamboo spine + sacroilitis + square vertebral bodies + syndesmophytes (fusion of vertebral bodies)
MRI = Can show sacroilitis before Xray (better screening tool)
High ESR/CRP
HLA B27 +ve
Tx for AS?
Symptoms = exercise, NSAIDs
DMARD (Improve disease) - TNF alpha blockers (Infliximab, etanercept)
Last resort = Surgery
How many people with psoriasis develop psoriatic arthritis?
10-40% with psoriasis develop within 10 years
Sx of psoriatic arthritis?
Moderate
Moderate = Inflamed DIPJ
+ NAIL DYSTROPHY (Pitting of nails, onchylosis, separation of nail from nail bed)
+Diactylitis
+Enthesitis
+psoratic rash on skin
Sx of psoriatic arthritis?
Severe
Arthritis Mutilans (in phalanges) = digits shrink
5% = Pencil in cup deformity = osteolysis of bone = progressive shortening + fingers telescope in on themselves
Where are hidden areas the psoriatic skin rash can be found?
behind ears
scalp
under nails
penile
Tx for psoriatic arthritis
Sx = NSAIDs (steroids if severe)
DMARD = Methotrexate
If fails = Anti TNF - Infliximab, etanercept
If fails = Ustekinumab
What is Ustekinumab?
IL12/23 mAb
What is reactive arthritis?
Sterile sinovitis (inflammation of the synovium)
Synovium membrane + tendons, due to a recent infective trigger (usually GI + STI)
What infections cause Reactive arthritis?
Gastrenteritis = C.jejuni, salmonella, shigella
STI = C.trachomatis MC or N.Gonorrhoea
What does N.Gonorrhoea often cause?
Gonococcal septic arthritis
What type of arthritis is reactive and what joint does it affect mostly?
Acute mono arthritis
often knee
Sx of reactive?
Reiters triad
Can’t see - uveitis
Can’t pee - urethritis/balantitis
Can’t climb a tree - arthritis
What is a DDx of these symptoms?
Septic arthritis
Painful hot red swollen joint + signs/Hx of joint infection
But in reaction = no joint infection
Dx of Reactive?
Joint aspirate = gram stain, culture and sensitivities (C+S) - shows no organism
Plane polarised light microscopy = -ve for crystal arthropathy
High ESR/CRP
HLA B27 +ve
Sexual health review and stool culture
