Spondylarthropathies

Question 1

What are Spondylarthropathies?

Answer 1

Asymmetrical seronegative (RF -ve) arthritis associated with HLA B27

An MHC1 serotype (interacts with Tc) - Inflammatory

Question 2

What 4 arthritises are spondylathropathies?

Answer 2

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
+ IBD associated arthritis

Question 3

General features of spondylarthropathies?
acronym

Answer 3

SPINEACHE

Question 4

What does SPINEACHE stand for?

Answer 4

Sausage fingers (dactylitis)
Psoriasis
Inflammation/back ache
NSAIDs - good response
Enthesitis (plantar fasciitis, inflamed heel tendon)
Arthritis
Crohns or collitis
HLA B27
Eyes - uveitis

Question 5

What is ankylosing spondylitis?

Answer 5

Abnormal stiffening of the joints (sacroiliac + vertebral) due to new bony formation

Question 6

Who does it affect?

Answer 6

Young male
HLA B27 +ve

Question 7

Pathology of AS?

Answer 7

Syndesmophytes (vertical abnormal bony growths) replace spinal bone damage by inflammation + make spine less mobile

Question 8

Sx of AS?

Answer 8

Young make with progressively worsening back stiffness, worse at night/morning, better with exercise

Question 9

Where is inflammation also caused?

Answer 9

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

Question 10

Dx of AS?

Answer 10

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

Question 11

Tx for AS?

Answer 11

Symptoms = exercise, NSAIDs
DMARD (Improve disease) - TNF alpha blockers (Infliximab, etanercept)
Last resort = Surgery

Question 12

How many people with psoriasis develop psoriatic arthritis?

Answer 12

10-40% with psoriasis develop within 10 years

Question 13

Sx of psoriatic arthritis?
Moderate

Answer 13

Moderate = Inflamed DIPJ
+ NAIL DYSTROPHY (Pitting of nails, onchylosis, separation of nail from nail bed)
+Diactylitis
+Enthesitis
+psoratic rash on skin

Question 14

Sx of psoriatic arthritis?
Severe

Answer 14

Arthritis Mutilans (in phalanges) = digits shrink
5% = Pencil in cup deformity = osteolysis of bone = progressive shortening + fingers telescope in on themselves

Question 15

Where are hidden areas the psoriatic skin rash can be found?

Answer 15

behind ears
scalp
under nails
penile

Question 16

Tx for psoriatic arthritis

Answer 16

Sx = NSAIDs (steroids if severe)
DMARD = Methotrexate
If fails = Anti TNF - Infliximab, etanercept
If fails = Ustekinumab

Question 17

What is Ustekinumab?

Answer 17

IL12/23 mAb

Question 18

What is reactive arthritis?

Answer 18

Sterile sinovitis (inflammation of the synovium)
Synovium membrane + tendons, due to a recent infective trigger (usually GI + STI)

Question 19

What infections cause Reactive arthritis?

Answer 19

Gastrenteritis = C.jejuni, salmonella, shigella

STI = C.trachomatis MC or N.Gonorrhoea

Question 20

What does N.Gonorrhoea often cause?

Answer 20

Gonococcal septic arthritis

Question 21

What type of arthritis is reactive and what joint does it affect mostly?

Answer 21

Acute mono arthritis
often knee

Question 22

Sx of reactive?

Answer 22

Reiters triad
Can’t see - uveitis
Can’t pee - urethritis/balantitis
Can’t climb a tree - arthritis

Question 23

What is a DDx of these symptoms?

Answer 23

Septic arthritis
Painful hot red swollen joint + signs/Hx of joint infection
But in reaction = no joint infection

Question 24

Dx of Reactive?

Answer 24

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