Spondylarthropathies

Question 1

what 4 conditions cover spondylarthropathies

Answer 1

ankylosing spondylitis
reactive arthritis
psoriatic arthritis
enteropathic arthritis

Question 2

list the core symptoms/presentations of spondylarthropathies

Answer 2

HLA B27 positive 
inflammation of spine and sacro iliac joints 
seronegativity (Rh factor -ve)
asymmetrical oligoarthritis 
enthesitis - inflammation of tendons

Question 3

who usually presents with ankylosing spondylitis

Answer 3

male in 20-40s

Question 4

what are the clinical features of ankylosing spondylitis

Answer 4

spinal stiffness that improves with movement
morning stiffness
SI pain radiating to hips
question mark spine on examination

Question 5

what test is used to diagnose ankylosing spondylitis

Answer 5

Schobers test - assesses spinal flexion, positive test indicates less than 20cm on forward flexion

Question 6

what are the other investigations for ankylosing spondylitis

Answer 6

occiput to wall test
MRI showing features of inflammation and bone marrow oedema
x-ray showing sclerosis, calcification of intervertebral discs and bamboo spine

Question 7

describe the question mark spine appearance

Answer 7

loss of lumbar lordosis and increased thoracic kyphosis

Question 8

what is the treatment for ankylosing spondylitis

Answer 8

physio/exercise to improve movement
NSAIDs for pain relief
DMARDs are not effective for spinal inflammation

Question 9

arthritis can present before psoriasis in psoriatic arthritis true/false

Answer 9

true

Question 10

describe the clinical presentation of psoriatic arthritis

Answer 10

usually asymmetrical oligoarthritis but can also have similar pattern to RA in the hands
dactylitis and enthesitis

Question 11

what is dactylitis

Answer 11

increased swelling of the digits

Question 12

what are the nail changes in psoriatic arthritis

Answer 12

onycholysis and pitting

Question 13

list the investigations and findings of psoriatic arthritis

Answer 13

raised inflammatory markers and -veRF

x-ray showing erosions, pencil in cup deformity and osteolysis

Question 14

what is the treatment for psoriatic arthritis

Answer 14

NSAIDs, DMARDs, joint replacement for larger joints if severe

Question 15

enteropathic arthritis occurs in which group of people

Answer 15

those with IBD, affects up to 20% of patients

Question 16

what is the treatment of enteropathic arthritis

Answer 16

improvement of GI symptoms will improve arthritis

Question 17

what is the pathogenesis of reactive arthritis

Answer 17

bodys natural response to infection, autoimmune response 1-3 weeks

Question 18

what organisms cause reactive arthritis

Answer 18

salmonella, shigella and campylobacter - GI

chlamydia and neisseria - GU

Question 19

what is reiters syndrome

Answer 19

triad of uveitis, urethritis and arthritis - occurs with reactive arthritis

Question 20

what are the other manifestations of reactive arthritis other than reiters syndrome

Answer 20

painless oral ulcers
possible penile ulceration
hyperkeratotic nails

Question 21

what is the treatment for reactive arthritis

Answer 21

usually self-resolves after some time
treat underlying cause eg sexual health review
NSAIDs and steroid injections for joint pain