Spondylarthropathy

Question 1

What are the common features associated with spondylarthropathy?

Answer 1

Inflammation of spine (axial inflammation)

Sacro-iliac joint involvement
-sacroilitis is hall mark of disease

Enthesis

Peripheral asymmetric arthritis

• large joint + often the lower limb
• could be oligoarthritis or monoarthritis with other signs of SpA

Dactylitis

Ocular inflammation

Skin lesions

Question 2

What is enthesis?

What are the common sites for enthesitis?

Answer 2

Inflammation of the point of attachment of a ligament or tendon to bone
(Distinguishes from conditions which primarily effect the synovium)

Achilles tendon 
Origins of plantar fascia 
Inferior patellar poles 
Anterior superior iliac spines 
Lateral epicondylar region i.e. might be mistaken for tennis elbow

Question 3

What conditions are classified as principle spondylarthropathies?

Answer 3

Ankylosing Spondylitis 
Reactive Arthritis 
Psoriactic arthritis 
Enteropathic spondylarthropathy (IBD related arthritis) 
Undifferentiated spondylarthropathy

Question 4

What is the aetilogy of spondylarthropathies?

Answer 4

Susceptible individuals 
Genetic factors (HLA B27)
-increased prevalence in white population 
Environmental factors 
Infective trigger

Question 5

How does the sacroiliac and spinal features of SpA manifest clinically?

Answer 5

Inflammatory back pain

• chronic >3 months
• worse in morning or inactivity (>30 mins morning stiffness)
• improved with movement
• pain can wake them at night

Buttock pain i.e. radiation of back pain down leg

Question 6

What investigation can be done to investigate sacroiliac problems associated with SpA?
What would you expect to find?

Answer 6

Xray pelvis

• Erosion of joint margin i.e. loss of smooth edges
• Fusion of SI joints i.e. when reach end-stage disease

MRI
-sacro-iliac inflammation visible i.e. bright oedema around the joint

Question 7

What needs to be done if person suspected of SpA presents with mono-arthritis?

Answer 7

Need to aspirate to rule out crystal arthopathy or septic arthritis

Question 8

What is dactylitis?

Answer 8

Inflammation within joint/tendons/peri-articular region causing pain and swelling of whole digit i.e. sausage shaped

(More commonly associated with Psoriatic arthritis + reactive arthiritis rather than AS)

Question 9

How would someone with uveitis present?

Answer 9

Painful red eye
Photophobia
(Can be recurrent so ask about history of red eye)

Question 10

What are important skin lesions to look for is psoriactic arthritis?

Answer 10

Psoriasis of scalp/umbilicus or natal cleft (dry, red flaky patches)
Nail pitting
Onycholysis (seperatioj of nail from nail bed)
NOTE:
-nail changes in psoriatic arthritis are normally accompanied by adjacent DIP joint swelling

Question 11

What type of skin lesion is associated with reactive SpA?

Answer 11

Keratoderman blennorrhagica