Spondyloarthitis Flashcards
Spondyloarthopathies Aetiology
HLA associate B27
May be triggered by infection
Mostly unknown
Spondyloarthopathies Pathology
Inflammation of the enthesis -> erosions -> fibrosis -> ossification Synovitis Seronegative for RF
Ankylosing Spondylitis definition
-> inflam of axial skeleton 1% of pop Inflammation of the outer fibres of the vertical discs -squaring of vertebra -syndesmophyte formation -sacroiliac formation
AS clinical features
Insidious lower back pain Male 20's FH Early morning stiffness and after immobility Improves with exercise Chest pain if T spine Buttock pain when walking Decreased forward flexion Hips and shoulders, heels, plantar and chest pain
AS Disease progression signs
Loss of lumbar lordosis
Increased kyphosis or cervical and thoracic
Stooped posture
AS Extra articular signs
Anterior uveitis 25-40%
Aortic incompetence/aortis-> diastolic murmur
Apical lung fibrosis
Amyloidosis
AS investigations
Bloods
- anaemia of chronic disease
- increased CRP and ESR
- RF
X Ray
- normal in early disease
- sacroilitis
MRI
-SIJ and lumbar spine inflammation
AS management
Physiotherapy
High dose, strong NSAIDS 70-80% benefit
TNF inhibitors -> fatigue and spine symptoms
Psoriatic arthritis clinical features
Dactylitis -> tendinitis and synovitis -> entire digit
Enthesitis
Oligoarthritis
DIPJ and nails-> dystrophy, pitting, ridges, oncolysis
Sacroilitis
Osteolysis-> telescoping digits
PA investigations
FBC-> anaemia Increased CRP and ESR RF X Ray -small joints of hands and feet -erosions -> fluffy -resorption of terminal phalanges -pencil deformity Periostitis
PA management
Similar to RA
- > lefulomide
- anti-TNF a
- NSAIDS
Reactive arthritis aetiology
-> form of spondylarthritis that is triggered by specific infections GI and GU infections -salmonella -campylobacter -C.coli -shigella -c. Trachiomatis
Reactive arthritis clinical features
Acute, oligoarthritis Asymetrical wt bearing joints Inflammatory back ache Fever Malaise Swollen hot joints History of previous infection New sexual partner Conjunctivitis Urethritis Erythema nodosum
Reactive arthritis investigations
Increased CRP and ESR, neutrophilia
Joint aspiration -> sterile, WBC
Stool and urethral cultures
Serology
Reactive arthritis managment
NSAIDS Infra articular steroids If persistent-> sulfasalazine/methotrexate Treat infection 80% symptom free within 1 y 10% persistent
