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Musculoskeletal > Spondyloarthopathies > Flashcards

Spondyloarthopathies Flashcards

1
Q

What is the definition of a spondyloarthropathy?

A
  • inflammatory arthritis
  • involves spine and joints
  • genetically predisposed
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2
Q

What genetic predisposition is commonly seen in spondyloarthropathies?

A

HLA B27

only important if patients also have symptoms

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3
Q

What subgroups of spondyloarthopathies exist?

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

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4
Q

What is the difference between mechanical and inflammatory back pain?

A

Mechanical:

  • worsened by activity
  • worst at end of day
  • better with rest

Inflammatory

  • worse with rest
  • better with activity
  • early morning stiffness (>30 minutes)
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5
Q

What rheumatological features are common to all of the spondyloarthropathies

A
  • Sacroiliac and spinal involvement
  • Enthesitis: inflammation at insertion of tendons into bones eg Achilles tendinitis, plantar fasciitis
  • Inflammatory arthritis
  • Dactylitis - inflammation of entire digit
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6
Q

What extra articular features are common to all spondyloarthropathies

A
  • Ocular inflammation (Anterior uveitis, conjuntivitis)
  • Mucocutaneous lesions
  • Rare Aortic incompetence or heart block
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7
Q

In what age group does ankylosing spondylitis usually present?

A

Late adolescence or early adulthood

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8
Q

What is the ratio of ankylosing spondylitis in males:females

A

More common in men 3-5:1

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9
Q

What is the classification criteria for ankylosing spondylitis?

A

EITHER:

  • sacroilitis on imaging
  • 1 spA feature

OR

  • HLA B27 positive
  • 2 spA features
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10
Q

What are the main clinical features of ankylosing spondylitis?

A
  • Back pain (neck, thoracic, lumbar)
  • Enthesitis
  • RARE Peripheral involvement (shoulders,hips)
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11
Q

What extra articular features are often present in ankylosing spondylitis?

A 
uveitis
Cardio = (aortic valve/root )
Resp = (fibrosis upper lobes)
GI = Enteric mucosal inflammation
Neurological = (Rarely A-A subluxation)
Amyloidosis
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12
Q

Why is ankylosing spodylitis known as the ‘A’ disease?

A 
Axial Arthritis
Anterior Uveitis
Aortic Regurgitation
Apical fibrosis
Amyloidosis/ Ig A Nephropathy
Achilles tendinitis
Plantar Fasciitis
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13
Q

What is it called when the vertebrae fuse?

A

Syndesmophytes

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14
Q

What examinations can be used to check for ankylosing spondylitis?

A

Examination:

  • Tragus/occiput to wall
  • Chest expansion
  • Modified Schober test

Bloods

  • Inflammatory (ESR, CRP, PV)
  • HLA B27

X-rays

  • Sacroiliitis
  • Syndesmophytes
  • “Bamboo” spine due to fusion
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15
Q

What is the drawback of using X-Rays in ankylosing spondylitis?

A

usually show changes after a long period of time

=> irrelevant in early disease

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16
Q

What X-Ray changes are often seen in ankylosing spondylitis?

A

Reduced bone density
Shiny corners
Flowing Syndesmophytes
Fusion (Bamboo spine)

17
Q

Why are MRIs more useful in early AS?

A

Can detect early manifestations

  • bone marrow oedema
  • enthesitis
18
Q

What treatments are used in AS?

A
  • Physiotherapy/ Occupational therapy
  • NSAID
  • Disease modifying drugs (e.g. MTX)
  • Biologics = Anti TNF treatment e.g. Infliximab
    NEW = Secukinumab( anti-IL17)
19
Q

What is psoriatic arthritis?

A

Inflammatory arthritis associated with psoriasis

** 10 -15% of patients can have PsA without psoriasis

20
Q

What clinical features are usually present in psoriatic arthritis?

A
  • Sacroiliitis
  • Nail involvement
  • Dactylitis
  • Enthesitis
  • Extra articular features (eye disease)
21
Q

Name each of the 5 subgroups of psoriatic arthritis

A

1) Confined to distal interphalangeal joints (DIP)
2) Symmetric polyarthritis (similar to RA)
3) Spondylitis (spine involvement) +/- peripheral joint involvement
4) Asymmetric oligoarthritis with dactylitis
5) Arthritis mutilans

22
Q

What investigations are useful in diagnosing psoriatic arthritis?

A

Bloods:

  • Inflammatory markers (raised)
  • Negative RF

X-rays

  • Marginal erosions and “whiskering”
  • “Pencil in cup” deformity
  • Osteolysis
  • Enthesitis
23
Q

What medical treatments are available to treat psoriatic arthritis?

A

NSAIDs
Corticosteroids/joint injections
Disease Modifying Drugs (Methotrexate, Sulfasalazine, Leflunomide)
Anti TNF in severe disease unresponsive to NSAIDs and Methotrexate
Secukinumab (anti-IL17)

24
Q

What non-medical treatments are available to treat psoriatic arthritis?

A

Physiotherapy
Occupational Therapy
Orthotics, Chiropodist

25
Q

What is reactive arthritis?

A 
synovitis secondary to infection
Symptoms 1-4 weeks after infection
Most common infections:
Urogenital eg. Chlamydia
Enterogenic eg. Salmonella, Shigella, Yersinia
26
Q

At what age is reactive arthritis most commonly seen?

A 
Young adults (20-40)
Equal sex distribution
27
Q

What genetic factor is commonly seen in reactive arthritis?

A

HLA B27 positive

28
Q

What is Reiter’s syndrome?

A

Form of reactive arthritis

TRIAD

  • Urethritis
  • Conjuntivitis/Uveitis/Iritis
  • Arthritis
29
Q

What medical treatment is used to treat Reiter’s syndrome?

A

** 90% resolve spontaneously within 6 months**
Medical:
NSAIDs
Corticosteroids (Oral or Inj. once sepsis ruled out)
Eye drops
Antibiotics for underlying infection eg respiratory/ GI
DMARDs (SZP) - If resistant/chronic

30
Q

What is enteropathic arthritis?

A

Associated with IBD

Arthritis in several joints:

  • knees ankles, elbows, and wrists
  • sometimes in the spine, hips, or shoulders

Worsening of symptoms during flare-ups of IBD

31
Q

What clinical symptoms can present in enteropathic arthritis

A 
GI - loose, watery stool with mucous and blood
Weight loss, low grade fever
Eye involvement ( uveitis)
Skin involvement ( pyoderma gangrenosum)
Enthesitis 
Oral- apthous ulcers
32
Q

What investigations can be carried out to determine if a patient has enteropathic arthritis

A

Upper and lower GI endoscopy with biopsy showing ulceration/ colitis

Joint aspirate- no organisms or crystals

Raised inflammatory markers- CRP, PV

X ray/ MRI showing sacroiliitis

USS showing synovitis/ tenosynovitis

33
Q

What treatments are used in enteropathic arthritis?

A

primarily treat IBD

NSAID usually not good idea as may exacerbate IBD

=> Normal analgesia eg Paracteamol, Co-codamol
=> Steroids ( oral, IA, IM)
=> Disease Modifying Drugs (Methotrexate, Sulfasalazine)
=> Anti-TNF e.g. Infliximab licensed for both Crohn’s disease and inflammatory arthritis

Musculoskeletal (27 decks)

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