spondyloarthritides Flashcards
what are spondyloarthritides
group of arthritic conditions that share the following features:
- seronegative
- HLA-B27 positive
- arthritis of spine and sacro-iliac joint
- inflammatory arthritis of < 5 lower limb joints
-dactylitis
- enthesitis
- extra-articular features e.g. anterior uveitis, ulcers, rashes, IBD, aortic valve incompetence
ankylosing spondylitis is most common in
men < 30
ankylosing spondylitis pathophysiology
- widening and subchondral sclerosis of sacro-iliac joints and eventually fusion of these joints
- formation of syndresmophytes (bony outgrowths caused by enthesitis in the spine) -> can fuse causing ankylosis (stiffening and immobility of the spine)
- calcification of the vertical ligaments (bamboo spine on x-ray)
ankylosing spondylitis presentation
- progressive lower back pain that radiates to buttocks and is better on activity and as the day goes on
- fatigue
- hip pain
- anterior uveitis
- Achilles tendonitis and plantar fasciitis
- shortness of breath (upper lobe fibrosis)
- aortic regurgitation
- amyloidosis
- IgA nephropathy
- advanced disease presents with question mark posture due to increases thoracic kyphosis, loss of lumbar lordosis and hyper-extension of the cervical spine
- tender sacro-iliac joints
- positive Schober’s test
ankylosing spondylitis diagnosis
- clinical
- MRI/x-ray showing bamboo spine, subchondral sclerosis and squaring of lumbar vertebrae
- HLA-B27 positive
- pelvic x-ray showing sacro-ilitis
ankylosing spondylitis management
- physiotherapy
- NSAIDs
- intra-articular steroids
- sulfasalazine
- anti-TNF (etanercept/adalimumab)
what is psoriatic arthritis
inflammatory arthritis associated with psoriasis, with the psoriasis typically developing first
psoriatic arthritis presentation
- arthritis including DIP of hands of feet, symmetrical polyarthritis, asymmetrical sacro-iliatis and arthritis mutilans
- rheumatoid arthritis like
- psoriatic rash
- nail changes (pitting and onycholysis)
psoriatic arthritis diagnosis
x-ray showing pencil in cup deformity
psoriatic arthritis management
- NSAIDs and physiotherapy
- DMARDs (methotrexate) and anti-TNF for progressive disease
reactive arthritis pathophysiology
sterile synovitis that develops 1-4 weeks after an infection (most commonly STI or gastroenteritis)
reactive arthritis presentation
- acute, asymmetrical lower limb joint pain with knee being most common site
- red eye and blurred vision
- urethritis
- mouth ulcers
- rash on sole of the feet or palms of the hands (keratoderma and blennorrhagica)
- can cause dactylitis
what is Reiter’s syndrome
can’t see, can’t pee, can’t climb a tree (uveitis, urethritis and arthritis)
reactive arthritis diagnosis
- urine sample
- joint aspiration to rule out septic arthritis
reactive arthritis management
- rest and analgesia
- risk that it may relapse and require treatment with DMARDs
