Spondyloarthritides Flashcards
What are the typical clinical features of axial spondyloarthritis?
Chronic back pain that improves with exercise, morning stiffness >30 minutes, alternating buttock pain, and limited spinal mobility.
What extra-articular symptoms may be seen in spondyloarthritis?
Uveitis, psoriasis, inflammatory bowel disease, and enthesitis.
What is enthesitis and how does it present clinically?
Inflammation at tendon or ligament insertion sites, presenting as localized pain, especially in the Achilles tendon or plantar fascia.
What is dactylitis and in which condition is it common?
Uniform swelling of a whole digit (‘sausage digit’), common in psoriatic arthritis.
What are the common sites of peripheral arthritis in spondyloarthritis?
Lower limb joints such as knees and ankles, often asymmetric.
Which symptom pattern suggests inflammatory back pain?
Insidious onset, improvement with exercise, no relief with rest, and night pain.
What genetic factor is most strongly linked to spondyloarthritis?
HLA-B27.
How does HLA-B27 contribute to spondyloarthritis?
It is thought to alter immune function, leading to inappropriate inflammation, particularly at entheses and axial joints.
What role does the gut play in the pathogenesis of spondyloarthritis?
Gut dysbiosis may trigger systemic inflammation via mucosal immune activation.
Which cytokines are involved in the pathogenesis of spondyloarthritis?
TNF-alpha and IL-17 are key pro-inflammatory cytokines.
What is the first imaging study typically used to evaluate suspected axial spondyloarthritis?
X-ray of the sacroiliac joints.
Which imaging modality is more sensitive than X-ray for early disease detection?
MRI, which can detect active sacroiliitis and inflammation.
What is the modified New York criteria used for?
Diagnosing ankylosing spondylitis.
What blood tests may support the diagnosis of spondyloarthritis?
Elevated CRP or ESR, and HLA-B27 positivity.
Why is HLA-B27 testing not diagnostic alone?
Because HLA-B27 can be present in healthy individuals without disease.
What is the first-line treatment for axial spondyloarthritis?
NSAIDs.
When should biologics be considered in spondyloarthritis?
When there is inadequate response to NSAIDs and physical therapy.
Which biologics are commonly used in spondyloarthritis?
TNF inhibitors (e.g., etanercept, adalimumab) and IL-17 inhibitors (e.g., secukinumab).
What is the role of physical therapy in spondyloarthritis?
It helps maintain mobility and reduce stiffness.
Are corticosteroids commonly used in axial spondyloarthritis?
Systemic steroids are generally avoided; local injections may be used for peripheral joint involvement.
What lifestyle changes are recommended for spondyloarthritis?
Regular exercise, smoking cessation, and maintaining posture.
How is psoriatic arthritis typically diagnosed?
Clinical features (psoriasis, dactylitis, nail pitting) and exclusion of other arthritides.
Which features help distinguish psoriatic arthritis from rheumatoid arthritis?
Asymmetry, dactylitis, nail changes, DIP joint involvement.
What is the CASPAR criteria used for?
Classification of psoriatic arthritis.
