Spondyloarthritides Flashcards
What are spondyloarthritides?
Aka seronegative spondyloarthritis
Several inflammatory arthritic conditions without a positive ANA or RF and have both similar genetic predispositions and clinical presentations
What are some share features of spondyloarthritides conditions ?
Inflammation of the axial skeleton joints
Dactylitis « sausage digits»
Asymmetric oligo arthritis of the large joints
Enthesitis- inflammation where tendons/ ligaments insert into bones
What is the epidemiology of ankylosing spondylitis?
Usual onset in young adult during 2nd or 3rd decade
Affects more male than female
Have a strong genetic association with HLA-B27
What is the clinical presentation of ankylosing spondylitis?
Sacroiliitis with low back/buttock pain present for 3 or more months
Significant morning stiffness lasting hours
Improved with activity
Worsens with inactivity, including lying down
Joint fusion aka Bamboo spine
Causes squaring or barreling of the vertebrae
How to diagnose ankylosing spondylitis ?
Xrays- may not be apparent for up to 10 years
MRI- more sensitive
HLA-B27 positive in 90% of the time
ESR, CRP elevated
Elevated IgA
Elevated alkaline phosphatase in severe disease
How to treat ankylosing spondylitis ?
Exercise Stretching Proper pillow positioning NSAIDs Biologics for more severe axial disease Sulfasalazine or methotrexate for peripheral disease Surgery for severe hip disease
What are the characteristics of psoriatic arthritis ?
Most often develops in the 4th or 5th decades of life
Most often lesions present before arthritis and have nail involvement
Affects DIP joints, spine, sacroiliac joints
Have a higher incidence of cardiac death than general population
Some develop aortic valve insufficiency
How to diagnose psoriatic arthritis ?
Elevated CRP and ESR
HLA-B27 in 70% of cases with axial involvement but only 20% with peripheral
Pencil cup deformity on imaging
Whiskering
How to treat psoriatic arthritis ?
NSAIDs for pain and inflammation Biologic anti TNF alpha (etanerdept, infliximab, adalimumab, golibumab) Cyclosporine Retinoic acid derivatives Leflunomide
What is reactive arthritis ?
Aka reiters syndrome Acute arthritis related to an infection Arthritis+ urethritis + conjunctivitis Usually in patients<50 Can occur post chlamydial (always male)
What are some common causes of reactive arthritis ?
Chlamydia trachomatis Shigella Salmonella Yersinia Campylobacter HIV Enterovirus
What are some associated symptoms of reactive arthritis ?
Enthesitis especially of Achilles tendon and plantar fascia
Urogenital lesions: circinate balantitis
Keratoderma blennorrhagica- palms and soles
How to diagnose reactive arthritis ?
Often HLA-B27 Significant ESR elevation Slight anemia Loss of joint space and erosions on imaging Periositis- new bone formation
How to treat reactive arthritis ?
NSAIDs ( + antibiotics if acute infection) Methotrexate Sulfasalazine Azathioprine Intralesional steroids Anti TNF alpha in only severe cases
What is SAPHO syndrome?
Synovitis Acne Pustulosis Hyperostosis Osteitis Syndrome with skin and musculoskeletal manifestations affecting mostly children and young adults
