Spondyloarthritides Flashcards
What are spondyloarthropathies?
- They are a group of related chronic inflammatory conditions
- They tend to, although not always, affect the axial skeleton with shared clinical features
There are 7 shared clinical features of spondyloarthropathies. What are they?
- Seronegativity (RF -ve)
- HLA-B27 association
- Axial arthritis pathology in spine and sacroilliac joints
- Assymmetrical large joint oligoarthritis (>5 joints) or monoarthritis
- Enthesitis
- Inflammation at the site of insertion of tendon or ligament into the bone
- Dactylitis
- Inflammation of an entire digit (sausage digit)
- This is due to soft tissue inflammation, oedema and tenosynovial and joint inflammation
- Extra-articular manifestations
- Iritis
- Psoriaform rashes
- Oral ulcers
- Aortic valve incompetence
- IBD
What are 3 examples of enthesitis?
- Plantar fasciitis
- Costochronditis
- Achilles tendonitis
What is Ankylosing spondylitis?
- A chronic inflammatory disease of the spine and sacroilliacs joints of unknown aetiology
- Men present earlier
- 90% are HLA B27 positive
What are the signs and symptoms of Ankylosing spondylitis?
- Mostly men >30 years old
- Gradual onset of lower back pain
- Worse at night
- Morning stiffness
- Relieved by exercise
- Pain radiates from sacroilliac joint to hips and buttocks
- Pain improves towards the end of the day
- Progressive loss of spinal movement
- Therefore decreased thoracic spinal expansion
- Enthesitis
- Costochondritis
- Achilles tendonitits
- Plantar fasciitis
- Extra-articular manifestations
- Iritis –> blindness if untreated
- Fatigue
Describe the disease course of ankylosing spondylitits?
- Variable
- Few progree to kyphosis –> neck hyperextension –>question mark posture
- Spinal-cranial ankylosis
What conditions is ankylosing spondylitis associated with?
- Osteoporosis
- Aortic valve incompetence
- Pulmonary apical fibrosis
How is ankylosing spondylitis diagnosed?
- FBC
- Normocytic anaemia
- Raised ESR
- Raised CRP
- HLA B27 positive
- MRI can show soft tissue changes (enthesitis), inflammation
- X rays show joint space narrowing, sclerosis, ankylosis, fusion erosion, bony proliferations
- Bamboo spine appearance due to fusion and calcification of spine
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- Bamboo spine appearance due to fusion and calcification of spine
How is ankylosing spondylitis treated?
- Exercise
- Physiotherapy
- NSAIDs
- Biological agents = Anti-TNF alpha
- Steroid injections locally
- Surgery
There is an increased risk of osteoporotic spinal fractures in patients with ankylosing spondylitis. How can this be managed?
Bisphosphonates
When is the prognosis worse in ankylosing spondylitits?
- When the onset is <16 years
- When the ESR >30
- Early hip involvement
- Poor response to NSAIDs
What are enteropathic arthopathies or arthritis?
- Enteropathic arthritis is a form of chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD), Coeliac disease, GI bypass and Whipples disease.
What are the symptoms of enteropathic arthritis?
- The symptoms of enteropathic arthritis (EnA) can be divided in two groups:
- Symptoms of inflammatory bowel disease (IBD)
- Arthritic symptoms in the joints and, possibly, elsewhere in the body.
How is enteropathic arthritis treated?
- Arthropathy often improves with the treatment of bowel symptoms
- Avoid NSAIDs
- Use DMARDs in resistant cases
What is psoriatic arthritis?
- Psoriatic arthritis is a type of arthritis that develops in 10-40% of people with the skin condition psoriasis.
- It typically causes affected joints to become inflamed (swollen), stiff and painful.
- It can present before the skin changes
- Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse.
What is psoriatic arthritis mutilans?
- Psoriatic arthritis mutilans is a rare form of psoriatic arthritis.
- It causes bone tissue to disappear.
- Psoriatic arthritis mutilans usually happens in the hands. It sometimes affects the wrists, feet, or spine.
What is pencil in cup deformity? Which arthritis is it associated with?
- Pencil-in-cup deformity is the description given to one of the appearances on plain radiograph in psoriatic arthritis.
- The appearance results from periarticular erosions and bone resorption giving the appearance of a pencil in a cup.
- Although classically described with psoriatic arthritis, this appearance can also be seen in systemic sclerosis, rheumatoid arthritis or reactive arthritis.
What are acneiform rashes? Which arthritic disease are they associated with?
- Acneiform eruptions are a group of dermatoses including acne vulgaris, rosacea, folliculitis, and perioral dermatitis.
- Restated, acneiform eruptions are follicular eruptions characterized by papules and pustules resembling acne.
- The hybrid term acneiform, literally, refers to an appearance similar to acne.
What is Palmoplantar pustulosis? Which arthritic disease are they associated with?
- Palmoplantar pustulosis is a chronic skin condition.
- Blisters and fluid-filled bumps known as pustules appear on the palms of the hands and the soles of the feet.
- It’s a rare autoimmune condition, and it’s more likely to affect people who currently or used to smoke.
- Its associated with psoriatic arthritis
What is Keratoderma Blenorrhagica? Which arthritic disease is it associated with?
- Brown, raised plaques on soles and palms
