Spondyloarthritides

Question 1

What are seronegative spondyloarthropathies?

Answer 1

Group of inflammatory arthritidies affecting the spine and peripheral joints without the production of rheumatoid factors

Question 2

What are the common features of spondyloarthopathies?

Answer 2

Axial arthritis and sacroilitis
Asymmetrical large joint oligoarthritis or mono arthritis
Enthesitis
Dactylitis
Extra articular: iritis, psooriaform rashes, ulcers, aortic regurgitation, IBD
HLA B27 association

Question 3

What is enthesitis?

Answer 3

Inflammation at site of insertion of tendon or ligament into bone e.g. plantar fasciitis, achilles tendonitis

Question 4

What is dactyitis?

Answer 4

Inflammation of entire digit = sausage digit

Due to soft tissue oedema and joint inflammation

Question 5

What is ankylosing spondylitis?

Answer 5

Chronic disease of unknown aetiology characterised by stiffening and inflammation of the spine and sacroiliac joints

Question 6

What is the epidemiology of ankylosing spondylitis?

Answer 6

M>F 6:1
Men present earlier - early 20s
95% HA B27 +ve

Question 7

What is the typical presentation of ankylosing spondylitis?

Answer 7

Gradual onset back pain 
- Radiates from SI joints to hips and buttocks 
- Worse at night with morning stiffness 
- Relieved by exercise
Progressive loss of all spinal movements in all directions 
Question mark posture  
Enthesitis
Costochondritis

Question 8

What causes the question mark posture in ankylosing spondylitis?

Answer 8

Thoracic kyphosis and neck hyper extension

Question 9

What are some extra articular manifestations of ankylosing spondylitis?

Answer 9

Osteoporosis 60%
acute iritis/anterior uveitis
Aortic valve incompetence
Apical pulmonary fibrosis

Question 10

How is ankylosing spondylosis usually diagnosed? and why

Answer 10

Clinical diagnosis

Xray changes are usually late

Question 11

What radiological changes can be seen in ankylosing spondylitis?

Answer 11

Sacroilitis- sclerosis and erosions
Corner erosions, squaring and syndesmophytes (bony proliferations) on vertebrae
Bamboo spine - calcification of ligaments, periosteal bone formation

Question 12

What investigations can be done if suspect ankylosing spondylosis is suspected? What will they show?

Answer 12

xray
FBC: anaemia, increased ESR and CRP, HLA B27
DEXA can
CXR

Question 13

What is the conservative management of ankylosing spondylosis?

Answer 13

Exercise

Physio

Question 14

What is the medical treatment for ankylosing spondylitis?

Answer 14

NSAIDs
Anti TNF if severe
Local steroid injections
Bisphosphonates if they are at increased risk of spinal fractures

Question 15

What is the surgical treatment for ankylosing spondylitis?

Answer 15

Hip replacement to reduce pain and increase mobility

Question 16

In what % of people with psoriasis does psoriatic arthritis occur?

Answer 16

10-40%

Question 17

What joint involvement pattern is most common in PA?

Answer 17

Asymmterical oligoarthritis

Question 18

What is the classical pattern of joint involvement in PA?

Answer 18

DIP joints

Question 19

What are some other features of PA?

Answer 19

Psoriatic plaques
Nail changes: pitting, subungal hyperkeratosis, onchyolysis
Enthesitis
Dactylitis

Question 20

What may be seen on X-ray in PA?

Answer 20

Erosion causing pencil in cup deformity

Question 21

What is the treatment for PA?

Answer 21

NSAIDs
Sulfasalazine, methorexate, ciclosporin
Anti TNF

Question 22

What is reactive arthritis?

Answer 22

Sterile arthritis 1-4 weeks after infection usually GI or GU
Urethritis: chlamydia, ureaplasma
Dysentry: campy, salmonella, shigella, yersinia

Question 23

How does reactive arthritis present?

Answer 23

Asymmetrical lower limb oligoarthritis esp knee
Iritis, conjunctivitis
Keratoderma blenorrhagica: plaques on soles/palms
Circinate balanitis: painless serpiginous penile ulceration
Enthesitis
Mouth ulcers

Question 24

What investigations should be performed if suspect creative arthritis?

Answer 24

FBC: increased ESR and CRP
Stool culture if diarrhoea
Urine chlamydia PCR

Question 25

What medications can be given for reactive arthritis?

Answer 25

NSAIDs and local steroids
Relapse may need sulfasalazine or methotrexate
No specific cure
Splint joint

Question 26

What is enteropathic arthritis associated with?

Answer 26

IBD