Spondyloarthritides Flashcards
What are seronegative spondyloarthropathies?
Group of inflammatory arthritidies affecting the spine and peripheral joints without the production of rheumatoid factors
What are the common features of spondyloarthopathies?
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
What is enthesitis?
Inflammation at site of insertion of tendon or ligament into bone e.g. plantar fasciitis, achilles tendonitis
What is dactyitis?
Inflammation of entire digit = sausage digit
Due to soft tissue oedema and joint inflammation
What is ankylosing spondylitis?
Chronic disease of unknown aetiology characterised by stiffening and inflammation of the spine and sacroiliac joints
What is the epidemiology of ankylosing spondylitis?
M>F 6:1
Men present earlier - early 20s
95% HA B27 +ve
What is the typical presentation of ankylosing spondylitis?
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
What causes the question mark posture in ankylosing spondylitis?
Thoracic kyphosis and neck hyper extension
What are some extra articular manifestations of ankylosing spondylitis?
Osteoporosis 60%
acute iritis/anterior uveitis
Aortic valve incompetence
Apical pulmonary fibrosis
How is ankylosing spondylosis usually diagnosed? and why
Clinical diagnosis
Xray changes are usually late
What radiological changes can be seen in ankylosing spondylitis?
Sacroilitis- sclerosis and erosions
Corner erosions, squaring and syndesmophytes (bony proliferations) on vertebrae
Bamboo spine - calcification of ligaments, periosteal bone formation
What investigations can be done if suspect ankylosing spondylosis is suspected? What will they show?
xray
FBC: anaemia, increased ESR and CRP, HLA B27
DEXA can
CXR
What is the conservative management of ankylosing spondylosis?
Exercise
Physio
What is the medical treatment for ankylosing spondylitis?
NSAIDs
Anti TNF if severe
Local steroid injections
Bisphosphonates if they are at increased risk of spinal fractures
What is the surgical treatment for ankylosing spondylitis?
Hip replacement to reduce pain and increase mobility
In what % of people with psoriasis does psoriatic arthritis occur?
10-40%
What joint involvement pattern is most common in PA?
Asymmterical oligoarthritis
What is the classical pattern of joint involvement in PA?
DIP joints
What are some other features of PA?
Psoriatic plaques
Nail changes: pitting, subungal hyperkeratosis, onchyolysis
Enthesitis
Dactylitis
What may be seen on X-ray in PA?
Erosion causing pencil in cup deformity
What is the treatment for PA?
NSAIDs
Sulfasalazine, methorexate, ciclosporin
Anti TNF
What is reactive arthritis?
Sterile arthritis 1-4 weeks after infection usually GI or GU
Urethritis: chlamydia, ureaplasma
Dysentry: campy, salmonella, shigella, yersinia
How does reactive arthritis present?
Asymmetrical lower limb oligoarthritis esp knee
Iritis, conjunctivitis
Keratoderma blenorrhagica: plaques on soles/palms
Circinate balanitis: painless serpiginous penile ulceration
Enthesitis
Mouth ulcers
What investigations should be performed if suspect creative arthritis?
FBC: increased ESR and CRP
Stool culture if diarrhoea
Urine chlamydia PCR
What medications can be given for reactive arthritis?
NSAIDs and local steroids
Relapse may need sulfasalazine or methotrexate
No specific cure
Splint joint
What is enteropathic arthritis associated with?
IBD
