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Rheumatology > Spondyloarthritides > Flashcards

Spondyloarthritides Flashcards

1
Q

Shared features of spondyloarthropathies

A
  • RF negative
  • Preponderance for extra-articular features
  • Classically affect axial skeleton (spine + sacroiliac joints)
  • Genetic association with B27
  • Affect tendons + tendon insertions (enthesis) - esp Achilles
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2
Q

Presentation of ankylosing spondylitis

A

Young male gradually worsening back/sacro-iliac (buttock) pain, improves with exercise, worse at night

May progress to kyphosis + neck hyperextension (Q mark posture)

Enthesitis (esp Achilles and pelvis)

Costochondritis

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3
Q

Extra-articular features of AS

A

Disease of As:

Achilles tendonitis

Anterior uveitis + hypopyon

Apical pulmonary fibrosis

Aortic incompetence

Atlanto-axial subluxation

Osteoporosis

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4
Q

Imaging features of ankylosing spondylitis

A

Syndesmophytes (bony growths at ligament/tendon insertions)

Shiny corners of bone marrow oedema (Romano’s lesions) on T2-weighted MRI

Fusion of syndesmophytes with vertebral bodies –> ankylosis –> eventually bamboo spine (ONLY ON X-RAY)

T2W MRI investigation of choice –> bone marrow oedema from active inflammation

Affects T11-L1 initially

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5
Q

Management of ankylosing spondylitis

A

Exercise (w. physio)

NSAIDs symptomatic relief

TNF-a blockers if severe,active; also IL-17 and IL-12/23

NOT B/T-cell blockade, NOT steroids

Consider bisphosphonates for osteoporosis risk

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6
Q

TNF-a blockers for ankylosing spondylitis

A

Etanacept, adilimumab

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7
Q

Poor prognostic factors for ankylosing spondylitis

A

ESR >30

age <16

unresponsive to NSAIDs

early hip involvement

early loss of lumbar mobility

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8
Q

Anterior uveitis features in AS

A

Sight-threatening

Injected

Irregular pupil

Photophobic

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9
Q

Syndesmophyte vs osteophyte appearance

A

Syndesmophytes grow longitudinally

Osteophytes grow laterally

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10
Q

What is BASDAI

A

Bath Ankylosing Spondylitis Disease Activity Index

POatient-reported, >4 is bad

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11
Q

What is BASMI?

A

Bath Ankylosing Spondylitis Metrology Index: for measuring disease progression

Cervical rotation + wall-to-tragus

Lumbar flexion (Schober’s index) + lateral movement

Chest expansion

Inter-malleolar straddle

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12
Q

Presentation of enteric arthropathy

A

Assoc w/ IBD, coeliac, Whipple’s

Peripheral arthropathy that may be associated with flares, tends to improve with treating bowel symptoms

Sacroiliac arthropathy not associated with bowels

Seulphasalazine if severe

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13
Q

Pathophysiology of reactive arthritis

A

Autoimmune reaction to GI/GU infection –> symptoms incl. arthritis

Infection may have resolved by this point

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14
Q

Features of Reiter’s syndrome

A

Conjunctivitis

Arthritis

Urethritis

As autoimmune reaction (falls under reactive arthritis)

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15
Q

Clinical features of reactive arthritis

A

Large joint (commonly knee)

Keratoderma blennorhagica (brown raised plaques on soles and palms)

Conjunctivitis/anterior uveitis

Circinate balanitis (inflammatory rash on urethral meatus)

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16
Q

Management of reactive arthritis

A

Steroid injection +/- knee aspiration +/- NSAIDs

Sulphasalazine if >6mo

17
Q

Features of psoriatic arthritis

A

Any pattern of joint disease (classically rays rather than rows)

Psoriasis (silver-scale) OR family history of psoriasis

Age 20-40

Dactylitis

Nail disease (pitting, ridging)

DIP joint involvement

18
Q

Management of psoriatic arthritis

A

NOT hydroxychloroquine

Methotrexate, sulphasalazine, NSAIDs

Anti-TNF or anti IL-17/IL-12/23 if refractory, also cyclosporin

19
Q

X-ray features of PsA

A

Whittling of terminal phalanges

Pencil-in-cup deformity

Ankylosis

20
Q

Organisms that may produce reactive arthritis post-infection

A

GI: Salmonella, Shigella, Campylobacter

GU: Chlamydia, gonnorhoea

21
Q

Rheumatological association of anterior uveitis

A

Ankylosing spondylitis

22
Q

Rheum association of conjunctivitis

A

SLE

(RA to a lesser extent)

23
Q

Rheum association of keratoconjunctivitis sicca

A

Sjogren’s

RA

Systemic sclerosis

24
Q

HLA B27 prevalence in population

A

5-10%

25
Q

HLA B27 prevalence in ankylosing spondylitis

A

90%

26
Q

Prevalence of spondyloarthropathy in HLA B27 +VE

A

5-10% AS

20% reactive arthritis

27
Q

Biologics in PsA/AS

A

TNF-a blockade: Etanacept, adilimumab, infliximab

IL-17 blockade: secukinimab

IL-12/23 blockade: ustekinumab

Rheumatology (6 decks)

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