Spondyloarthritis

Question 1

Spondyloarthritis refers to a group of inflammatory musculoskeletal conditions with shared features which affect both _____________ and ______________ joints

Answer 1

axial

peripheral

Question 2

Most people with spondyloarthritis have either axial spondyloarthritis (which includes ________________ and _______________) or psoriatic arthritis

Answer 2

ankylosing spondylitis

non-radiographic axial spondyloarthritis

Question 3

Most people with spondyloarthritis have either ______________ or ______________

Answer 3

axial spondyloarthritis (which includes ankylosing spondylitis and non-radiographic axial spondyloarthritis)

psoriatic arthritis

Question 4

Axial spondyloarthritis primarily affects the spine, in particular the _____________ joint

Answer 4

sacroiliac

Question 5

Psoriatic arthritis may present in several forms, including involvement of _______________, ________________, or combinations of both.

Answer 5

small joints (in the hands and feet)

large joints (particularly in the knees)

Question 6

Psoriatic arthritis may present in several forms, including involvement of small joints (in the ___________ and ____________), large joints (particularly in the ____________), or combinations of both.

Answer 6

Hands

Feet

knees

Question 7

Psoriatic arthritis may also involve the __________ joints, ____________ and ____________ joints, and inflammation of the connective tissue between ______________ and ____________.

Answer 7

Axial

Finger

Toe

tendon/ligament

bone

Question 8

Less common subgroups of spondyloarthritis are ________________, and ________________.

Answer 8

enteropathic spondyloarthritis, which is associated with inflammatory bowel disease (Crohn’s disease and Ulcerative colitis)

reactive arthritis (a form of peripheral arthritis), which can occur following gastro-intestinal or genito-urinary infections

Question 9

What are the non-drug treatments of spondyloarthritis?

Answer 9

Patients who have difficulties with everyday activities should be referred to a specialist therapist (such as a physiotherapist, occupational therapist, hand therapist, orthotist or podiatrist)

Hydrotherapy can be considered as an adjunctive therapy to manage pain and maintain or improve function for people with axial spondyloarthritis

Question 10

What is the first line treatment for axial spondyloarthritis?

Answer 10

NSAIDs, lowest effective dose

• Clinical assessment, monitoring of risk factors, and the use of gastroprotective treatment should be considered

Question 11

In the treatment of axial spondyloarthritis, if an NSAID taken at the maximum tolerated dose for 2–4 weeks does not provide adequate pain relief, what should be done?

Answer 11

consider switching to a different NSAID

Question 12

A _____________ is recommended as an option for treating severe active ankylosing spondylitis or severe non-radiographic axial spondyloarthritis in patients whose disease has responded inadequately to, or who are intolerant of, NSAIDs.

Answer 12

tumour necrosis factor (TNF) alpha inhibitor

• The choice of treatment should depend on factors such as patient preference and extra-articular involvement

Question 13

_____________ and _____________ are recommended as options for treating active ankylosing spondylitis or non-radiographic axial spondyloarthritis in patients who have responded inadequately to NSAIDs and/or TNF-alpha inhibitors

Answer 13

Ixekizumab

secukinumab

Question 14

The response to treatment should be assessed after ____________ (depending on the treatment used) and should only be continued if there is clear evidence of response

Answer 14

12 to 20 weeks

Question 15

Monotherapy with _______________ injections should be considered for non-progressive monoarthritis associated with psoriatic arthritis and other peripheral spondyloarthridites

Answer 15

local corticosteroid

Question 16

Standard disease-modifying antirheumatic drugs (DMARDs), such as ______________, _____________ or ______________, can be used for patients with peripheral polyarthritis, oligoarthritis, or persistent or progressive monoarthritis associated with peripheral spondyloarthritis

Answer 16

methotrexate

leflunomide

sulfasalazine

Question 17

Standard disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, leflunomide or sulfasalazine, can be used for patients with peripheral polyarthritis, oligoarthritis, or persistent or progressive monoarthritis associated with ______________

Answer 17

peripheral spondyloarthritis

Question 18

The choice of DMARD will depend on numerous factors such as… (3)

Answer 18

1. the patient’s circumstances (such as pregnancy planning and alcohol consumption)
2. comorbidities (such as uveitis, psoriasis and inflammatory bowel disease)
3. potential side-effects

Question 19

If a standard DMARD taken at the maximum tolerated dose for at least 3 months does not provide adequate relief from symptoms of psoriatic arthritis or other peripheral spondyloarrthridites, a switch to or the addition of ______________ can be considered

Answer 19

another standard DMARD

Question 20

____________ can be used as an adjunct to standard DMARDs or biological DMARDs to manage symptoms in psoriatic arthritis or other peripheral spondyloarthridites

Answer 20

An NSAID

*If NSAIDs do not provide adequate relief from symptoms, consider corticosteroid injections or short-term oral corticosteroid therapy as an adjunct to standard DMARDs or biological DMARDs to manage symptoms

Question 21

If extra-articular disease is adequately controlled by an existing standard DMARD but peripheral spondyloarthritis is not, consider _______________

Answer 21

adding another standard DMARD

Question 22

After treating the initial infection, ___________ (do/do not) offer long-term (4 weeks or longer) treatment with an antibacterial solely to manage reactive arthritis caused by a gastro-intestinal or genito-urinary infection

Answer 22

Do NOT

Question 23

What is the treatment of reactive arthritis?

Answer 23

Symptomatic: analgesia, NSAIDs, intra-articular steroids
Sulfasalazine and MTX are sometimes used for persistent disease

*after treating the initial infection, do NOT offer long-term antibacterial therapy solely to manage symptoms