Spondyloarthritis Flashcards
Spondyloarthritis refers to a group of inflammatory musculoskeletal conditions with shared features which affect both _____________ and ______________ joints
axial
peripheral
Most people with spondyloarthritis have either axial spondyloarthritis (which includes ________________ and _______________) or psoriatic arthritis
ankylosing spondylitis
non-radiographic axial spondyloarthritis
Most people with spondyloarthritis have either ______________ or ______________
axial spondyloarthritis (which includes ankylosing spondylitis and non-radiographic axial spondyloarthritis)
psoriatic arthritis
Axial spondyloarthritis primarily affects the spine, in particular the _____________ joint
sacroiliac
Psoriatic arthritis may present in several forms, including involvement of _______________, ________________, or combinations of both.
small joints (in the hands and feet)
large joints (particularly in the knees)
Psoriatic arthritis may present in several forms, including involvement of small joints (in the ___________ and ____________), large joints (particularly in the ____________), or combinations of both.
Hands
Feet
knees
Psoriatic arthritis may also involve the __________ joints, ____________ and ____________ joints, and inflammation of the connective tissue between ______________ and ____________.
Axial
Finger
Toe
tendon/ligament
bone
Less common subgroups of spondyloarthritis are ________________, and ________________.
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
What are the non-drug treatments of spondyloarthritis?
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
What is the first line treatment for axial spondyloarthritis?
NSAIDs, lowest effective dose
- Clinical assessment, monitoring of risk factors, and the use of gastroprotective treatment should be considered
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?
consider switching to a different NSAID
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.
tumour necrosis factor (TNF) alpha inhibitor
- The choice of treatment should depend on factors such as patient preference and extra-articular involvement
_____________ 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
Ixekizumab
secukinumab
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
12 to 20 weeks
Monotherapy with _______________ injections should be considered for non-progressive monoarthritis associated with psoriatic arthritis and other peripheral spondyloarthridites
local corticosteroid
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
methotrexate
leflunomide
sulfasalazine
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 ______________
peripheral spondyloarthritis
The choice of DMARD will depend on numerous factors such as… (3)
- the patient’s circumstances (such as pregnancy planning and alcohol consumption)
- comorbidities (such as uveitis, psoriasis and inflammatory bowel disease)
- potential side-effects
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
another standard DMARD
____________ can be used as an adjunct to standard DMARDs or biological DMARDs to manage symptoms in psoriatic arthritis or other peripheral spondyloarthridites
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
If extra-articular disease is adequately controlled by an existing standard DMARD but peripheral spondyloarthritis is not, consider _______________
adding another standard DMARD
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
Do NOT
What is the treatment of reactive arthritis?
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
