Spondyloarthritis

Question 1

Name the 4 different Spondyloarthritis disorders

Answer 1

Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
IBD associated Arthritis

Question 2

Strongest Genetic Risk Factor for Spondyloarthritis

Answer 2

HLA-B27 - 95% of patients with AS

postive to a lesser extent in psoriatic arthritis and IBD-associated

Question 3

Which infections are most implicated in Reactive Arthritis (Reiter’s Syndrome)?

Answer 3

GI and genitourinary infections

Question 4

Clinical Features of Ankylosing Spondylitis

Answer 4

Males
20-30yo
Progressive inflammatory back pain with STIFFNESS
Initial LBP/SIJ/buttock pain –> progression, ascending back pain
Reduced ROM of the spine (limited flexion –> lat flex + rotation)
Stooped posture

Dactylitis - sausage inflammation of toe/fingers
IBD
Uveitis

Bamboo Spine on XR

Question 5

Cardiovascular associations with Ank Spond

Answer 5

Aortic Regurgitation
Aortitis
Conduction abnormalities
CAD

Question 6

Clinical Features of Psoriatic Arthritis

Answer 6

Enthesitis
Dactylitis
Tenosynovitis (synovium arouund tendon sheath)
Arthritis of the DIPs
Spondylitis (inflammation of the vertebrae)
Oligoarthritis (<5 joints)
Arthritis Mutilans (extensive osteolysis)

Psoriasis - skin condition of the extensor surfaces and scalp
Nail pitting/ onycholysis (when nail splits from nail bed)

Erosive changes
X-RAYS - pencil in cup deformity, erosive changes + new bone formation concurrently

Question 7

Clinical features of IBD associated arthritis

Answer 7

50% of IBD patients will develop MS problems
Can precede bowel changes
MCP
Axial involvement 20%
Sacroilitis
Spondylitis

Avascular necrosis risk due to corticosteroid use

Question 8

Clinical features of reactive arthritis

Answer 8

Post infectious arthritis that is sterile
Men and women equally

Classic triad - arthritis, urethritis and conjunctivitis

Occurs days to weeks post infection
Oligoarthritis

Self limiting - nil erosive changes

Question 9

Pathogens involved in reactive arthritis

Answer 9

Chlamydia
Yersinia
Salmonella 
Shigella
Campylobacter

Question 10

Lab findings in spondyloarthritis

Answer 10

Negative for RF and anti-CCP
Often negative for ESR and CRP in ankylosis spondylitis, higher in IBD associated arthritis

?HIV testing in patients with reactive or psoriatic arthritis

Look for pathogens in stool, urine in reactive arthritis (first pass urine)

Question 11

Imaging in Spondyloarthritis

Answer 11

Ank Spondylitis:
XR of the SIJ - grades of disease from sacroilitis to fusion of bones
XR of Spine - syndesmophytes, squaring of the vertebrae, bamboo spine

Psoriatic:
Erosive changes
Osteolysis
Arthritis mutilans

Question 12

Treatment of spondyloarthropathies

Answer 12

NSAIDs
Dmards
TNF alpha inhibitors (if axial disease)