Spondyloarthritis Flashcards
A disease affecting the joint of the spine, that does NOT have the rheumatoid factor in the blood
Seronegative Spondyloarthritis
Inflammation in the spine
- i.e. Sacroiliitis, spondyltitis
Synovitis
- Affecting peripheral joints of the legs>arms
- Typically on one side of the body
Enthesopathy
- Inflammation where ligaments, tendons, & joint capsule attach to bone
Inflammatory Eye Disease
- i.e. Iritis (Uveitis), Conjunctivitis
Blood Work
- Usually does NOT show Rheumatoid Factor (Seronegative)
Tendency to run in families
- Often associated w/ HLA-B27 genetic marker
Common Features
Psoriasis
- Common skin disease (2% US pop)
- Dry, red/grey, scaly patches of skin
- Finger/toenails: Discolouration, pitting, ridging
- 10% may develop inflammatory arthritis
Appears in families - Multigenic Inheritance
M=F: 30-50 y/o
Can begin in childhood
Dactylitis: sausage-like finger & toes due to swelling
Enthesitis: esp. in heels & back
Psoriatic Arthritis
1) Primarily joints of fingers & toes (DIP ARTHRITIS)
2) Joints of limbs - asymmetric (OLIGOARTHRITIS ≤ 2-4 joints involved)
3) Multiple joints - symmetric - resembles RA (Symmetrical POLYARTHRITIS)
4) Arthritis Mutilans - rare, deforming
5) Sacrioiliac Joints & Spine - “PSORIATIC SPONDYLITIS”
Can have conjunctivitis/iritis in the eyes
Spondylitis & iritis more common in people who are HLA-B27 (+)
5 Subgroups of Psoriatic Arthritis
Ulcerative colitis & Chron’s disease
- Inflammatory conditions of the bowel - result in diarrhea
Associated w/ arthritis
May affect the spine & sacroiliac joints
- may also affect the joints in the legs & arms
Enteropathic Spondylitis (Intestinal Arthropathy)
Aka: Reiter’s arthritis
Generally asymmetrical
Typically causes hot, swollen joints
Usually occurs in the lower limbs
May cause stiffening in the spine as well
Triggered by infection in the bowel or genitourinary tract
May become chronic
Reactive Arthritis
Stiffness/fusing of the spine by inflammation
Documented since ancient times
Essentially a disease of young adults
- Onset: adolescence/young adulthood
Average age: 26 y/o
Rare beyond 45 yrs
Delay in diagnosis average 8.9 yrs
Prevelance
- 0.1% African & Inuit
- 0.5-1% White
- 6% Haida Indigenous people
- M:F 1:1
Ankylosing Spondylitis
Many advancements have been made in recent years, yet exact cause still unclear
Familial clustering
Association w/ genetic marker HLA-B27
- 90-95% are HLA-B27 (+)
Possible multigenic
Infective mechanism being explored as trigger but no evidence in the joint
Causes of AS
MSK Involvement
- Sacroilitis
- Enthesitis
- Synovitis
Other systems & organs involved
- Eyes
- Bowels
- Lungs
- Heart
Features of AS
Hallmark sign of AS
90% or more cases start with ________
6025% w/ Chrohn’s/ulcerative colitis have _________
Slow onset of pain
- deep, dull, diffuse pain in buttock area
- d/t inflammation in SI joints
Bilateral disease
- initially comes & goes on one side, then other side
Fusion can occur over time
Sacroilitis
s can impinge on spinal nerves
Entheses: Place where tendons, ligaments & joint capsule attach to bone
Inflammation of the sites, leading to bony erosion, bony overgrowth (syndesmophytes), possible bony fusion & rigidity
Inflammation starts at SI joints, progresses in ascending fashion affecting all levels of spine
Common sites can include both spine & peripheral regions
Can take several years; diagnosis can take 5-6 years
Early stage: bony loss -> osteopenia
Later stage osteoporosis -> risk of #
- fusion/rigidity -> risk of #s
Stiffness
- lumbar/thoracic/cervical region -> Loss of ROM
- ribcage - ↓ lung capacity
Enthesitis
Inflammation -> Erosive Damage Repair -> New Bone Formation
Normal -> Inflamed -> Encroach -> Fusion -> Full fusion
Sequence of Structural Damage in AS
Inflammation of the synovium
Usually affects peripheral joints - commonly: shoulders, hips, knees
Involvement of joints may precede, accompany, or follow spinal involvement
Peripheral joint involvement occurs in 30% of cases
Synovitis
Clinical Criteria:
- LBP & stiffness for more than 3 months that improves w/ exercise but is not relieved by rest
- Limitation of motion of the lumbar spine in both sagittal & frontal planes
- Limitation of chest expansion relative to normal values correlated for age & sex
Radiological Criterion:
- Sacroiliitis grade ≥ 2 bilaterally or grade 3-4 unilaterally
- Definite AS:
- If radiological criterion is associated w/ at least 1 clinical criterion
New York Criteria for AS
In patients with ≥3months back pain & age at onset <45yrs:
Sacroiliitis on imaging + ≥1 SpA feature
OR
HLA-B27 + ≥ other SpA features
ASAS Classification Criteria for SpA
