Spondyloarthritis

Question 1

Spondyloarthritis is characterized by:

Answer 1

peripheral inflammatory arthritis (particularly an asymmetric oligoarthritis of large joints)
enthesitis (inflammation of tendon insertion points)
dactylitis (inflammation of digital tendon sheaths)
uveitis
inflammatory back pain (axial arthritis)

Question 2

7 different types of spondyloarthritis?

Answer 2

Psoriatic Arthritis
Ankylosing Spondylitis
Nonradiographic Axial Spondyloarthropathy 
IBD-Related Arthritis
Reactive Arthritis
Peripheral Spondyloarthritis 
Juvenile Spondyloarthritis

Question 3

Psoriatic arthritis features?

Answer 3

personal or family history of psoriasis
asymmetric oligoarthritis of large joints
symmetrical polyarthritis of proximal small joints
DIP joint arthritis (typically seen with nail psoriasis)
axial spondyloarthritis
arthritis mutilans (aggressive, deforming with typical appearances of pencil-in-cup deformity on XR and eventually opera-glass deformity of the hands)

Question 4

Diagnosis of psoriatic arthritis?

Answer 4

> 3 CASPAR criteria: personal or fam hx of psoriasis, nail dystrophy, - RF, current or hx of dactylitis, juxta-articular new bone formation on XR

Question 5

Psoriatic arthritis XR findings?

Answer 5

Typically combination of bone loss (with eccentric erosions) and new bone formation (with ankyloses, enthesophytes, syndesmophytes, and periostitis)
Bone formation at the site of periarticular structural insertions (such as tendons)
Periostitis at the lateral margins of the IP joints as a fluffy-appearing opacification
Pencil-in-cup deformities, seen with the arthritis mutilans
Enthesitis, seen as a calcification in line with the tendon insertion on the bone
Dactylitis, observed as a swelling of soft tissue of the digit
Axial involvement, asymmetrically in the SI joints

Question 6

Txt psoriatic arthritis?

Answer 6

Mild: NSAIDs and Tylenol
Mod: DMARDS (MTX, leflunomide and sulfasalazine)
Sev: biological DMARDS (TNF inh, IL 17/12/23 inh, Janus kinase inh)
Glucocorticoids PRN but try to limit
UV light or cyclosporine for skin dz

Question 7

Ankylosing spondylitis features?

Answer 7

lower-back pain centering on the sacroiliac joints
<45 yo, >3 months pain, awakening in night d/t pain
morning stiffness > 30 min and improvement with exercise

Question 8

Diagnosis of Ankylosing spondylitis?

Answer 8

XR or MRI evidence
HLA B27
Improvement with NSAIDS

Question 9

Nonradiographic Axial Spondyloarthritis features and txt?

Answer 9

preradiographic stage of AS
MRI can help identify bone-marrow edema near the sacroiliac joints, suggesting inflammation
Txt: NSAIDs, physical activity, stretching, DMARDs (MTX and sulfasalazine for peripheral arthritis NOT back pain), and bDMARDs (TNF inh)

Question 10

IBD related arthritis features and txt?

Answer 10

IBD sxs: hematochezia, diarrhea, abdominal pain, and recurrent aphthous ulcers, confirmation with upper/lower endoscopy and tissue bx
Peripheral, axial, and extra-articular manifestations of spondyloarthritis
Txt: Optimize control of IBD (w/ biologics likey TNF-alpha inh)
NSAIDs, though they may worsen IBD activity and/or increase bleeding risk
Peripheral arthritis-DMARDs such as MTX or sulfasalazine
Oligoarthritis- targeted intra-articular steroid injections Uveitis-treatment of acute flares, recurrent- TNF inh

Question 11

Reactive arthritis features and txt?

Answer 11

asymmetric oligoarthritis occurring with uveitis and urethritis
within 3 months hx of a GI or GU infxn
Dx: Urine or stool sample showing Chlamydia, Campylobacter jejuni, Yersinia enterocolitica, Shigella, Salmonella
Txt: resolve in 3-6 months usually
mild- NSAIDS
severe-glucocorticoids, DMARDs (Sulfasalazine or weekly MTX)

Question 12

Continuous vs intermittent NSAID use for ankylosing spondylitis?

Answer 12

Continuous use has been shown to have reduced rate of radiographic progression