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Finals - MSK: Rheumatology, Metabolic Bone Disease, Trauma and Orthopaedics > Spondyloarthritis/Reactive Arthritis/Psoriatic Arthritis > Flashcards

Spondyloarthritis/Reactive Arthritis/Psoriatic Arthritis Flashcards

1
Q

What is spondyloarthropathy?

A

Group of over-lapping conditions associated with tissue type HLA-B27

Patients often display features of more than one disease from the group

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2
Q

What is the role of HLA-B27?

A

HLA-B27 has a role in angigen presentation within the immune system

You can be +ve or -ve for HLA-B27.

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3
Q

Name some diseases associated with HLA-B27?

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthriitis (Crohns/UC)

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4
Q

If you are HLA-B27 +ve are you likely to have the disease?

A

No
UK prevalence of HLA-B27 is 9% but AS is <0.5%
(or related disease)

Prevalence of AS increases with B27 prevalence in population.

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5
Q

How is HLA-B27 linked with disease?

A

Potentially molecular minicry where an infecton with similar structure triggers an auto-immune response against HLA-B27.

There are also other theories including the misfolding theory and heavy chain homodimer hypothesis.

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6
Q

What are the clinical features of SpA?

A 
Inflammatory arthritis of the axial skeleton, primarily spine, rib and hops - results in fusion of the vertebrae and joints.
Acute anterior uveitis (iritis)
Peripheral arthritis
Skin psoroasis
Sub-clinical inflammatory bowel disease.
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7
Q

What makes up the SPINE ACHE pneumonic for SpA?

A 
Sausage digit (dactylitis)
Psoriasis
Inflammatory back pain
NSAID responsivve
Enthesitis (heel)
Arthritis
Crohn's/Colitis/elevated CRP
HLA B27
Eye (uveitis)
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8
Q

What is Ankylosing Spondylitis?

A

An SpA where there is inflammatory arthritis of the spine and rib cage, eventually leading to new bone formation and fusion of the joints.

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9
Q

How may the spine appear on x-ray in Ankylosing Spondylitis?

A

Bamboo spine - fusion of joints, loss of joint space

Romanus lesions - new bone formation

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10
Q

When does Ankylosing Spondylitis typically start?

A

Late teens / early 20s

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11
Q

What would advanced Ankylosing Spondylitis look like clinically?

A

Severe kyphosis of thoracic and cervical spine

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12
Q

What is specific about the back pain in SpA (Inflammatory back pain)?

A 
Younger age of onset (<45 years)
Insidious onset
Morning stiffness (>30 min)
Improvement with exercise
Pain at night, improved with movement
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13
Q

Treatment of Ankylosing Spondylitis?

A

TNFi (tumor necrosis factor inhibitors)
Etanercept, infliximab, adalimumab, certolizumab and golimumab
(Most effective)

NSAIDS
Physiotherapy

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14
Q

What are the signs of psoriatic arthritis?

A 
Similar
DIPJ only
RA like
Large joint
Axial 
Arthritis mutilans

Dactylitis
Psoriasis
Nail changes

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15
Q

What signs are seen on x-ray in psoriatic arthritis?

A

Telescoping

Pencil in cup x-ray changes

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16
Q

What is the management of psoriatic arthritis?

A

Similar to RA
Early intervention with DMARDs (methotrexate, ciclosporin, sulfasalazine)
Anti-TNF drugs - infliximab, enteracept
IL 12/23 blockers

17
Q

What is reactive arthritis/reiter’s disease?

A

Sterile inflammation of the synovial membrane, tendons and fascia, triggered by an infection at a distant site, usually GI or genital.

18
Q

What infections are associated with RA?

A

Salmonella
Shigella
Yersinia

Chlamydia
Uraeplasma uraelyticum

19
Q

What are the signs of reactive arthritis/ reiter’s disease?

A

Arthritis (2d - 2w post infection)
Conjunctivitis
(Sterile) urethritis

Can’t see, can’t pee can’t climb a tree.
(psoriatic like skin lesions)

20
Q

What is the ddx and should be excluded from RA?

A

Septic arthritis
Gout

Raised ESR/CRP
Aspirate joint to exclude infection/crystals
Urethral swab, stool culture
Contract tracing if necessary

21
Q

What is enteropathic arthritis?

A

Episodic peripheral synovitis which occurs in up to 20% of baties with IBD.

22
Q

What signs would lead you to consider SpA?

A 
Inflammatory back pain
Asymmetrical (large joint) arthritis 
Skin psoriasis
Inflammatory bowel disease
Inflammatory eye disease

Finals - MSK: Rheumatology, Metabolic Bone Disease, Trauma and Orthopaedics (10 decks)

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