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MSK lectures > Spondyloarthropathies 10/10/18 > Flashcards

Spondyloarthropathies 10/10/18 Flashcards

1
Q

What is spondyloarthropathy?

A

Family of inflammatory arthritides characterized by involvement of both the spine and joints principally in genetically predisposed individuals

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2
Q

What can cause a predisposition to spondyloarthropathy?

A

HLA B27 gene

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3
Q

What are the 4 main groups of spondyloarthropathy?

A

Ankyllosing spondylitis
Psoriatic arthritis
Rective arthritis
Enteropathic arthtitis

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4
Q

What is mechanical back pain?

A

WOrsed by activity
Worse at end of day
Better with rest

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5
Q

What is inflammatory back pain?

A

Worse with rest
Better with acivity
Signifigant early morning stiffness

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6
Q

What are shared rheumatological features of the spondyloarthropathys?

A 
Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthritis
-oligoarticular
-Assymmetric
Lower limb
Dactylitis
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7
Q

What are shared extra-articular features of the spondyloarthropathies?

A

Ocular inflammation
Mucocutaneous lesions
Aortic incompetence
No rheumatoid nodules

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8
Q

Where does ankylosing spondylitis affect?

A

Spine

Sarcoiliac joint

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9
Q

What gender does ankylosing spondylitis affect most?

A

Men

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10
Q

What is the criteria for ankylosing spondylitis?

A

ASAS classification

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11
Q

What are SpA features of the ASAS classification?

A 
Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriaris
Chrohns
Response to NSAIDs
Family history
HLA-B27
Elevated CRP
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12
Q

What would sacrolitis show on imaging?

A

Active inflammation on MRI highly suggestive of sacrolitis associated with spa
Definitie radiographic sacroilitis

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13
Q

What is a must for ankylosing spondylitis?

A

> 3 months back pain

<45 years old

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14
Q

What are the clinical features of ankylosing spondylitis?

A 
Back pain
Enthesitis
Peripheral arthritis
Uvitis
Cardio involvement
Pulmonary involvement
Mucosal inflammation
Neuro involvement
Amyloidosis
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15
Q

What are the As of ankylosing spondylitis?

A 
Axial arthritis
Anterior Uveitis
Aortic regurg
Apical fibrosis
AMylodosis
Achilles tendinitis
plAntar fascitis
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16
Q

How is ankylosing spondylitis diagnosed?

A 
History
Examination
-Tragus to wall
-Chest expansion
- Modified Schober test
Bloods 
-Inflammatory
-HLA B27
X-rays
-Sacroilitis
-Syndesmop?ytes
-Bamboo spine
17
Q

What imaging is used for ankylosing spondylitis?

A

x-rays show changes after long period of time

MRI - Stir images shows changes in bone marrow, oedema, enthesitis

18
Q

Are normal SI joints reassuring?

A

No

19
Q

How are OA and AS differentiated?

A 
AS
-Bone density reduced
Shiny corners
Syndesmophytes
Bamboo spine
OA
Normal bone density
Reduced joint space
Subchondral sclerosis
Subchondral cyst formation
Osteophyte formation
20
Q

What is the treatment for ankylosing spondylitis?

A 
Physio
Occupational therapy
NSAID
SZP MTX
Anti-TNF
Secukinumab
21
Q

What is psoritatic arthritis?

A

Inflammatory arthritis associated with psoriasis

No rheumatoid factor or nodules

22
Q

What are the features of psoritatic arthritis?

A 
Inflammatory
Sacroilitis
Nail involvement
Dactylitis
Enthesitis
Extra articular features
23
Q

What are the 5 subgroups of psoritatic arthritis?

A 
confined to DIPs
Symmetric polyarthritis
Spondylitis
Asymmetric oligoarthritis
Arthritis mutilans
24
Q

How is psoritatic arthritis diagnosed?

A 
History 
Family history
Bloods
-Raised inflammatory markers
-Negative RF
X-rays
-Marginal erosions and whiskering
Pencil in cup deformitu
Osteolysis
Enthesitis
25
Q

What is the treatment of psoritatic arthritis?

A 
NSAIDs
Corticosteroids
Disease modifying drugs
MTX
Anti-TNF
Secukinumab
Physion
Occupational therapy
Orthotics
26
Q

What is reactive arthritis?

A

Infection induced systemic illness characterized primarily by inflammatory synovitis from which viable microorganisms cannot be cultures

27
Q

When do symptoms occur in reactive arthritis?

A

1-4 weeks after infection

28
Q

What are the most common infections in reactive arthritis?

A

Urogenital

Enterogenic

29
Q

Who gets reactive arthritis?

A

Young adults

Equal sex

30
Q

What is Reiter’s syndrome?

A 
A form of  reactive arthritis
Triad
-Urethritis
Conjunctivitis 
Arthritis
31
Q

What are the clinical features of reactive arthritis?

A 
Fever
Fatigue
Malaise
Monoarthritis
Enthesitis
Mucocutaneous lesions
Ocular lesions
Renal disease
Carditis
32
Q

How is reactive arthritis diagnosed?

A 
History
Examination
Bloods
-Inflammatory
-FBC
-U and Es
-HLAB27
Cultures
Joint fluid analysis
X-ray of affected joints
Ophthalmology opinon
33
Q

What is the treatment of reactive arthritis?

A 
Resolves spontaneously in 6 months
NSAIDs
Corticosteroids
Antibiotics
DMARDs
Physiotherapy
Occupational therapy
34
Q

What is enterohepatic arthritis associated with?

A

IBD

35
Q

What is the presentation of enterohepatic arthritis?

A 
Several joint involvement
Bowel disease
Loose watery stools
Weight loss
Eye involvement
SKin involvement
Enthesitis
Oral involvement
36
Q

What are the investigations for enterohepatic arthritis?

A 
Upper and lower GI endoscopy
Joint aspirate
Raised inflammatory markers
X-ray/MRI
USS
37
Q

What is the treatment for enterohepatic arthritis?

A 
Treat IBD
No NSAIDs
Normal analgesia
Steroids
Disease modifying drugs
Anti-TNF
38
Q

What non-medical treatments can be used for Spondyloarthropathies?

A

Physiotherapy
Occupational therapy
Orthotics
Chiropodist

MSK lectures (50 decks)

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