Spondyloarthropathies 10/10/18 Flashcards
What is spondyloarthropathy?
Family of inflammatory arthritides characterized by involvement of both the spine and joints principally in genetically predisposed individuals
What can cause a predisposition to spondyloarthropathy?
HLA B27 gene
What are the 4 main groups of spondyloarthropathy?
Ankyllosing spondylitis
Psoriatic arthritis
Rective arthritis
Enteropathic arthtitis
What is mechanical back pain?
WOrsed by activity
Worse at end of day
Better with rest
What is inflammatory back pain?
Worse with rest
Better with acivity
Signifigant early morning stiffness
What are shared rheumatological features of the spondyloarthropathys?
Sacroiliac and spinal involvement Enthesitis Inflammatory arthritis -oligoarticular -Assymmetric Lower limb Dactylitis
What are shared extra-articular features of the spondyloarthropathies?
Ocular inflammation
Mucocutaneous lesions
Aortic incompetence
No rheumatoid nodules
Where does ankylosing spondylitis affect?
Spine
Sarcoiliac joint
What gender does ankylosing spondylitis affect most?
Men
What is the criteria for ankylosing spondylitis?
ASAS classification
What are SpA features of the ASAS classification?
Inflammatory back pain Arthritis Enthesitis Uveitis Dactylitis Psoriaris Chrohns Response to NSAIDs Family history HLA-B27 Elevated CRP
What would sacrolitis show on imaging?
Active inflammation on MRI highly suggestive of sacrolitis associated with spa
Definitie radiographic sacroilitis
What is a must for ankylosing spondylitis?
> 3 months back pain
<45 years old
What are the clinical features of ankylosing spondylitis?
Back pain Enthesitis Peripheral arthritis Uvitis Cardio involvement Pulmonary involvement Mucosal inflammation Neuro involvement Amyloidosis
What are the As of ankylosing spondylitis?
Axial arthritis Anterior Uveitis Aortic regurg Apical fibrosis AMylodosis Achilles tendinitis plAntar fascitis
How is ankylosing spondylitis diagnosed?
History Examination -Tragus to wall -Chest expansion - Modified Schober test Bloods -Inflammatory -HLA B27 X-rays -Sacroilitis -Syndesmop?ytes -Bamboo spine
What imaging is used for ankylosing spondylitis?
x-rays show changes after long period of time
MRI - Stir images shows changes in bone marrow, oedema, enthesitis
Are normal SI joints reassuring?
No
How are OA and AS differentiated?
AS -Bone density reduced Shiny corners Syndesmophytes Bamboo spine OA Normal bone density Reduced joint space Subchondral sclerosis Subchondral cyst formation Osteophyte formation
What is the treatment for ankylosing spondylitis?
Physio Occupational therapy NSAID SZP MTX Anti-TNF Secukinumab
What is psoritatic arthritis?
Inflammatory arthritis associated with psoriasis
No rheumatoid factor or nodules
What are the features of psoritatic arthritis?
Inflammatory Sacroilitis Nail involvement Dactylitis Enthesitis Extra articular features
What are the 5 subgroups of psoritatic arthritis?
confined to DIPs Symmetric polyarthritis Spondylitis Asymmetric oligoarthritis Arthritis mutilans
How is psoritatic arthritis diagnosed?
History Family history Bloods -Raised inflammatory markers -Negative RF X-rays -Marginal erosions and whiskering Pencil in cup deformitu Osteolysis Enthesitis
What is the treatment of psoritatic arthritis?
NSAIDs Corticosteroids Disease modifying drugs MTX Anti-TNF Secukinumab Physion Occupational therapy Orthotics
What is reactive arthritis?
Infection induced systemic illness characterized primarily by inflammatory synovitis from which viable microorganisms cannot be cultures
When do symptoms occur in reactive arthritis?
1-4 weeks after infection
What are the most common infections in reactive arthritis?
Urogenital
Enterogenic
Who gets reactive arthritis?
Young adults
Equal sex
What is Reiter’s syndrome?
A form of reactive arthritis Triad -Urethritis Conjunctivitis Arthritis
What are the clinical features of reactive arthritis?
Fever Fatigue Malaise Monoarthritis Enthesitis Mucocutaneous lesions Ocular lesions Renal disease Carditis
How is reactive arthritis diagnosed?
History Examination Bloods -Inflammatory -FBC -U and Es -HLAB27 Cultures Joint fluid analysis X-ray of affected joints Ophthalmology opinon
What is the treatment of reactive arthritis?
Resolves spontaneously in 6 months NSAIDs Corticosteroids Antibiotics DMARDs Physiotherapy Occupational therapy
What is enterohepatic arthritis associated with?
IBD
What is the presentation of enterohepatic arthritis?
Several joint involvement Bowel disease Loose watery stools Weight loss Eye involvement SKin involvement Enthesitis Oral involvement
What are the investigations for enterohepatic arthritis?
Upper and lower GI endoscopy Joint aspirate Raised inflammatory markers X-ray/MRI USS
What is the treatment for enterohepatic arthritis?
Treat IBD No NSAIDs Normal analgesia Steroids Disease modifying drugs Anti-TNF
What non-medical treatments can be used for Spondyloarthropathies?
Physiotherapy
Occupational therapy
Orthotics
Chiropodist
