Spondyloarthropathies

Question 1

symptoms of SLE

Answer 1

eye: retinal exudates, blindness, conjunctivitis, sjogrens

CNS: seizures, paralysis, neuropathies

bloods: decreased platelets, abnormal antibodies

lining membranes: pericarditis, endocaridtis

kidney: renal failure, proteinuria, oedema, hypertension

GI: poor appetite, vomiting, diarrhoea

reproductive: menorrhea, amenorrhoea, prematurity, still births

MSK: arthralgia, arthritis, myalgia

lymphadenopathy: liver and spleen
skin: baldness, discoid, butterfly rash, raynards, photosensitivity, ulcers

fatigue, ache, ever, rash, weakness, weight gain / loss

(ACR criteria)

Question 2

investigation

Answer 2

FBC, U+E, LFT, CRP, PV
ANA  +/- ENA
ds DNA, complement
cardiolipin antibody
lupus anticoagulant
bet 2 glycoprotein
organ/system specific investigations

Question 3

Anti-phospholipid antibody syndrome

Answer 3

can be connected to lupus

at risk of specific complications

• thrombocytopenia
• venous and arterial thrombosis
• cerebral disease (CV accident, TIA, chorea, amaurosis fugal)
• recurrent foetal loss
• pulmonary HTN
• lived reticular

Question 4

Raynards

Answer 4

keep the core warm
white > blue > pink
avoid getting too cold

Question 5

levied reticularis

Answer 5

can be subtle

seen on thighs

Question 6

butterfly discoid rash (lupus)

Answer 6

often photosensitive

Question 7

treatment

Answer 7

corticosteroids (PO/IV/topical)
hydroxychloroquine
azathioprine
methotrexate
cyclophaoamide
cilcosporin A
thalidomie
leeflunomide
rituximab
IV Ig

Question 8

seronegative spondyloarthropathies

Answer 8

group of inflammatory arthrides

spine / few peripheral joints
young M/F

inflamamtory symptoms
enthesitis extra articular

HLA-B27 association
(genetic testing)

Question 9

extra-articular features

Answer 9

fatigue
weight loss
anaemia
irtis
upper lobe lung fibrosis
reduced chest expansion
IgA nephropathy
aortic incompetence
cardiomyopathy
conduction defects

Question 10

extra-articular features

Answer 10

fatigue
weight loss
anaemia
irtis (anterior uveititis) red painful eye
upper lobe lung fibrosis
reduced chest expansion
IgA nephropathy
aortic incompetence
cardiomyopathy
conduction defects

Question 11

investigations

Answer 11

inflammatory markers
HLA-B27
Imaging: MRI with STIR sequences
Xray (rarely done as an MRI is diagnostic)

Question 12

prognosis

Answer 12

early hip involvement
ESR >30
poor response to NSAIDs
early loss of lumbar mobility
dactylics
oligoarticular disease
onset <16 yrs

Question 13

management

Answer 13

patient education
posture
mobility

swimming / exercise
physio / hydrotherapy
smoking cessation
NSAIDs

sulfasalazine (only evidence that they help peripheral arthritis)

IA steroids

anti TNF (Axial symptoms)

joint replacement

Question 14

nail pitting

Answer 14

associated with psoriatic arthritis

Question 15

transverse naisl

Answer 15

arrested growth

Question 16

lifting of nail

Answer 16

onchylisis

Question 17

dactylitis

Answer 17

sausage toes

psoriatic arthritis

Question 18

ankylosing spondylitis

Answer 18

bamboo spine / question mark posture

significant curvature of the lumbar spine

Question 19

desmophytes

Answer 19

sacroiliac fusion following sacroilitis

Question 20

arthritis mutilans

Answer 20

secondary to psoriatic arthritis (floppy and shortened fingers- telescoping of fingers)

Question 21

psoriatic arthritis classical XRAY changes

Answer 21

pencil in cup deformity

Question 22

calcareoum (heel)

Answer 22

boney spur, calcification

‘calcaenal spur’

Question 23

reactive arthritis feet

Answer 23

keratoderma blenorrhagia

Question 24

PMR

Answer 24

15mg of steroids if they get better then it is likely to be PMR

gradually bring them down over next year or 2

if they do not get better then it’s unlikely to be PMR so can stop the steroids

Question 25

suggestive features of SLE

Answer 25

history of raynaud's
photosensitive rash in summer
arthralgia/arthritis
symptoms suggestive of pericarditis
early pregnancy loss

Question 26

ACR criteria for diagnosis of SLE

Answer 26

• Malar rash
• Discoid rash
• Photosensitivity
• Oral ulcers
• Arthritis
• Serositis – pleuritis or pericaritis
• Renal disorder – persistent proteinuria >0.5g/d, or +3 on dipstick
• Neurologic disorder – seizures or psychosis
• Haematologic disorder – haemolytic anaemia, leukopenia,
lymphopenia, thromboctytopenia
• Immunologic disorder – positive anti-dsDNA or anti-Sm or false
positive test for syphilis
• Anti-nuclear antibody

Question 27

what does seronegative spondyloarthropathies mean?

Answer 27

seronegative= absence of RF / CCP / ANA

spend = spine
arthropathies= joint problems

Question 28

degenerative vs inflammatory

Answer 28

similar: pain, reduced movement, functional loss, deformity
difference: stiffness, diurnal, swelling, location