Spondyloarthropathies Flashcards
symptoms of SLE
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)
investigation
FBC, U+E, LFT, CRP, PV ANA +/- ENA ds DNA, complement cardiolipin antibody lupus anticoagulant bet 2 glycoprotein organ/system specific investigations
Anti-phospholipid antibody syndrome
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
Raynards
keep the core warm
white > blue > pink
avoid getting too cold
levied reticularis
can be subtle
seen on thighs
butterfly discoid rash (lupus)
often photosensitive
treatment
corticosteroids (PO/IV/topical) hydroxychloroquine azathioprine methotrexate cyclophaoamide cilcosporin A thalidomie leeflunomide rituximab IV Ig
seronegative spondyloarthropathies
group of inflammatory arthrides
spine / few peripheral joints
young M/F
inflamamtory symptoms
enthesitis extra articular
HLA-B27 association
(genetic testing)
extra-articular features
fatigue weight loss anaemia irtis upper lobe lung fibrosis reduced chest expansion IgA nephropathy aortic incompetence cardiomyopathy conduction defects
extra-articular features
fatigue weight loss anaemia irtis (anterior uveititis) red painful eye upper lobe lung fibrosis reduced chest expansion IgA nephropathy aortic incompetence cardiomyopathy conduction defects
investigations
inflammatory markers
HLA-B27
Imaging: MRI with STIR sequences
Xray (rarely done as an MRI is diagnostic)
prognosis
early hip involvement ESR >30 poor response to NSAIDs early loss of lumbar mobility dactylics oligoarticular disease onset <16 yrs
management
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
nail pitting
associated with psoriatic arthritis
transverse naisl
arrested growth
lifting of nail
onchylisis
dactylitis
sausage toes
psoriatic arthritis
ankylosing spondylitis
bamboo spine / question mark posture
significant curvature of the lumbar spine
desmophytes
sacroiliac fusion following sacroilitis
arthritis mutilans
secondary to psoriatic arthritis (floppy and shortened fingers- telescoping of fingers)
psoriatic arthritis classical XRAY changes
pencil in cup deformity
calcareoum (heel)
boney spur, calcification
‘calcaenal spur’
reactive arthritis feet
keratoderma blenorrhagia
PMR
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
suggestive features of SLE
history of raynaud's photosensitive rash in summer arthralgia/arthritis symptoms suggestive of pericarditis early pregnancy loss
ACR criteria for diagnosis of SLE
• 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
what does seronegative spondyloarthropathies mean?
seronegative= absence of RF / CCP / ANA
spend = spine arthropathies= joint problems
degenerative vs inflammatory
similar: pain, reduced movement, functional loss, deformity
difference: stiffness, diurnal, swelling, location
