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msk > spondyloarthropathies > Flashcards

spondyloarthropathies Flashcards

1
Q

definition of 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 are the four types of spondyloarthropathies

A
  • ankylosing spondylitis
  • enteropathic arthritis
  • reactive arthritis
  • psoriatic arthritis
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3
Q

what is mechanical back pain

A

worsened by activity, typically worst at end of day

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4
Q

what is inflammatory back pain

A

worse with rest, better with activity, significant early morning stiffness

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5
Q

what are some shared rheumatological features of the spondyloarthropathies

A
  • sarcoiliac and spinal involvement
  • enthesitis
  • inflammatory arthritis
  • dactylitis
  • ocular inflammation
  • skin involvement
  • rare aortic incompetence or heart block
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6
Q

what is ankylosing spondylitis

A

chronic systemic inflammatory disorder that primarily affects the spine

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7
Q

what is the modified New York criteria for ankylosing spondylitis

A
  1. limited lumbar motion
  2. lower inflammatory back pain for 3 months
  3. reduced chest expansion
  4. bilateral, grade 2-4, sarcoilitis on X-ray
  5. unilateral, grade 3-4, sarcoilitis on X-ray
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8
Q

whats a newer criteria for axial spondyloarthritis

A

ASAS

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9
Q

clinical features of ankylosing spondylitis

A
  • back pain
  • enthesitis
  • peripheral arthritis
  • extra articular : anterior uveitis, cardio involvement, resp involvement, amyloidosis, neuro involvement
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10
Q

what are the A’s of ankylosing spondylitis

A 
Axial arthritis 
Anterior uveitis
Aortic regurgitation
Apical fibrosis 
Amyloidosis
Achilles tendinitis 
plAntar fasciitis
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11
Q

what do you look for in X-rays for ankylosing spondylitis

A
  • sarcoliitis
  • syndesmophytes
  • bamboo spine
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12
Q

definition of psoriatic arthritis

A

inflammatory arthritis associated with psoriasis

but 10-15% can have without psoriasis

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13
Q

what are the 5 subgroups of psoriatic arthritis

A
  1. confined to DIP joints (hands/feet)
  2. symmetric polyarthritis
  3. spondylitis with or without peripheral involvement
  4. asymmetric oligoarthritis with dactylitis
  5. arthritis mutilans
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14
Q

clinical features of psoriatic arthritis

A
  • nail involvement (pitting, onycholysis)
  • dactylitis
  • enthesitis - achillies tendinitis, plantar fasciilitis
  • eye disease
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15
Q

what would you look for on X-ray for psoriatic arthritis

A
  • marginal erosions and whiskering
  • pencil in cup deformity
  • osteolysis
  • enthesitis
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16
Q

what is reactive arthritis

A

infection induced systemic illness characterized primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured

17
Q

what are the most common infections for reactive arthritis

A

urogenital and enterogenic

18
Q

what does the Reiter’s syndrome show

A
  • urethritis
  • conjunctivitis/uveitis
  • arthritis
19
Q

clinical features of reactive arthritis

A
  • fever
  • fatigue
  • malaise
  • asymmetrical monoarthritis or oligoarthritis
  • enthesitis
  • mucocutaneous lesions
20
Q

ocular lesions of reactive arthritis

A

conjunctivitis and iritis

21
Q

what are looked for in bloods for reactive arthritis

A
  • inflammatory parameters
  • FBC, U&E’s
  • HLA B27
22
Q

what are investigations for reactive arthritis

A
  • examination
  • bloods
  • cultures
  • joint fluid analysis
  • X-ray of affected joints
  • ophthalmology opinion
23
Q

what other disease is enteropathic arthritis associated with

A

inflammatory bowel disease

24
Q

clinical symptoms of enteropathic arthritis

A
  • arthritis in several joints
  • loose watery stool with mucous and blood
  • weight loss, low grade fever
  • eye involvement
  • skin involvement
  • enthesitis
  • oral - apthous ulcers
25
Q

investigations for enteropathic arthritis

A
  • upper and lower GI endoscopy with biopsy showing ulceration/colitis
  • joint aspirate (no organisms or crystals)
  • raised inflammatory markers
  • X-ray/MRI showing sacroiliitis
  • USS showing synovitis/tenosynovitis
26
Q

pharmacological management of spondyloarthropathies

A
  • NSAIDs
  • corticosteroids
  • topical steroid eyedrops
  • disease modifying drugs
  • Anti TNF in severe disease unresponsive to NSAIDs and Methotrexate
  • Secukinumab only for PsA and AS
27
Q

non-pharmological management for spondyloarthropathies

A
  • physiotherapy
  • occupational therapy
  • orthotics, chiropodist

msk (45 decks)

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