spondyloarthropathies Flashcards
definition of spondyloarthropathy
family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed individuals
what are the four types of spondyloarthropathies
- ankylosing spondylitis
- enteropathic arthritis
- reactive arthritis
- psoriatic arthritis
what is mechanical back pain
worsened by activity, typically worst at end of day
what is inflammatory back pain
worse with rest, better with activity, significant early morning stiffness
what are some shared rheumatological features of the spondyloarthropathies
- sarcoiliac and spinal involvement
- enthesitis
- inflammatory arthritis
- dactylitis
- ocular inflammation
- skin involvement
- rare aortic incompetence or heart block
what is ankylosing spondylitis
chronic systemic inflammatory disorder that primarily affects the spine
what is the modified New York criteria for ankylosing spondylitis
- limited lumbar motion
- lower inflammatory back pain for 3 months
- reduced chest expansion
- bilateral, grade 2-4, sarcoilitis on X-ray
- unilateral, grade 3-4, sarcoilitis on X-ray
whats a newer criteria for axial spondyloarthritis
ASAS
clinical features of ankylosing spondylitis
- back pain
- enthesitis
- peripheral arthritis
- extra articular : anterior uveitis, cardio involvement, resp involvement, amyloidosis, neuro involvement
what are the A’s of ankylosing spondylitis
Axial arthritis Anterior uveitis Aortic regurgitation Apical fibrosis Amyloidosis Achilles tendinitis plAntar fasciitis
what do you look for in X-rays for ankylosing spondylitis
- sarcoliitis
- syndesmophytes
- bamboo spine
definition of psoriatic arthritis
inflammatory arthritis associated with psoriasis
but 10-15% can have without psoriasis
what are the 5 subgroups of psoriatic arthritis
- confined to DIP joints (hands/feet)
- symmetric polyarthritis
- spondylitis with or without peripheral involvement
- asymmetric oligoarthritis with dactylitis
- arthritis mutilans
clinical features of psoriatic arthritis
- nail involvement (pitting, onycholysis)
- dactylitis
- enthesitis - achillies tendinitis, plantar fasciilitis
- eye disease
what would you look for on X-ray for psoriatic arthritis
- marginal erosions and whiskering
- pencil in cup deformity
- osteolysis
- enthesitis
what is reactive arthritis
infection induced systemic illness characterized primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
what are the most common infections for reactive arthritis
urogenital and enterogenic
what does the Reiter’s syndrome show
- urethritis
- conjunctivitis/uveitis
- arthritis
clinical features of reactive arthritis
- fever
- fatigue
- malaise
- asymmetrical monoarthritis or oligoarthritis
- enthesitis
- mucocutaneous lesions
ocular lesions of reactive arthritis
conjunctivitis and iritis
what are looked for in bloods for reactive arthritis
- inflammatory parameters
- FBC, U&E’s
- HLA B27
what are investigations for reactive arthritis
- examination
- bloods
- cultures
- joint fluid analysis
- X-ray of affected joints
- ophthalmology opinion
what other disease is enteropathic arthritis associated with
inflammatory bowel disease
clinical symptoms of enteropathic arthritis
- arthritis in several joints
- loose watery stool with mucous and blood
- weight loss, low grade fever
- eye involvement
- skin involvement
- enthesitis
- oral - apthous ulcers
investigations for enteropathic arthritis
- 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
pharmacological management of spondyloarthropathies
- NSAIDs
- corticosteroids
- topical steroid eyedrops
- disease modifying drugs
- Anti TNF in severe disease unresponsive to NSAIDs and Methotrexate
- Secukinumab only for PsA and AS
non-pharmological management for spondyloarthropathies
- physiotherapy
- occupational therapy
- orthotics, chiropodist
