Spondyloarthropathies

Question 1

what gene predisposes to spondyloarthropathies?

Answer 1

HLA-B27

Question 2

what are the four main spondyloarthropathies?

Answer 2

ankylosing spondylitis
enteropathic arthritis
reactive arthritis
psoriatic arthritis

Question 3

describe mechanical back pain

Answer 3

worsened by activity
worse at the end of the day
improves with rest

Question 4

describe inflammatory bakc pain

Answer 4

worse with rest
better with activity
significant early morning stiffness >30 mins

Question 5

what is enthesitis?

Answer 5

inflammation at the insertion of tendons into bones

Question 6

what is dactylitis?

Answer 6

inflammation of the whole digit

Question 7

what eye problems can be seen in spondyloarthropathies?

Answer 7

anterior uveitis

conjunctivitis

Question 8

what area is predominantly affected in ankylosing spondylitis?

Answer 8

the spine

Question 9

when does ankylosing spondylitis tend to come on?

Answer 9

late adolescence or early adulthood

Question 10

which sex is more commonly affected by ankylosing spondylitis?

Answer 10

males

Question 11

what is the name of the criteria used to diagnose ankylosing spondylitis?

Answer 11

modified new york criteria
- AS if 4 or 5 met plus one other feature

OR

ASAS criteria

Question 12

what are the five criteria in the new york criteria for diagnosis of ankylosing spondylitis?

Answer 12

limited lumbar motion 
inflammatory back pain for three months 
reduced back pain 
bilateral, grade 2-4 sacroiliitis on XR
unilateral, grade 3-4 sacroiliitis on XR

Question 13

when is ankylosing spondylitis diagnosed under the ASAS criteria?

Answer 13

sacroiliitis on imaging and >1 SpA feature

OR

HLA-B27 positive and >2 SpA features

Question 14

what are the rheumatological features seen in ankylosing spondylitis?

Answer 14

back pain
enthesitis
peripheral arthritis is rare

Question 15

what are the possible extra-articular features in ankylosing spondylitis?

Answer 15

anterior uveitis
fibrosis of upper lung lobes
enteric mucosa inflammation
amyloidosi s

Question 16

what part of the cardiovascular system can be involved in ankylosing spondylitis?

Answer 16

the aortic valve

Question 17

what happens to the spine in ankylosing spondylitis?

Answer 17

vertebrae fuse and syndesmophytes form between vertebrae

Question 18

what tests can be done on clinical examination for ankylosing spondylitis?

Answer 18

tragus/occiput to wall
chest expansion
modified schober test

Question 19

what bloods should be assessed in ankylosing spondylitis?

Answer 19

inflammatory markers

HLA-B27

Question 20

what can be seen on x-ray of ankylosing spondylitis?

Answer 20

sacroiliitis
syndesmophytes
“bamboo spine”

Question 21

what nail features can be seen in psoriatic arthritis?

Answer 21

pitting

onycholysis

Question 22

what can be seen on x-ray of psoriatic arthritis?

Answer 22

marginal erosions and whiskering
pencil in cup deformity
osteolytes
enthesitis

Question 23

what is reactive arthritis?

Answer 23

infection induced systemic illness causing joint involvement

Question 24

when do symptoms occur in reactive arthritis?

Answer 24

1-4 weeks after infection

Question 25

what are the most common causes of reactive arthritis?

Answer 25

urogenital - chlamydia enterogenic - salmonella, shigella

Question 26

who gets reactive arthritis?

Answer 26

young adults usually (20-40) | equal sex distribution

Question 27

what is reiter's syndrome?

Answer 27

a form of reactive arthritis where urethritis, conjunctivitis/uveitis/iritis and arthritis are seen

Question 28

how does reactive arthritis present?

Answer 28

``` fever, fatigue, malaise asymmetric mono/oligoarthritis enthesitis mucucutaneous lesions ocular lesions ```

Question 29

what is enteropathic arthritis associated with?

Answer 29

IBD

Question 30

what joints are affected in enteropathic arthritis?

Answer 30

patients usually have arthritis in several joints especially knees, elbows, ankles and wrists

Question 31

when do symptoms of enteropathic arthritis get worse?

Answer 31

during IBD flare ups

Question 32

how does enteropathic arthritis present?

Answer 32

symptoms of IBD uveitis enthesitis

Question 33

what dermatological complication can be seen in patients with enteropathic arthritis?

Answer 33

pyoderma gangrenosum - associated with IBD

Question 34

what are the first line options for spondyloarthropathies?

Answer 34

NSAIDs | corticosteroid injections

Question 35

name three disease modifying drugs that can be used in spondyloarthropathies

Answer 35

methotrexate sulfasalazine leflunomide

Question 36

when is anti TNF given for spondyloarthropathies?

Answer 36

unresponsive to NSAIDs and methotrexate