Spondyloarthropathies Flashcards
what gene predisposes to spondyloarthropathies?
HLA-B27
what are the four main spondyloarthropathies?
ankylosing spondylitis
enteropathic arthritis
reactive arthritis
psoriatic arthritis
describe mechanical back pain
worsened by activity
worse at the end of the day
improves with rest
describe inflammatory bakc pain
worse with rest
better with activity
significant early morning stiffness >30 mins
what is enthesitis?
inflammation at the insertion of tendons into bones
what is dactylitis?
inflammation of the whole digit
what eye problems can be seen in spondyloarthropathies?
anterior uveitis
conjunctivitis
what area is predominantly affected in ankylosing spondylitis?
the spine
when does ankylosing spondylitis tend to come on?
late adolescence or early adulthood
which sex is more commonly affected by ankylosing spondylitis?
males
what is the name of the criteria used to diagnose ankylosing spondylitis?
modified new york criteria
- AS if 4 or 5 met plus one other feature
OR
ASAS criteria
what are the five criteria in the new york criteria for diagnosis of ankylosing spondylitis?
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
when is ankylosing spondylitis diagnosed under the ASAS criteria?
sacroiliitis on imaging and >1 SpA feature
OR
HLA-B27 positive and >2 SpA features
what are the rheumatological features seen in ankylosing spondylitis?
back pain
enthesitis
peripheral arthritis is rare
what are the possible extra-articular features in ankylosing spondylitis?
anterior uveitis
fibrosis of upper lung lobes
enteric mucosa inflammation
amyloidosi s
what part of the cardiovascular system can be involved in ankylosing spondylitis?
the aortic valve
what happens to the spine in ankylosing spondylitis?
vertebrae fuse and syndesmophytes form between vertebrae
what tests can be done on clinical examination for ankylosing spondylitis?
tragus/occiput to wall
chest expansion
modified schober test
what bloods should be assessed in ankylosing spondylitis?
inflammatory markers
HLA-B27
what can be seen on x-ray of ankylosing spondylitis?
sacroiliitis
syndesmophytes
“bamboo spine”
what nail features can be seen in psoriatic arthritis?
pitting
onycholysis
what can be seen on x-ray of psoriatic arthritis?
marginal erosions and whiskering
pencil in cup deformity
osteolytes
enthesitis
what is reactive arthritis?
infection induced systemic illness causing joint involvement
when do symptoms occur in reactive arthritis?
1-4 weeks after infection
what are the most common causes of reactive arthritis?
urogenital - chlamydia
enterogenic - salmonella, shigella
who gets reactive arthritis?
young adults usually (20-40)
equal sex distribution
what is reiter’s syndrome?
a form of reactive arthritis where urethritis, conjunctivitis/uveitis/iritis and arthritis are seen
how does reactive arthritis present?
fever, fatigue, malaise asymmetric mono/oligoarthritis enthesitis mucucutaneous lesions ocular lesions
what is enteropathic arthritis associated with?
IBD
what joints are affected in enteropathic arthritis?
patients usually have arthritis in several joints
especially knees, elbows, ankles and wrists
when do symptoms of enteropathic arthritis get worse?
during IBD flare ups
how does enteropathic arthritis present?
symptoms of IBD
uveitis
enthesitis
what dermatological complication can be seen in patients with enteropathic arthritis?
pyoderma gangrenosum - associated with IBD
what are the first line options for spondyloarthropathies?
NSAIDs
corticosteroid injections
name three disease modifying drugs that can be used in spondyloarthropathies
methotrexate
sulfasalazine
leflunomide
when is anti TNF given for spondyloarthropathies?
unresponsive to NSAIDs and methotrexate
