Spondyloarthropathies

Question 1

What are spondyloarthropathies?

Answer 1

Group of seronegative inflammatory conditions

Question 2

What does seronegative mean?

Answer 2

Rheumatoid arthritis without rheumatic factor

Question 3

What 6 conditions are part of the spondyloarthropathy group?

Answer 3

Ankylosing Spondylitis
Psoriatic Arthropathy
Reactive Arthropathy
Enteropathic arthropathy
Juvenile Ankylosing spondylitis
Undifferentiated spondyloarthropathy

Question 4

What are the features of spondyloarthropathies?

Answer 4

Inflammation, pain and stiffness in the spine and pelvic joints
Enthesitis
HLA-B27 gene

Question 5

What is enthesitis?

Answer 5

Inflammation where a ligament or tendon attaches to bone

Question 6

What are some SpA features?

Answer 6

Inflammatory back pain
Arthritis
Enthesitis (heel)
Uveitis
Dactylitis
Psoriasis
CD/UC

Question 7

What is dactylitis?

Answer 7

Inflammation of a digit

Question 8

What is ankylosing spondylitis (AS)?

Answer 8

Prototype for spondylarthritis
90% have HLA B27 gene

Question 9

What joints are affected in AS?

Answer 9

Sacroiliac joints
Joints of vertebral column

Question 10

What is the typical presentation of AS?

Answer 10

Lower back pain and stiffness
Sacroiliac pain in the buttock region
Pain worse with rest and improves with movement
Morning stiffness

Question 11

What is a key complication of AS?

Answer 11

Vertebral fractures

Question 12

What features are associated with AS?

Answer 12

Systemic symptoms
Chest pain
Enthesitis
Dactylitis
Anaemia
Anterior uveitis
Aortitis
Heart block
Restrictive lung disease
Pulmonary fibrosis
IBD- CD, UC

Question 13

What investigations are done for AS?

Answer 13

CRP and ESR
HLA B27 genetic test
X ray of spine and sacrum
MRI spine

Question 14

What is the typical appearance of AS on x ray?

Answer 14

Bamboo spine

Question 15

What is the management of AS?

Answer 15

NSAIDs
DMARDs- sulfalazine
Steroids
Anti-TNF
Physio
Exercise and mobilisation
Avoid smoking
Bisphosphonates for osteoporosis

Question 16

What is psoriatic arthritis?

Answer 16

Inflammatory arthritis associated with psoriasis

Question 17

What are the patterns of psoriatic arthritis?

Answer 17

Symmetrical
Asymmetrical
Oligoarthritic (<5 joints)
Arthritis mutilans
Spondylitic

Question 18

What is arthritis mutilans?

Answer 18

Most severe form of psoriatic arthritis
Occurs in phalanges
Osteolysis of the bones around the joints in the digits
Leads to progressive shortening of the finger - telescopic finger

Question 19

What is the presentation of psoriatic arthritis?

Answer 19

Plaques of psoriasis on the skin
Nail pitting
Oncholysis
Dactylitis
Enthesitis
Conjunctivitis
Anterior uveitis
Aortitis

Question 20

What is the management of psoriatic arthritis?

Answer 20

NSAIDs
DMARDS- sulfalazine, methotrexate, leflunomide
Anti-TNF meds

Question 21

What is reactive arthritis?

Answer 21

Arthritis as a reaction to a recent infective trigger

Question 22

What is the usual presentation of reactive arthritis?

Answer 22

Acute monoarthritis- single joint in the lower limb
Warm, swollen and painful

Question 23

What is the main differential for reactive arthritis?

Answer 23

Septic arthritis
In reactive arthritis there is no infection in the joint

Question 24

What are common infective triggers for reactive arthritis?

Answer 24

Chlamydia- most common
Gonorrhoea
Salmonella
Shigella
Campylobacter

Question 25

What is Reiter syndrome?

Answer 25

Reactive arthritis, urethritis and conjunctivitis

Question 26

What are the investigations for reactive arthritis?

Answer 26

Give antibiotics until the possibility of septic arthritis is excluded
Aspirate the joint and send a sample for gram stain, culture and sensitivity testing

Question 27

What is the treatment of reactive arthritis?

Answer 27

NSAIDs
Steroid injections
DMARDs for chronic infetcion