Spondyloarthropathies Flashcards
What are spondyloarthropathies?
Group of seronegative inflammatory conditions
What does seronegative mean?
Rheumatoid arthritis without rheumatic factor
What 6 conditions are part of the spondyloarthropathy group?
Ankylosing Spondylitis
Psoriatic Arthropathy
Reactive Arthropathy
Enteropathic arthropathy
Juvenile Ankylosing spondylitis
Undifferentiated spondyloarthropathy
What are the features of spondyloarthropathies?
Inflammation, pain and stiffness in the spine and pelvic joints
Enthesitis
HLA-B27 gene
What is enthesitis?
Inflammation where a ligament or tendon attaches to bone
What are some SpA features?
Inflammatory back pain
Arthritis
Enthesitis (heel)
Uveitis
Dactylitis
Psoriasis
CD/UC
What is dactylitis?
Inflammation of a digit
What is ankylosing spondylitis (AS)?
Prototype for spondylarthritis
90% have HLA B27 gene
What joints are affected in AS?
Sacroiliac joints
Joints of vertebral column
What is the typical presentation of AS?
Lower back pain and stiffness
Sacroiliac pain in the buttock region
Pain worse with rest and improves with movement
Morning stiffness
What is a key complication of AS?
Vertebral fractures
What features are associated with AS?
Systemic symptoms
Chest pain
Enthesitis
Dactylitis
Anaemia
Anterior uveitis
Aortitis
Heart block
Restrictive lung disease
Pulmonary fibrosis
IBD- CD, UC
What investigations are done for AS?
CRP and ESR
HLA B27 genetic test
X ray of spine and sacrum
MRI spine
What is the typical appearance of AS on x ray?
Bamboo spine
What is the management of AS?
NSAIDs
DMARDs- sulfalazine
Steroids
Anti-TNF
Physio
Exercise and mobilisation
Avoid smoking
Bisphosphonates for osteoporosis
What is psoriatic arthritis?
Inflammatory arthritis associated with psoriasis
What are the patterns of psoriatic arthritis?
Symmetrical
Asymmetrical
Oligoarthritic (<5 joints)
Arthritis mutilans
Spondylitic
What is arthritis mutilans?
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
What is the presentation of psoriatic arthritis?
Plaques of psoriasis on the skin
Nail pitting
Oncholysis
Dactylitis
Enthesitis
Conjunctivitis
Anterior uveitis
Aortitis
What is the management of psoriatic arthritis?
NSAIDs
DMARDS- sulfalazine, methotrexate, leflunomide
Anti-TNF meds
What is reactive arthritis?
Arthritis as a reaction to a recent infective trigger
What is the usual presentation of reactive arthritis?
Acute monoarthritis- single joint in the lower limb
Warm, swollen and painful
What is the main differential for reactive arthritis?
Septic arthritis
In reactive arthritis there is no infection in the joint
What are common infective triggers for reactive arthritis?
Chlamydia- most common
Gonorrhoea
Salmonella
Shigella
Campylobacter
What is Reiter syndrome?
Reactive arthritis, urethritis and conjunctivitis
What are the investigations for reactive arthritis?
Give antibiotics until the possibility of septic arthritis is excluded
Aspirate the joint and send a sample for gram stain, culture and sensitivity testing
What is the treatment of reactive arthritis?
NSAIDs
Steroid injections
DMARDs for chronic infetcion
