Spondyloarthropathies Flashcards
What are Sondyloarthropathies?
Group of seronegative chronic inflammatory conditions that affect the spine
What do spondyloarthropathies have in common?
- Seronegative (for RF)
- HLA-B27 assciated
- Axial
- pathology in spine and scroiliac joints
- Assymetrical large joint oligoarthritis/monoartyhtirs
- Enthesitis
- Dactylitis
- Extra-articular manifestations
- IBD, iritis,m psoraform rashes, oral ulcers, Aortic valve incompetence
Which conditions count as Spondyloarthropathies?
- Ankylosing spondylitis
- Enteric arthropathy
- Psoriatic arthritis
- Reactive arthritis
What is ankylosing spondylitis?
Morbus Bechterew= Chronic inflammatory condition of spine and sacroiliac joints of unknown aetiology
- type of seronegative spondyloarthropathies
- Ankylosing = stiffening, spondylitis = inflammation of spine
What is the aetiology of ankylosing spondylitis?
Unknown
- autoimmune condition
Which joints are normally affected in akylosing spondylitis?
- Intervertebral
- and fascet (synovial) joints of spine
- sacroiliac joint
Which genetic predisposition do all spindyloarthropathies in common?
HLA-B27 associated
What is the pathophysiological process in ankylosing spondylitis?
Fibroblasts replace immune-destroyed with FIBRIN
+
Ostecyte activation (ossification)
–> immobile + stiffening
What are signs on examination of ankylosing spondylitis?
Spinal
- decreased range of movement, progressive in all directions
Extra-articular
- Anterior uveitis
- Aortic regurgitation
- Enthesitis (e.g. achilles tendon)
- weight loss, fever, fatigue
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What are symptoms of a patient with ankylosing spondylitis?
- Gradual onset lower back pain
- might be butthock
- neck
- Worse at night
- morning stiffness, relieved by exercise
- Stiffness
What is the prevalence of ankylosing spondylitis?
- 0.05-0.23% of population
- predominantly men
- onset between 20-30
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What are risk factors for the devlopment of ankylosing spondylitis?
- Male
- Age <30
- FH of spondyloarthropathies (HLA-B27)
Which investigations would you do in a patient with suspected ankylosing spondylitis?
Clinical diganosis supported by imaging
- Genetic Testing for HLA B27
- MRI
- active inflammation and destructive changes
- spinal X-ray
- “Bamboo spine “
- joint-space narrowing/widening, sclerosis, ankylosis/fusion
- vertebral syndesmophytes
What are vertebral syndesmophytes?
paravertebral ossifications that run parallel with the spine c.f. osteophytes which typically protrude perpendicular to the spine
What is Reactive arthritis?
Type of Seroneative spondyloarthropathies
Inflammation of joint ususally after an infection
What is the aetiology of reactive arthritis?
Normally due to previous infections (may have resolved by time of symptom onset) - 2-3 weeks after
- STI
- e.g clamydia
- GI
- Salmonella, shigella, Yersinia, E-coli, Campylobacter –> Gram -ve
What are risk factors for developing reactive arthritis?
- Male Sex
- HLA-B27 associated
- Previous GI/Genit urinary infection
Which tissues are normally affected in reactive arthritis?
- Joint space
- Lining of urethra
- conjunctive
What are symptoms of Reactive arthritis?
- Pain and swelling of a single, large joint
- ankle, hip, knee, small joints in feet
- might be multiple joints
- Pain in uriation and redness of eyes
- dyspurgia
-
Chest-pain and fever
- All rare
What are signs on examination of Reactive arthritis?
- Arthtiris
- asymmetrical oligoarthritis
- might py mono/polyarthrits (atypical)
- Soft joint swelling
- warm , red, stiff, tender
- Keratoderma Belenorrhagia
- conjunctivitis
- Urethitis
- Arthritis –> 3 together= Reiters syndrome
What is Keratoderma Belenorrhagia?
Brownm, raised plaques on soles and palms
Sign of reactive arthritis
Which investigations would you do in someone with suspected reactive arthritis?
- Hx of previous infection
- Clinical Exam
- Positive for HLA-B27
If suspecting septic arthritis
- aspiration (will be sterile)
What is the epidemiology of reactive arthritis?
Different in different patient groups
- adults
- 30-40/100.000 annually
- arthritis sometimes can persist for >2 years
