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Year 3 > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What are Sondyloarthropathies?

A

Group of seronegative chronic inflammatory conditions that affect the spine

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2
Q

What do spondyloarthropathies have in common?

A
  • 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
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3
Q

Which conditions count as Spondyloarthropathies?

A
  1. Ankylosing spondylitis
  2. Enteric arthropathy
  3. Psoriatic arthritis
  4. Reactive arthritis
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4
Q

What is ankylosing spondylitis?

A

Morbus Bechterew= Chronic inflammatory condition of spine and sacroiliac joints of unknown aetiology

  • type of seronegative spondyloarthropathies
  • Ankylosing = stiffening, spondylitis = inflammation of spine
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5
Q

What is the aetiology of ankylosing spondylitis?

A

Unknown

  • autoimmune condition
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6
Q

Which joints are normally affected in akylosing spondylitis?

A
  • Intervertebral
  • and fascet (synovial) joints of spine
  • sacroiliac joint
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7
Q

Which genetic predisposition do all spindyloarthropathies in common?

A

HLA-B27 associated

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8
Q

What is the pathophysiological process in ankylosing spondylitis?

A

Fibroblasts replace immune-destroyed with FIBRIN

+

Ostecyte activation (ossification)

–> immobile + stiffening

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9
Q

What are signs on examination of ankylosing spondylitis?

A

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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10
Q

What are symptoms of a patient with ankylosing spondylitis?

A
  • Gradual onset lower back pain
    • might be butthock
    • neck
  • Worse at night
  • morning stiffness, relieved by exercise
  • Stiffness
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11
Q

What is the prevalence of ankylosing spondylitis?

A
  • 0.05-0.23% of population
  • predominantly men
  • onset between 20-30
    *
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12
Q

What are risk factors for the devlopment of ankylosing spondylitis?

A
  • Male
  • Age <30
  • FH of spondyloarthropathies (HLA-B27)
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13
Q

Which investigations would you do in a patient with suspected ankylosing spondylitis?

A

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
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14
Q

What are vertebral syndesmophytes?

A

paravertebral ossifications that run parallel with the spine c.f. osteophytes which typically protrude perpendicular to the spine

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15
Q

What is Reactive arthritis?

A

Type of Seroneative spondyloarthropathies

Inflammation of joint ususally after an infection

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16
Q

What is the aetiology of reactive arthritis?

A

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
17
Q

What are risk factors for developing reactive arthritis?

A
  • Male Sex
  • HLA-B27 associated
  • Previous GI/Genit urinary infection
18
Q

Which tissues are normally affected in reactive arthritis?

A
  • Joint space
  • Lining of urethra
  • conjunctive
19
Q

What are symptoms of Reactive arthritis?

A
  • 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
20
Q

What are signs on examination of Reactive arthritis?

A
  • Arthtiris
    • asymmetrical oligoarthritis
    • might py mono/polyarthrits (atypical)
  • Soft joint swelling
    • warm , red, stiff, tender
  • Keratoderma Belenorrhagia
  • conjunctivitis
  • Urethitis
  • Arthritis –> 3 together= Reiters syndrome
21
Q

What is Keratoderma Belenorrhagia?

A

Brownm, raised plaques on soles and palms

Sign of reactive arthritis

22
Q

Which investigations would you do in someone with suspected reactive arthritis?

A
  • Hx of previous infection
  • Clinical Exam
  • Positive for HLA-B27

If suspecting septic arthritis

  • aspiration (will be sterile)
23
Q

What is the epidemiology of reactive arthritis?

A

Different in different patient groups

  • adults
  • 30-40/100.000 annually
  • arthritis sometimes can persist for >2 years

Year 3 (52 decks)

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