Spondyloarthropathies Flashcards
What are the spondyloarthropathies?
Heterogenous group of inflammatory musculoskeletal diseases that have similar features
What inflammatory marker is seronegative/absent in spondyloarthropathies?
Rheumatoid Factor
What does seronegative RF in spondyloarthropathies indicate about their pathology compared to RA?
Spondyloarthropathies have different underlying pathology to RA
What genetic marker is associated with spondyloarthropathies?
HLA B27 gene
Why do spondyloarthropathies have similar clinical features?
They share the HLA B27 gene, which causes them to express similar features
What is the HLA B27 associated feature, sacroiliitis?
Inflammation of sacroiliac joint
What is the HLA B27 associated feature, uveitis?
Inflammation of uvea/middle eye layer
What is the HLA B27 associated feature, spondylitis?
Inflammation of ligaments and joints in spine
What direction does spondylitis usually develop in, in spondyloarthropathies?
Usually ascending
What is the HLA B27 associated feature, enthesitis?
Inflammation of enthesis (area where tendon/ligament meets bone)
What is the HLA B27 associated feature, upper lobe fibrosis?
Lung diseases that occur due to thickening and scarring of upper lobes of lungs
Give 3 examples of skin diseases that are associated with HLA B27?
Psoriasis
Keratoderma
Balanitis
What are the axial joints?
Joints in chest, spine, pelvis
What are the peripheral joints?
Joints in limbs except from shoulder and pelvic joints
Does HLA B27 cause involvement of axial joints only in spondyloarthropathies?
No, HLA B27 can also cause involvement of peripheral joints
What are the 4 HLA B27 associated features involving the heart?
Aortitis: inflammation of aorta
Valve disease
Heart block: heart doesn’t pump properly
Aortic root lesions:
What 2 main groups are spondyloarthropathies classed as?
Axial spondyloarthritis (axSpA)
Peripheral spondyloarthritis (pSpA)
What are the 2 main groups of axSpA, and what determines the difference between the 2 groups?
If there is radiological evidence of sacroiliitis, it is classed as radiographic axSpA/Ankylosing spondylitis (AS)
If there isn’t radiological evidence of sacroiliitis, it is classed as non-radiographic axSpA (nr-axSpA)
What are the 4 main groups of pSpA?
psoriatic arthritis (PsA)
reactive arthritis (ReA)
IBD-associated arthritis/enteropathic arthritis,
undifferentiated spondyloarthritis
Why is there a small overlap between spondyloarthropathies classed as axSpA and pSpA?
A small percentage of pSpA can progress to become axSpA
What percentage of individuals aged 10-20 have spondyloarthropathies?
10-20%
What age range is most affected by spondyloarthropathies?
20-40
What percentage of individuals over 45 have spondyloarthropathies?
less than 5%
What is the ratio of males to females affected by spondyloarthropathies?
2:1
What is the estimated prevalence of spondyloarthropathies worldwide?
close to 1%
How many years can it take for spondyloarthropathy to progress until a diagnosis is made?
Up to 8 years
Do spondyloarthropathies have familial aggregation, and why?
Yes, because the HLA B27 gene is inherited
What is familial aggregation?
Clustering of certain traits, behaviours, or disorders within a given family, that can arise from genetic or environmental factors
Are spondyloarthropathies usually directly inherited?
No, very few are directly inherited
Why is HLA B27 presence not a screening test for spondyloarthropathies?
Only 5% of HLA B27 positive individuals develop MSK symptoms overall, which shows that having gene variant doesn’t mean that individual has the condition
What percentage of individuals with AS are HLA B27 positive?
over 95%
What percentage of the British Caucasian population is HLA B27 positive?
8%
What 3 places is pain common in when an individual has axSpA?
Hip, buttock, lower back
Does inflammatory back pain caused by axSpA have a sudden or insidious onset, and at what age does the onset begin?
Insidious (slow with no obvious symptoms at first) at approximately 40 years old
Does inflammatory back pain caused by axSpA have an identifiable cause?
No
What improves inflammatory back pain caused by axSpA, and what doesn’t improve it?
Only improved by activity/movement/exercise
Not improved by rest
When is inflammatory back pain caused by axSpA worse in the day?
Worse at late night and causes early morning stiffness
Is neck pain commonly presented in spondyloarthropathies, and is it equally as common in men and women?
Neck pain is a rare clinical feature that is more common in women
In what 2 planes is there reduced range of spinal movements caused by spondyloarthropathies?
Frontal, sagittal
What is the effect of fatigue caused by spondyloarthropathies?
Chronic sleep disturbance
What extra-articular features are presented in spondyloarthropathies?
Usually features associated with HLA B27
In AS, what 5 radiographic features indicate sacroiliitis?
Erosions (dark areas)
Narrow joint spaces
irregularity
sclerosis
spinal fusions
What are syndesmophytes, and what imaging medium is used to see them?
bony outgrowths from the spinal ligaments as they attach to adjacent vertebral bodies and cause spine to fuse
Seen with MRI
What 2 imaging mediums are used to see enthesitis?
MRI, ultrasound
What is a bone marrow edema, and how is it seen with MRI?
fluid buildup inside bone marrow that indicates inflammation
White areas on MRI
Why does ultrasound/MRI need to be used to identify nr-axSpA instead of x-ray?
X-ray won’t show signs of inflammation
What are the 3 main aspects of acute spondyloarthropathy management?
Analgesia and NSAIDs are first-line therapies
physical therapy with mobilising exercises
occupational therapy
What medications can be given for chronic spondyloarthropathy management, and why are they suitable?
DMARDs eg. methotrexate and sulfasalazine, as they don’t affect the disease progression or spinal symptoms
Biologics can be considered, but DMARDs should be tried first
Give 3 examples of surgeries used to treat spondyloarthropathies?
total arthroplasty
ostectomy (correction of spinal abnormalities)
surgical spinal fusion using plates and screws
