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Rheumatology > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

Ankylosing spondylitis, Enteropathic arthritis, Psoriatic arthritis + Reactive arthritis

1
Q

What are the spondyloarthropathies?

A

A group of conditions that affect the spine + peripheral joints + are associated with presence of HLA-B27
- psoriatic arthritis
- ankylosing spondylitis
- Enteropathic arthritis
- reactive arthritis

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2
Q

List the spondylarthropathies

A

SPEAR
- Spondylarthropathies
- Psoriatic arthritis
- Enteropthic arthritis
- Ankylosing spondylitis
- Reactive arthritis

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3
Q

Common clinic features of spondyloarthropathies

A
  • sacroiliac disease (back/buttock pain)
  • inflammatory arthopathy of peripheral joints
  • enthesitis (inflammation of tendon insertions)
  • extra-articular features
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4
Q

What is ankylosing spondylitis?

A
  • Inflammatory conditions affecting the axial skeleton
  • Causes progressive stiffness + pain
  • Mainly affects the sacroiliac joints + vertebral column joints > can cause fusion of these joints
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5
Q

Presentation of ankylosing spondylitis

A
  • lower back or buttock pain + stiffness
  • > 30 mins morning stiffness
  • improve with activity + worsens with rest
  • chest pain + SOB
  • enthesitis
  • dactylitis
  • vertebral fracture
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6
Q

What is enthesitis?

A

Inflammation of tendon insertion points

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7
Q

What is dactylitis?

A

Inflammation of entire finger

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8
Q

Extra-articular manifestations of ankylosing spondylitis

A

ALL THE As
- Anterior uveitis
- Aoritc incompetence
- AV block
- Apical lung fibrosis
- Amyloidosis

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9
Q

What is Shober’s test?

A
  • assesses spinal mobility with patient standing straight
  • S2 vertebra located
  • point marked 10cm above + 5cm below
  • patient bends forward as far as possible
  • distance between points is measured
  • > 20cm is normal
  • <20cm indicates restriction in lumbar movement
  • helps to support diagnosis of ankylosing spondylitis
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10
Q

What test is used to help to diagnose ankylosing spondylitis?

A

Shober’s test

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11
Q

What is found on examination of ankylosing spondylitis?

A
  • loss of lumbar lordosis
  • exaggerated thoracic kyphosis
  • Shober’s test of <20cm
  • reduced chest expansion
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12
Q

Investigations of ankylosing spondylitis

A
  • X-ray of spine + sacrum
  • MRI of spine (can show bone marrow oedema before X ray changes)
    .
  • inflammatory markers (CRP+ESR)
  • HLA-B27 genetic testing
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13
Q

X ray features of ankylosing spondylitis

A
  • ‘bamboo spine’ due to fusion of sacroiliac + spinal joints
  • squaring of vertebral bodies
  • subchondral sclerosis + erosions
  • ossification of ligaments, discs + joints
  • areas of bone growth where ligaments insert (syndesmophytes)
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14
Q

Management of ankylosing spondylitis

A
  • first line: NSAIDs
  • second line: anti-TNF meds - e.g. etanercept, infliximab
  • third line: mab against IL17 - e.g. secukinumab
  • Physiotherapy
  • smoking cessation
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15
Q

What % of people with psoriasis will have psoriatic arthritis?

A

10%

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16
Q

Where does psoriatic arthritis tend of affect?

A

DIP
Axial skeleton

17
Q

Signs of psoriatic arthritis

A
  • psoriatic plaques on skin
  • nail pitting
  • onycholysis
  • dactylitis
  • enthesitis
18
Q

What is onycholysis?

A

Separation of nail from the nail bed

19
Q

What is used to screen psoriasis patients for psoriatic arthritis?

A

PEST
Psoriasis Epidemiological Screening Tool

20
Q

Investigations of psoriatic arthritis

A
  • X ray
  • raised CRP
  • MRI
21
Q

X ray features of psoriatic arthritis

A
  • pencil in cup appearance
  • periostitis > thickened + irregular bone outline
  • ankylosis (fusion of bone at joint)
  • osteolysis
  • dactylitis > soft tissue swelling
22
Q

What is the pencil in cup appearance on an X ray associated with?

A

Psoriatic arthritis
Arthritis mutilans

23
Q

Management of psoriatic arthritis

A
  • NSAIDs
  • steroids
  • DMARDs e.g. methotrexate, leflunomide, sulfasalazine
  • anti-TNF meds e.g. infliximab, etanercept
24
Q

What is reactive arthritis?
When does it occur?

A

Sterile synovitis developing after a distant infection either after gastroenteritis (salmonella/shigella/campylobacter) or following urethritis/cervicitis (chlamydia trachomatis)

25
Q

Who is reactive arthritis more common in?

A

Patients with HIV

26
Q

Presentation of reactive arthritis
+ associated features

A

- presenting a few days - 2 weeks post infection
- acute single warm swollen painful joint
- acute asymmetrical lower limb arthritis
.
- bilateral conjunctivitis
- uveitis
- urethritis
- circulate balanitis (dermatitis of head of penis)

27
Q

Classic triad of reactive arthritis

A

‘Can’t see, pee or climb a tree’
- conjunctivitis/uveitis
- urethritis
- reactive arthritis

28
Q

Investigations of reactive arthritis

A
  • joint aspiration to rule out septic arthritis + gout
  • serology/microbiology
29
Q

Management of reactive arthritis

A
  • treat infection
  • NSAIDs
  • steroid joint injections
  • most resolve within 2 years, if not > DMARDs
30
Q

What condition is Enteropathic arthritis associated with?

A

IBD - Crohn’s + ulcerative colitis

31
Q

What are the 2 types of peripheral disease in Enteropathic arthritis

A
  • type 1: asymmetric oligoarticular + correlation with IBD flares
  • type 2: symmetrical poly articular + less correlation with IBD flares
32
Q

Management of Enteropathic arthritis

A
  • DMARDs
  • TNF inhibitors e.g. infliximab will treat IBD + arthritis
  • avoid NSAIDs (may flare IBD)
33
Q

Associated features of spondyloarthropathies

A

SPINE ACHE
- Sausage fingers (dactylitis)
- Psoriasis
- Iritis (uveitis)
- NSAID response +
- Enthesitis
- Arthritis
- Crohn’s/UC
- HLA-B27
- Elevated inflammatory markers

Rheumatology (15 decks)

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