spondyloarthropathies Flashcards
clinical problems associated with spondyloarthritis
back pain
joint pain/swelling
red/painful eye
rash
what is spondyloarthritis
A group of related but distinct conditions with similar clinical features including chronic back pain due to spinal inflammation, peripheral arthritis, enthesitis and dactylitis
conditions involved
Ankylosing spondylitis/Axial Spondyloarthropathy
Psoriatic Arthritis
Enteropathic Arthritis
Reactive Arthritis
hLA-B27
associated with ankylosing spondylitis
mechanical back pain features
Worsened by activity
Improved with rest
Worse at end of day
Onset at any age
Variable speed of onset, may be acute
inflammatory back pain features
Improved by activity but not with rest
Associated with prolonged (>30min) morning stiffness
Responds well to NSAIDs
Insidious onset
Wakes patient in second half of the night
Age of onset <40 (some say <35)
enthesitis
inflammation where the tendons/ligaments insert into bone
dactilytis
inflammation of the tendons and entheses throughout the digit; entire digit swells
in fingers/ toes
state shared features of spondyloarthropathies
enthesitis
dactylitis
joint inflammation
shared extra articular features
occular inflammation; anterior uveitis, conjunctivitis
mucocutaneous lesions
cardiac; aortic incompetence, heart blcok
ankylosing spondyloarthritis
Chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine
which gender is ankylosing spondy more common in
men
what happens to a spine with ankylosing spondylitis
syndesmophyte; fusion of the vertebrae
diagnosis of ankylosing spondylitis
history and exam
bloods; crop and hla-b27
xrays and mri
what is seen on xray of ankyosing
Syndesmophytes
Marginal Ossification
Bamboo spine
Shiny corners
Sacroiliac joint erosions
Sacroiliac joint fusion
what is seen on mri in akylosing
Bone oedema
Sacroiliac joints
Vertebrae- shiny corners
complications of ankylosing
osteoporosis and reduced spinal flexibility
Ventilatory impairment
Aortic Regurgitation
Heart Block
Amyloidosis
what is psoriatic arthritis
Seronegative inflammatory arthropathy occurring in patients with psoriasis
clinical features of psoriatic arthritis
peripheral joint involvement
axial involvement
nail involvement
dactylitis
enthesitis
extra articular features ; eye disease and psoriasis
reactive arthritis
Seronegative, sterile, systemic disease characterised primarily by an inflammatory arthritis induced by infective illness
no infection in joint itself
when does reactive arthritis occur
1-4 weeks after infection
triad of reactive arthritis
urethritis
conjunctivitis
arthritis
enteropathic arthritis
Seronegative arthritis associated with inflammatory bowel disease
management of spondyloarthritis
Physiotherapy
Particularly important in sacroiliitis/spondylitis
Occupational therapy
Podiatry
Orthotics
NSAIDs
Corticosteroids/Joint injections
Initial bridging therapy
Topical steroid eyedrops- Uveitis
Disease Modifying Anti-Rheumatic Drugs
Methotrexate, Sulfasalazine, Leflunomide
Methotrexate also a treatment for uveitis
biologics
