Spondyloarthropathies Flashcards
What are the spondyloarthropathies?
A group of conditions that affect the spine and peripheral joints and are associated with the presence of HLA-B27.
List the four conditions that comprise spondyloarthropathies.
- Ankylosing spondylitis
- Enteropathic arthritis
- Psoriatic arthritis
- Reactive arthritis
Ankylosing spondylitis is the most common among these conditions.
What are the common clinical features of spondyloarthropathies?
- Sacroiliac/axial disease (back/buttock pain)
- Inflammatory arthropathy of peripheral joints
- Enthesitis (inflammation at tendon insertion)
- Extra-articular features (skin/gut/eye)
What is the typical age group for ankylosing spondylitis?
Usually in young men (teens to mid-thirties)
This age range is significant for the onset of symptoms.
What are the common examination findings in ankylosing spondylitis? (3)
- Loss of lumbar lordosis - later
- Exaggerated thoracic kyphosis
- Reduced chest expansion
Schober’s test is used to assess lumbar flexion.
What investigations are commonly used for ankylosing spondylitis?
- CRP levels
- MRI of the spine and SI joints (bone marrow oedema)
- X-ray
- HLA B27 genetic testing
MRI is more sensitive than X-ray for detecting changes.
What is the primary treatment for ankylosing spondylitis?
- NSAIDs
- Physiotherapy
- TNF inhibitors
- IL-17 inhibitors
These treatments aim to manage symptoms and improve function.
What percentage of psoriasis patients develop psoriatic arthritis?
10%
The prevalence is equal in males and females.
What are the typical exam findings in psoriatic arthritis?
- Oligo-arthritis
- Dactylitis
- Symmetrical or mono-arthritis
Severe deformities, such as arthritis mutilans, occur in about 5% of cases.
What are the key radiological investigation findings in psoriatic arthritis?
- Raised CRP levels
- Central joint erosions seen on ultrasound or MRI
‘Pencil in cup’ appearance on X-ray is a characteristic finding.
What is the typical presentation of reactive arthritis?
Sterile synovitis that after a distant infection, typically presenting with acute asymmetrical lower limb arthritis
It occurs a few days to 2 weeks post-infection.
What infections are commonly associated with reactive arthritis?
- Salmonella
- Shigella
- Campylobacter (post dysentery)
- Chlamydia trachomatis (post urethritis/cervicitis)
These infections can trigger sterile synovitis.
What are the complications of ankylosing spondylitis?
- Anterior uveitis
- Aortic incompetence
- AV block
- Apical lung fibrosis
- Amyloidosis
These features are important for diagnosis and management.
What mnemonic can help remember features of inflammatory back pain?
IPAIN!
I: Insidious onset
P: Pain at night
A: Age at onset < 40
I: Improvement with exercise
N: No improvement with rest.
Fill in the blank: In reactive arthritis, the mnemonic for symptoms is ‘Can’t see, can’t ______.’
wee
This refers to conjunctivitis and urethritis.
What percentage of individuals with IBD develop enteropathic arthritis?
10-20%
Of these, 2/3 develop peripheral arthritis and 1/3 develop axial disease.
What are the two types of peripheral disease in enteropathic arthritis?
- Type 1: Oligoarticular, asymmetric
- Type 2: Polyarticular, symmetrical
Type 1 has more correlation with IBD flares.
What is the treatment consideration for NSAIDs in enteropathic arthritis?
NSAIDs may flare IBD
Therefore, DMARDs and TNF inhibitors are often considered.
How does ankylosing spondylitis often present
Bilateral buttock pain
Chest wall and thoracic pain
What is Schober’s test
- mark skin 10cm above and 5cm below PSIS
- bend forward with straight legs
- distance increase to >20cm is normal
What is the treatment of psoriatic arthritis
- NSAIDS
- DMARDs
- TNFi
- IL-17 inhibitor
- IL12/23 inhibitor
What are extra-articular features of reactive arthritis
- skin (circinate balanitis,keratoderma blennorrhagica)
- eye (conjunctivitis, uveitis)
- enthesitis
What are relevant investigations for reactive arthritis
- serology/microbiology
- inflammatory markers raised
- may need joint aspirate to rule out septic/crystal arthritis
What are appropriate treatments for reactive arthritis
- treat infection (this may not improve arthritis). NSAIDs and joint injections
- most will resolve within 2 years; those that do not (esp if HLA-B27+) may need DMARDs
what is ankylosing spondylitis
inflammatory condition affecting the axial skeleton (mainly the spine and sacroiliac joints), causing progressive stiffness and pain
what are the main affected joints of ankylosing spondylitis
- sacroiliac
- vertebral column
can progress to spine and sacroiliac fusion
how might ankylosing spondylitis present
what is the typical X-ray finding of ankylosing spondylitis and what else might they show
bamboo spine in later stages: fusion of sacroiliac and spinal joints
- Squaring of the vertebral bodies
- Subchondral sclerosis and erosions
- Syndesmophytes (areas of bone growth where the ligaments insert into the bone)
- Ossification of the ligaments, discs and joints (these structures start turning into bone)
- Fusion of the facet, sacroiliac and costovertebral joints
What mnemonic can help remember the features of spondylarthropathies
Spineache!
Sausage digit
Psoriasis
Iritis
NSAID response
Enthesitis
Arthritis
Crohns
HLAB27
Elevated inflamm markers
what does characteristic feature of ASP does this X-ray show
sacroilitis
