Spondyloarthropathies

Question 1

What is a spondyloarthropathy

Answer 1

Inf arthropathy affecting axial skeleton and peripheral joints

Question 2

What is the strongly associated gene?

Answer 2

HLA-B27

Question 3

What are the 4 types?

Answer 3

Ankylosing Spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis

Question 4

What are the common features of the 4 types?

Answer 4

Seronegativity
Sacroiliac and spinal involvement
Synovitis, enthesitis, dactylitis
Eye involvement

Question 5

What is psoriatic arthritis?

Answer 5

Psoriasis associated inflammatory arthritis

Question 6

Who does it affect?

Answer 6

10-20% of psoriasis patients get this
It can occur before visible skin changes

Question 7

What are the 5 patterns of PsA

Answer 7

Asymmetrical oligoarthritis- affects 1-4 joints, often only unilaterally

Symmetrical polyarthritis- similar to RA

Distal interphalangeal predominant patternprimarily affects DIP joints. (However DIP joints can be affected across all types)

Spondylitispresents with back stiffness and pain. involvesaxial skeleton(spine and sacroiliac joints)

Arthritis mutilans-most severe, affectsphalanges. There isosteolysis around joints, leading to progressive digit shortening. Skin folds as digit shortens, resulting intelescoping digit

Question 8

How does PsA present?

Answer 8

Visible psoriasis
Nail pitting
Onycholysis- nail nail bed separation
Dactylitis and enthesitis

Question 9

X-ray signs of PsA

Answer 9

‘Pencil in cup’ in fingers

Question 10

What is dactylitis?

Answer 10

Sausage fingers

Question 11

How is PsA diagnosed?

Answer 11

PEST- psoriasis epidemiological screening tool

Screens psoriasis patients for PA, high scores get referred

Question 12

Treatment for PsA

Answer 12

MDT involvement (dermatology, rheumatology)

NSAIDs
Steroids
DMARDs
AntiTNFs

Ustekinumab last resort (IL12 IL23 antagonist)

Question 13

What is ankylosing Spondylitis?

Answer 13

Inflammation of spine and SI joints

Question 14

Most common presentation of AS

Answer 14

Slow onset lower back pain and stiffness
Worse at rest, better with movement

Question 15

Other associated symptoms of AS

Answer 15

Costochondritis
Enthesitis- inf of tendon/ligament insertions
Dactylitis
Vertebral fractures
SOB due to restricted chest wall movement
Plantar fasciitis

Question 16

What conditions are associated with AS?

Answer 16

Anterior uveitis
Aortic regurg
Atrioventricular block
Apical lung fibrosis
Anaemia of chronic disease

Question 17

How is AS diagnosed?

Answer 17

Schobers test
CRP and ESR
HLA B27 testing

X-ray findings-
bamboo spine (SI joint fusion)
Vertebral body squaring
Areas of bone growth where ligaments insert into bone
Ligament ossification

MRI findings-
Bone marrow oedema

Question 18

Management for AS

Answer 18

Non medical- physio, exercise, smoking cessation

Medical- NSAIDs, antiTNFs, IL17s and JAK inhibitors

Possible steroid injections

Question 19

What is enteropathic arthritis?

Answer 19

Arthritis associated with inflammatory bowel disease

Question 20

What are the clinical features of EA?

Answer 20

Large joint peripheral arthritis and axial arthritis
Enthesitis
May be active during flare of IBD

Question 21

How is enteropathic arthritis treated?

Answer 21

Manage IBD

NO NSAIDs- may make IBD worse
Corticosteroids for short term flares
DMARDs, IL12/23 eg ustekinumab, and JAK inhibitors

Question 22

What is reactive arthritis?

Answer 22

Any level of synovitis that has an infective trigger

Question 23

What commonly triggers it?

Answer 23

Gastroenteritis
STIs
Dysentery

Question 24

What is the common presentation of reactive arthritis?

Answer 24

Acute monoarthritis, commonly in the knee

Can’t pee, see, or climb a tree:
Urethritis, conjunctivitis, arthritis

Presentation can be confused with septic arthritis and gout

Question 25

Management for reactive arthritis

Answer 25

Exclude septic arthritis and gout

Steroid injections, treating triggering infections, NSAIDs

DMARDs and antiTNFs in chronic cases