Spondyloarthropathies Flashcards
What is spondyloarthropathy
Family of inflammatory arhritides characterised by involvement of both the spine and joints, principally in genetically predisposed (HLA B27 positive) individuals
What are the 4 disease subgroups of spondyloarthropathy
Ankylosing spondylitis
Psoriatic Arthritis
Reactive Arthritis (Reiter’s syndrome)
Enteropathic Arthritis
Describe the back pain in mechanical spondyloarthropathy
Worsened by activity, typically worst at the end of the day and better with rest
Describe the back pain in inflammatory spondyloarthropathy
Worse with rest, better with activity and early morning stiffness
What are some of the shared rheumatological features of the spondyloarthropathies
Sacroiliac and spinal involvement
Enthesitis (inflammation at insertion of tendons into bones (e.g. Achilles tendinitis and plantar fasciitis
Inflammatory arthritis (Oligoarticular, asymmetric and predominantly lower limb)
Dactylitis (sausage digits (inflammation of entire digit
What are some of the shared extra-articular features of spondyloarthropathy
Ocular inflammation (anterior uveitis, conjuntivitis
Mucocutaneous lesions
Rare Aortic incompetence or heart block
no rheumatoid nodules
What is ankylosing spondylitis
Chronic systemic inflammatory disorder that primarily affects the spine (sacroiliac joint involvement (sacroiliitis)
What age group /sex develop ankylosing spondylitis
Late adolescence or early adulthood
More common in men
What are some of the clinical features of Ankylosing spondylitis
Back pain (neck, thoracic and lumbar)
Enthesitis
Peripheral articular features:
-anterior uveitis
-cardiovascular involvement (aortic valve/ root)
-pulmonary involvement (fibrosis upper lobes
-asymptomatic enteric mucosal inflammation
-neurological involvement
-amyloidosis
What happens to the sacroiliac joint if ankylosing spondylitis is not diagnosed early enough
It can fuse
How can we form a diagnosis for ankylosing spondylitis
Tragus/occiput to wall Chest expasion Modified Schooner test HLA B27 X Rays -sarcoiliitis Syndesmophytes Bamboo spine
What is the Schober Test
Measuring 10cm above the ASIS and 5cm below and getting the patient to bend over
What happens to the bone density as ankylosing spondylitis progresses
The bone density decreases
What are the treatment options for someone with ankylosing spondylitis
Home exercises Physio OT NSAID Disease modifying drugs Anti-TNF treatment (inflicimab) Corticosteroids
What is psoriatic arthritis
Inflammatory arthritis associated with psoriasis but 10-15% of patients can have it without psoriasis
No rheumatoid nodules
Rheumatoid factor negative
What are some of the clinical features for psoriatic arthritis
Inflammatory arhtiritis Sacroilitis Nail involvement (pitting, onycholysis) Dactylitis Enthestits Extra articular features (eye disease)
How can we make a diagnosis of Psoriatic Arthritis
Bloods: --inflammatory parameters are raised --negative RF XRays --marginal erosions and whispering --pencil in cup appearance --osteolysis ---Enthesitis
What are the treatment for psoriatic arthritis
NSAID Corticosteroids / joint injections Disease modifying drugs (methotrexate etc) Anti-TNF in severe disease Physio OT Orthotics Chiropodist
What is reactive arthritis
Infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
Symptoms arise 1-4 weeks post infection
Who is most likely to develop reactive arthritis
Both male and females aged between 20 and 40
What is Reiter’s syndrome
A form of reactive arthritis
What are the 3 areas that make up the Reiter’s syndrome triad
Urethritis
Conjuntivitis / Uveitis/ Iritis
Arthritis
What are some of the clinical features of Reactive Arthritis
General - fever, fatigue, malaise Asymmetrical mono arthritis or oligoarthritis Enthesitis Mucocutaneous lesions --Keratodema Blenorrhagica --Painless oral ulcers --Hyperkeratotic nails
Ocular lesions (unilateral or bilateral)
- conjuntivitis
- Iritis
Visceral manifestations
- Mild renal disease
- Carditis
How can we make a diagnosis of Reactive Arthritis
Inflammatory parameters FBC and U&E HLA B27 Cultures Joint fluid analysis X ray of affected joints Ophthalmology opinion Aspirate to exclude septic arthritis
What is the treatment for Reactive arthritis
90% resolve spontaneously in 6 months NSAIDs Corticosteroids --Intra articular --Oral --Eye drops AB for underlying infection DMARDs Physio OT
What is the prognosis for a patient with Reactive Arthritis
Generally good
recurrences are not uncommon
Some develop a chronic form
What is enteropathic arthritis
Patients present with Arthritis in several joints, especially the knees, ankles, elbows and wrists and sometimes in the spine, hips or shoulders
What is enteropathic arthritis associated with
IBD (more commonly crohn’s disease)
What are some of the clinical symptoms of Enteropathic arthritis
GI
–loose, watery stool with mucous and blood
–Weight loss, low grade fever
Eye involvement (uveitis)
Skin involvement (pyoderma gangrenosum)
Enthesitis (Achilles tendonitis, plantar fasciitis, lateral epicondylitis
Oral -apthous ulcers
What investigations can be done for Enteropathic arthritis
Upper and lower GI endoscopy with biopsy showing ulceration / colitis
Joint aspirate - no organisms or crystals
Raised inflammatory markers - CRP or PV
XRay / MRI showing sacroiliitis
USS showing synovitis / tenosynovitis
What is the treatment plan for someone with enteropathic arthritis
Treat IBD in order to control arthritis
NSAID usually not a good idea as may exacerbate IBD
Normal analgesia
Steroids (oral, intraarticular, Intramuscular)
Disease modifying drugs (methotrexate, sulfasalazine, azathioprine
Anti-TNF (infliximab, adalimumab
