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MSK SM > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What is spondyloarthropathy

A

Family of inflammatory arhritides characterised by involvement of both the spine and joints, principally in genetically predisposed (HLA B27 positive) individuals

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2
Q

What are the 4 disease subgroups of spondyloarthropathy

A

Ankylosing spondylitis
Psoriatic Arthritis
Reactive Arthritis (Reiter’s syndrome)
Enteropathic Arthritis

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3
Q

Describe the back pain in mechanical spondyloarthropathy

A

Worsened by activity, typically worst at the end of the day and better with rest

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4
Q

Describe the back pain in inflammatory spondyloarthropathy

A

Worse with rest, better with activity and early morning stiffness

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5
Q

What are some of the shared rheumatological features of the spondyloarthropathies

A

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

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6
Q

What are some of the shared extra-articular features of spondyloarthropathy

A

Ocular inflammation (anterior uveitis, conjuntivitis
Mucocutaneous lesions
Rare Aortic incompetence or heart block
no rheumatoid nodules

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7
Q

What is ankylosing spondylitis

A

Chronic systemic inflammatory disorder that primarily affects the spine (sacroiliac joint involvement (sacroiliitis)

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8
Q

What age group /sex develop ankylosing spondylitis

A

Late adolescence or early adulthood

More common in men

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9
Q

What are some of the clinical features of Ankylosing spondylitis

A

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

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10
Q

What happens to the sacroiliac joint if ankylosing spondylitis is not diagnosed early enough

A

It can fuse

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11
Q

How can we form a diagnosis for ankylosing spondylitis

A 
Tragus/occiput to wall
Chest expasion
Modified Schooner test 
HLA B27
X Rays 
-sarcoiliitis 
Syndesmophytes 
Bamboo spine
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12
Q

What is the Schober Test

A

Measuring 10cm above the ASIS and 5cm below and getting the patient to bend over

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13
Q

What happens to the bone density as ankylosing spondylitis progresses

A

The bone density decreases

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14
Q

What are the treatment options for someone with ankylosing spondylitis

A 
Home exercises 
Physio
OT 
NSAID 
Disease modifying drugs 
Anti-TNF treatment (inflicimab)
Corticosteroids
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15
Q

What is psoriatic arthritis

A

Inflammatory arthritis associated with psoriasis but 10-15% of patients can have it without psoriasis
No rheumatoid nodules
Rheumatoid factor negative

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16
Q

What are some of the clinical features for psoriatic arthritis

A 
Inflammatory arhtiritis 
Sacroilitis 
Nail involvement (pitting, onycholysis)
Dactylitis 
Enthestits 
Extra articular features (eye disease)
17
Q

How can we make a diagnosis of Psoriatic Arthritis

A 
Bloods: 
--inflammatory parameters are raised 
--negative RF 
XRays 
--marginal erosions and whispering 
--pencil in cup appearance 
--osteolysis
---Enthesitis
18
Q

What are the treatment for psoriatic arthritis

A 
NSAID 
Corticosteroids / joint injections 
Disease modifying drugs (methotrexate etc)
Anti-TNF in severe disease 
Physio
OT
Orthotics 
Chiropodist
19
Q

What is reactive arthritis

A

Infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
Symptoms arise 1-4 weeks post infection

20
Q

Who is most likely to develop reactive arthritis

A

Both male and females aged between 20 and 40

21
Q

What is Reiter’s syndrome

A

A form of reactive arthritis

22
Q

What are the 3 areas that make up the Reiter’s syndrome triad

A

Urethritis
Conjuntivitis / Uveitis/ Iritis
Arthritis

23
Q

What are some of the clinical features of Reactive Arthritis

A 
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
24
Q

How can we make a diagnosis of Reactive Arthritis

A 
Inflammatory parameters
FBC and U&E
HLA B27
Cultures 
Joint fluid analysis 
X ray of affected joints 
Ophthalmology opinion 
Aspirate to exclude septic arthritis
25
Q

What is the treatment for Reactive arthritis

A 
90% resolve spontaneously in 6 months 
NSAIDs
Corticosteroids 
--Intra articular 
--Oral
--Eye drops
AB for underlying infection 
DMARDs
Physio
OT
26
Q

What is the prognosis for a patient with Reactive Arthritis

A

Generally good
recurrences are not uncommon
Some develop a chronic form

27
Q

What is enteropathic arthritis

A

Patients present with Arthritis in several joints, especially the knees, ankles, elbows and wrists and sometimes in the spine, hips or shoulders

28
Q

What is enteropathic arthritis associated with

A

IBD (more commonly crohn’s disease)

29
Q

What are some of the clinical symptoms of Enteropathic arthritis

A

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

30
Q

What investigations can be done for Enteropathic arthritis

A

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

31
Q

What is the treatment plan for someone with enteropathic arthritis

A

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

MSK SM (42 decks)

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