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Musculoskeletal > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What are spondyloarthropathies?

A

Inflammatory arthritides
Involves spine and other joints
In HLA B27 +ve individuals

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2
Q

Name 4 main spondyloarthropathies

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

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3
Q

Describe mechanical pain

A

Worsens with activity

Better with rest

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4
Q

Describe inflammatory pain

A

Worse with rest
Better with activity
Marked early morning stiffness

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5
Q

List 6 shared rheumatological features of spondyloarthropathies

A 
Sacroiliac involvement
Enthesitis
Dactylitis
Oligoarticular
Asymmetric
Lower limb mainly
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6
Q

List 4 extra-articular features of spondyloarthropathies

A

Ocular inflammation
Mucocutanous lesions (ulcers)
Aortic incompetence, heart block (RARE)
NO rheumatoid nodules

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7
Q

What is ankylosing spondylitis (AS)?

A

Chronic inflammatory disorder
Systemic effects but
Primarily affects spine

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8
Q

What is the hallmark feature of AS?

A

Sacroiliitis

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9
Q

What is the second most common feature of AS?

A

Enthesopathy

- Achilles tendonitis

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10
Q

Which demographic is mostly affected by AS?

A

Late adolescence-early adult

Mostly men

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11
Q

What features are rarely seen with AS?

A

Peripheral arthritis

- hips, shoulders etc

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12
Q

What are the 6 As associated with AS?

A 
Axial Arthritis
Anterior Uveitis
Aortic Regurgitation
Apical fibrosis
Amyloidosis/IgA Nephropathy
Achilles tendinitis
PlAntar Fasciitis
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13
Q

How does a person with AS look?

A

Increased thoracic kyphosis

Loss of lumbar lordosis

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14
Q

What can be done in examination can measure the extent of vertebral flexion in patients with AS?

A

Tragus/occiput to wall measurement

Modified Schober’s test

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15
Q

What are bloods checked for in AS?

A

ESR, CRP, PV

HLA B27

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16
Q

What is typically seen on Xray of a person with AS?

A

“Bamboo spine”
Sacroiliitis
Syndesmophytes

17
Q

What is the drawback of using Xray to diagnose AS?

A

Changes can only be seen in very advanced disease

18
Q

Is bone density affected in AS?

A

No

- contrast with OA

19
Q

What is the main therapy of AS?

A

Home exercise
Physiotherapy
OT
NSAIDs for pain

20
Q

Which drugs are used for AS with peripheral involvement?

A

DMARDs
- methotrexate
Steroids

21
Q

What is psoriatic arthritis (PsA)?

A 
Inflammatory
Associated w/psoriasis
Some cases occur without
NO rheumatoid nodules
Rheumatoid factor -ve
22
Q

List 5 clinical features of PsA

A 
(Asymmetric) sacroiliitis
Nail pitting
Dactylitis
Enthesitis (plantar fasciitis, achilles tendinitis)
Ocular inflammation
23
Q

What are the findings in bloods of patients with PsA?

A

Raised inflammatory markers

-ve RF

24
Q

What are 3 findings in Xrays of patients with PsA?

A

Marginal erosions; whiskering
Osteolysis
Enthesitis

25
Q

List 4 drug classes used to treat PsA

A

NSAIDs
Intra-articular steroids
DMARDs
Anti TNF (refractory)

26
Q

List 4 non-pharm treatments of PsA

A

Physiotherapy
OT
Chiropodist, ortotist

27
Q

What is Reiter’s syndrome?

A

Systemic illness caused by infection
Inflammatory synovitis but no culture possible
HLA B27 +ve

28
Q

How long after infection does Reiters’ come on?

A

1-4 weeks

29
Q

Which infections commonly trigger Reiters’?

A

Urogenital e.g. chlamydia

Enteropathic e.g. salmonella, shigella

30
Q

What is the Reactive Arthritis triad?

A

Urethritis
Conjuntivitis/Uveitis/Iritis
Arthritis

31
Q

What are the clinical features of Reactive Arthritis?

A

Constitutional symptoms
Asymmetrical mono/oligoarthritis
Enthesitis
Mucocutaneous lesions

32
Q

Which investigations are needed to diagnose Reactive Arthritis?

A

Bloods (inflammatory markers)
FBC, U+E
Bacterial cultures (excrement and blood)
Xray

33
Q

Should Reactive Arthritis always be treated?

A

No

90% spontaneous resolution within 6/12

34
Q

What are the pharmacological treatments of Reactive Arthritis?

A

NSAIDs
Corticosteroids
Antibiotics
DMARDs (refractory)

35
Q

What are the non-medical treatments of Reactive Arthritis?

A

Physiotherapy

OT

36
Q

What is Enteropathic Arthritis?

A

Associated with IBD
Worse symptoms during flare of IBD
Oligoarthritis - esp knees, ankles, elbows, wrist
May involve spine, hips, shoulders

37
Q

What are the clinical features of Enteropathic Arthritis?

A 
GI - obviously
Weight loss, low fever
Uveitis
Pyoderma gangrenosum
Enthesitis
Apthous ulcers
38
Q

How does one investigate for Enteropathic Arthritis?

A 
Upper and lower GI endoscopy
Joint aspirate (should be sterile + no crystals)
Raised inflammatory markers
Xray - sacroiliitis
USS - synovitis
39
Q

How is Enteropathic Arthritis treated?

A 
Control IBD
Analgesia NOT NSAIDs
Steroids
DMARDs
Anti-TNF

Musculoskeletal (19 decks)

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