Spondyloarthropathies Flashcards
What are spondyloarthropathies?
Inflammatory arthritides
Involves spine and other joints
In HLA B27 +ve individuals
Name 4 main spondyloarthropathies
Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis
Describe mechanical pain
Worsens with activity
Better with rest
Describe inflammatory pain
Worse with rest
Better with activity
Marked early morning stiffness
List 6 shared rheumatological features of spondyloarthropathies
Sacroiliac involvement Enthesitis Dactylitis Oligoarticular Asymmetric Lower limb mainly
List 4 extra-articular features of spondyloarthropathies
Ocular inflammation
Mucocutanous lesions (ulcers)
Aortic incompetence, heart block (RARE)
NO rheumatoid nodules
What is ankylosing spondylitis (AS)?
Chronic inflammatory disorder
Systemic effects but
Primarily affects spine
What is the hallmark feature of AS?
Sacroiliitis
What is the second most common feature of AS?
Enthesopathy
- Achilles tendonitis
Which demographic is mostly affected by AS?
Late adolescence-early adult
Mostly men
What features are rarely seen with AS?
Peripheral arthritis
- hips, shoulders etc
What are the 6 As associated with AS?
Axial Arthritis Anterior Uveitis Aortic Regurgitation Apical fibrosis Amyloidosis/IgA Nephropathy Achilles tendinitis PlAntar Fasciitis
How does a person with AS look?
Increased thoracic kyphosis
Loss of lumbar lordosis
What can be done in examination can measure the extent of vertebral flexion in patients with AS?
Tragus/occiput to wall measurement
Modified Schober’s test
What are bloods checked for in AS?
ESR, CRP, PV
HLA B27
What is typically seen on Xray of a person with AS?
“Bamboo spine”
Sacroiliitis
Syndesmophytes
What is the drawback of using Xray to diagnose AS?
Changes can only be seen in very advanced disease
Is bone density affected in AS?
No
- contrast with OA
What is the main therapy of AS?
Home exercise
Physiotherapy
OT
NSAIDs for pain
Which drugs are used for AS with peripheral involvement?
DMARDs
- methotrexate
Steroids
What is psoriatic arthritis (PsA)?
Inflammatory Associated w/psoriasis Some cases occur without NO rheumatoid nodules Rheumatoid factor -ve
List 5 clinical features of PsA
(Asymmetric) sacroiliitis Nail pitting Dactylitis Enthesitis (plantar fasciitis, achilles tendinitis) Ocular inflammation
What are the findings in bloods of patients with PsA?
Raised inflammatory markers
-ve RF
What are 3 findings in Xrays of patients with PsA?
Marginal erosions; whiskering
Osteolysis
Enthesitis
List 4 drug classes used to treat PsA
NSAIDs
Intra-articular steroids
DMARDs
Anti TNF (refractory)
List 4 non-pharm treatments of PsA
Physiotherapy
OT
Chiropodist, ortotist
What is Reiter’s syndrome?
Systemic illness caused by infection
Inflammatory synovitis but no culture possible
HLA B27 +ve
How long after infection does Reiters’ come on?
1-4 weeks
Which infections commonly trigger Reiters’?
Urogenital e.g. chlamydia
Enteropathic e.g. salmonella, shigella
What is the Reactive Arthritis triad?
Urethritis
Conjuntivitis/Uveitis/Iritis
Arthritis
What are the clinical features of Reactive Arthritis?
Constitutional symptoms
Asymmetrical mono/oligoarthritis
Enthesitis
Mucocutaneous lesions
Which investigations are needed to diagnose Reactive Arthritis?
Bloods (inflammatory markers)
FBC, U+E
Bacterial cultures (excrement and blood)
Xray
Should Reactive Arthritis always be treated?
No
90% spontaneous resolution within 6/12
What are the pharmacological treatments of Reactive Arthritis?
NSAIDs
Corticosteroids
Antibiotics
DMARDs (refractory)
What are the non-medical treatments of Reactive Arthritis?
Physiotherapy
OT
What is Enteropathic Arthritis?
Associated with IBD
Worse symptoms during flare of IBD
Oligoarthritis - esp knees, ankles, elbows, wrist
May involve spine, hips, shoulders
What are the clinical features of Enteropathic Arthritis?
GI - obviously Weight loss, low fever Uveitis Pyoderma gangrenosum Enthesitis Apthous ulcers
How does one investigate for Enteropathic Arthritis?
Upper and lower GI endoscopy Joint aspirate (should be sterile + no crystals) Raised inflammatory markers Xray - sacroiliitis USS - synovitis
How is Enteropathic Arthritis treated?
Control IBD Analgesia NOT NSAIDs Steroids DMARDs Anti-TNF
