Spondyloarthropathies

Question 1

Define spondyloarthropathy

Answer 1

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

Question 2

How is mechanical back pain defined?

Answer 2

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

Question 3

How is inflammatory back pain defined?

Answer 3

Worse with rest, better with activity, early morning stiffness

Question 4

What are some shared rheumatological features of the spondyloarthropathies?

Answer 4

Sacroiliac/spinal involvement. Enthesitis, inflammatory arthritis: oligoarticular, asymmetric, predominantly lower limb, dactylitis

Question 5

What is enthesitis?

Answer 5

Inflammation at insertion of tendons into bones e.g. achilles tendinitis, plantar fasciitis

Question 6

What is dactylitis?

Answer 6

Inflammation of entire digit

Question 7

What are the seronegative inflammatory arthropathies?

Answer 7

AS, psoriatic arthritis, enteropathic arthritis, reactive arthritis

Question 8

What antigen is often present in spondyloarthropathies?

Answer 8

HLA-B27

Question 9

What is ankylosing spondylitis?

Answer 9

Chronic inflammatory disease of spine and SI joints which can lead to fusion of intervertebral and SI joints.

Question 10

Who would likely present with AS?

Answer 10

Males 3M:1F, 20-40yo

Question 11

What symptoms and signs may a patient with AS present with?

Answer 11

Spinal pain, stiffness, knee/hip arthritis, decreased spinal movement, development of question mark spine-loss of lumbar lordosis and increased thoracic kyphosis

Question 12

What is used to test lumbar spine flexion?

Answer 12

Schobers test

Question 13

What are the associated conditions of AS?

Answer 13

Anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis

Question 14

What may imaging show in AS?

Answer 14

XR-sclerosis and fusion of SI joints, bony spurs from vertebral bodies known as syndesmophytes, can be normal. MRI- bone marrow oedema, enthesitis of spinal ligaments

Question 15

What is the treatment for AS?

Answer 15

Physio, exercise, NSAIDs and anti-TNF inhibitors. DMARDS no use on spinal disease, use if peripheral joint inflammation.

Question 16

What is psoriatic arthritis?

Answer 16

Arthritis affecting up to 30% psoriasis patients. Usually asymmetrical oligoarthritis, can be similar in halds to RA.

Question 17

What symptoms and signs occur in psoriatic arthritis?

Answer 17

Spondylitis, dactylitis, enthesitis commonly occur. Nail changes-pitting, oncholysis. Some patient have arthritis in DIP joints.

Question 18

What is the treatment of psoriatic arthritis?

Answer 18

DMARDs, usually methotrexate. Anti-TNF therapy available. Joint replacement, DIP joint fusion considered

Question 19

What is reactive arthritis?

Answer 19

An AI arthropathy which occurs in response to an infection in another part of the body. Usually self limiting (70-85%)

Question 20

What infections usually cause an infective arthritis?

Answer 20

Commonly GU infections (chlamydia, neisseria, or GI (salmonella, campylobacter).

Question 21

What symptons and signs occur in infective arthritis?

Answer 21

Large joints e.g knee become inflamed 1-3 wks post infection. Urethritis, uveitis/conjunctivitis and arthritis triad- Reiter’s syndrome.

Question 22

What is the treatment for infective arthritis?

Answer 22

Usually self limiting, 15-30% chronic or frequent relapses. Treat infectious cause, symptom relief- IA/IM steroid injections, occasionally DMARDs