Spondyloarthropathies Flashcards
What is spondyloarthorpathy?
family of inflam arthritides characterized by invovlement of both the spone and joints principally in geneticall predisposed individuals
What is the main gene associated the spondylarthropathies?
HLA-B27
What diseases is HLA-B27 associated with?
ank. spon; reactive arthritis, Crohn’s, uveitis
What diseases make p the spondyloarthropathies?
ankylosing spondylitis; psoriatic arthritis; reactive arthritis; enteropathic arthirits
What are hte differences betweeen mechanical and inflammatory back pain?
mechanical- worsened by actvity, typically worst at end of the day, better with rest
inflam-worse with rest, better with activity, signif early morning sitfness (>30 mins)
What are the shared rheumatological features of the spondyloarthropathies?
sacoriliac and spinal involvemtn; enthesitis; dactylitis
What is dactylitis?
“sausage digits”- inflam of entire digit
What are the extra-articular features seen in the spondyloarthropathies?
ocular inflammation (uveitis; conjunctivites; mucocutaneous lesions; aortic incompetence or heart blcok
What is ankylosing spondylitis
chronic systemic inflam disorder that primarly affects the spine
What is the hallmark features of ank spon?
sacroiliac joint involvemnt
Who is ank. spon seen in?
late adolescence or early adulthood; M:F- 3-5:1
What are the features of ank. spon in the classificitation?
inflam back pain for longer than 3 months arthritis enthesitis (heel) uveitis dactylitis psoriasis Crohn's good response to NSAIDs FHx HLA-B27 inc. CRP
What are the CVS; resp and neurological involvement seen with ank. spon?
aortic valve/ root-aortic regurg
fibrosis of upper lung lobes
A-A subluxation
What are the 7 As for ank. spon??
axial arthritis anterior uveitis aortic regurg apical fibrosis amyloidosis/Ig A nephropathy achilles tendinitis plAntar fasciitis
What happens to the spine in pts with ank. spon?
syndesmophytes- fusion of vertebrae; question mark posture- straightening of the lordosis
What examinations can be done in pts with ank. spon?
tragus/occiput to wall- wont be able to
chest expansion- costovertebral joints can be affected
modified schober test- should be >5cm when bend over
What is seen on MRI in ank. spon?
bone density is normal in early disease but reuced in late disease shiny corners flowing syndesmophytes fusion (bamboo spine) bone marrow oedema enthesitis
What is the treatment for ank. spon?
PT; OT; NSAIDs; DMARDS; anti-TNFs
What is the newest licensed drug for AS?
secukinumab- anti-IL17
What is psoriatic arthritis?
inflammatory arthritis assoc with psoriasis
How is psoriatic arthritis differentiated from RA?
no rheumatoid nodules; RF negative
What are the clinical features of psoriatic arthritis?
sacroilitis; nail involvement; dactylitis; enthesitis; extra-articular features eg eye disease
What is seen on x-ray in psoriatic arthritis?
marginal erosions and whiskering; pencil in cup deformity; osteolysis; enthesitis
Are inflam markers raised with psoriatic arthritis?
yes
What is the treatment for psoraitic arthritis?
PT;OT; NSAIDs; CS; DMARDs; anti-TNFs; anti-IL17
What is reactive arthritis?
infection induced systemic illness characterized primarly by an inflam synovitis from which viable microbes cannot be cultures
What infections tend to induce reactive arthritis?
GU- chlaymydia and GI- eg salmonella; shigella
Who gets reactive arthritis?
young adults (20-40); theres an equal sex distributiona
When do reactive arthritis symptoms start after an infeciton?
1-4 weeks post infection
What is reiters syndrome?
a form of reactive arthritis
triad of urethritis; eye inflam; arthritis
What are the clinical features of reactive arthritis?
general- fever fatigue; malaise asymmetrical monoarthritis or oligoarthritis enthesitis mucocutanoues lesions ocular lesions mild renal disease carditis
Why does joint fliud analysis need to be done in reactive arthritis?
to rule out infection
What is the prognosis for reactive arthritis?
spontaneously resolve within 6 months
What are the treaments for reactive arthritis?
NSAIDs; CS; antibiotics for underling infection; PT; OT
What treatment is given for resistant/chronic reactive arthritis?
DMARDs
What is enteropathic arthritis associated with?
inflammatory bowel disease
where do pts with enteropathic arthritis present with symptoms?
several joints, esp knees, ankles, elbows and wrists and sometimes in spine (20% of Crohns pts have sacroilitis) hip or shoulders
What are the clinical symptoms associated with enteropathic arthritis?
GI-loose, watery stool with mucous and blood
weight loos, low grade fever; eve involvemnet, skin involvement (pyoderma gangrenosum)
enthesitis
oral-apthous ulcers
What are the investigatsion done in enteropathic arthritis?
upper and lower GI endoscopy; joint aspirate- no organism or crystals; raised inflam markers
How does the IBD disease progression correlate with the arthrtisi?
arthritis worsens when IBD worsens
What is the treatmnet for enteropathic arthritis?
treat IBD controls the arthritis; normal analgesia eg paracetamol; steroids; DMARDs
Why are NSAIDs not a good idea in enteropathic arthritis?
may exacerbate inflam bowel disease
