Spondyloarthropathies

Question 1

What is spondyloarthorpathy?

Answer 1

family of inflam arthritides characterized by invovlement of both the spone and joints principally in geneticall predisposed individuals

Question 2

What is the main gene associated the spondylarthropathies?

Answer 2

HLA-B27

Question 3

What diseases is HLA-B27 associated with?

Answer 3

ank. spon; reactive arthritis, Crohn’s, uveitis

Question 4

What diseases make p the spondyloarthropathies?

Answer 4

ankylosing spondylitis; psoriatic arthritis; reactive arthritis; enteropathic arthirits

Question 5

What are hte differences betweeen mechanical and inflammatory back pain?

Answer 5

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)

Question 6

What are the shared rheumatological features of the spondyloarthropathies?

Answer 6

sacoriliac and spinal involvemtn; enthesitis; dactylitis

Question 7

What is dactylitis?

Answer 7

“sausage digits”- inflam of entire digit

Question 8

What are the extra-articular features seen in the spondyloarthropathies?

Answer 8

ocular inflammation (uveitis; conjunctivites; mucocutaneous lesions; aortic incompetence or heart blcok

Question 9

What is ankylosing spondylitis

Answer 9

chronic systemic inflam disorder that primarly affects the spine

Question 10

What is the hallmark features of ank spon?

Answer 10

sacroiliac joint involvemnt

Question 11

Who is ank. spon seen in?

Answer 11

late adolescence or early adulthood; M:F- 3-5:1

Question 12

What are the features of ank. spon in the classificitation?

Answer 12

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

Question 13

What are the CVS; resp and neurological involvement seen with ank. spon?

Answer 13

aortic valve/ root-aortic regurg
fibrosis of upper lung lobes
A-A subluxation

Question 14

What are the 7 As for ank. spon??

Answer 14

axial arthritis
anterior uveitis
aortic regurg
apical fibrosis
amyloidosis/Ig A nephropathy
achilles tendinitis
plAntar fasciitis

Question 15

What happens to the spine in pts with ank. spon?

Answer 15

syndesmophytes- fusion of vertebrae; question mark posture- straightening of the lordosis

Question 16

What examinations can be done in pts with ank. spon?

Answer 16

tragus/occiput to wall- wont be able to
chest expansion- costovertebral joints can be affected
modified schober test- should be >5cm when bend over

Question 17

What is seen on MRI in ank. spon?

Answer 17

bone density is normal in early disease but reuced in late disease
shiny corners
flowing syndesmophytes
fusion (bamboo spine)
bone marrow oedema
enthesitis

Question 18

What is the treatment for ank. spon?

Answer 18

PT; OT; NSAIDs; DMARDS; anti-TNFs

Question 19

What is the newest licensed drug for AS?

Answer 19

secukinumab- anti-IL17

Question 20

What is psoriatic arthritis?

Answer 20

inflammatory arthritis assoc with psoriasis

Question 21

How is psoriatic arthritis differentiated from RA?

Answer 21

no rheumatoid nodules; RF negative

Question 22

What are the clinical features of psoriatic arthritis?

Answer 22

sacroilitis; nail involvement; dactylitis; enthesitis; extra-articular features eg eye disease

Question 23

What is seen on x-ray in psoriatic arthritis?

Answer 23

marginal erosions and whiskering; pencil in cup deformity; osteolysis; enthesitis

Question 24

Are inflam markers raised with psoriatic arthritis?

Answer 24

yes

Question 25

What is the treatment for psoraitic arthritis?

Answer 25

PT;OT; NSAIDs; CS; DMARDs; anti-TNFs; anti-IL17

Question 26

What is reactive arthritis?

Answer 26

infection induced systemic illness characterized primarly by an inflam synovitis from which viable microbes cannot be cultures

Question 27

What infections tend to induce reactive arthritis?

Answer 27

GU- chlaymydia and GI- eg salmonella; shigella

Question 28

Who gets reactive arthritis?

Answer 28

young adults (20-40); theres an equal sex distributiona

Question 29

When do reactive arthritis symptoms start after an infeciton?

Answer 29

1-4 weeks post infection

Question 30

What is reiters syndrome?

Answer 30

a form of reactive arthritis | triad of urethritis; eye inflam; arthritis

Question 31

What are the clinical features of reactive arthritis?

Answer 31

``` general- fever fatigue; malaise asymmetrical monoarthritis or oligoarthritis enthesitis mucocutanoues lesions ocular lesions mild renal disease carditis ```

Question 32

Why does joint fliud analysis need to be done in reactive arthritis?

Answer 32

to rule out infection

Question 33

What is the prognosis for reactive arthritis?

Answer 33

spontaneously resolve within 6 months

Question 34

What are the treaments for reactive arthritis?

Answer 34

NSAIDs; CS; antibiotics for underling infection; PT; OT

Question 35

What treatment is given for resistant/chronic reactive arthritis?

Answer 35

DMARDs

Question 36

What is enteropathic arthritis associated with?

Answer 36

inflammatory bowel disease

Question 37

where do pts with enteropathic arthritis present with symptoms?

Answer 37

several joints, esp knees, ankles, elbows and wrists and sometimes in spine (20% of Crohns pts have sacroilitis) hip or shoulders

Question 38

What are the clinical symptoms associated with enteropathic arthritis?

Answer 38

GI-loose, watery stool with mucous and blood weight loos, low grade fever; eve involvemnet, skin involvement (pyoderma gangrenosum) enthesitis oral-apthous ulcers

Question 39

What are the investigatsion done in enteropathic arthritis?

Answer 39

upper and lower GI endoscopy; joint aspirate- no organism or crystals; raised inflam markers

Question 40

How does the IBD disease progression correlate with the arthrtisi?

Answer 40

arthritis worsens when IBD worsens

Question 41

What is the treatmnet for enteropathic arthritis?

Answer 41

treat IBD controls the arthritis; normal analgesia eg paracetamol; steroids; DMARDs

Question 42

Why are NSAIDs not a good idea in enteropathic arthritis?

Answer 42

may exacerbate inflam bowel disease