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MSK- Rheumatology > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

Define Spondyloarthropathy

A

Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed individuals

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2
Q

What predisposes you to Spondyloarthropathy?

A

HLA B27

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3
Q

What other disease is HLA B27 associated with?

A

Reactive Arthritis

Chron’s disease

Uveitis

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4
Q

What is the background prevelance of HLA-B27

A

around 25% so it is not useful to screen for.

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5
Q

What are the four Spondyloarthritis Disease subgroups?

A

REAP

Reactive Arthritis

Enteropathic Arthrisis

Ankylosing Spondylitis

Psoriatic Arthritis

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6
Q

What clincial feautes do all Spondyloarthropathies share?

A

Sacroiliac and spinal involvement

Enthesists

Dactylitis

Ocular inflamation

Mucocutaneous lesion

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7
Q

What is going on here?

A

Enthesitis

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8
Q

What is Ankylosing Spondylitis?

A

Chronic systemic inflammatory disorder primarily affecting the spine?

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9
Q

What is the hallmark of Ankylosing Spondylitis?

A

Sacroiliac joint involvement

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10
Q

Who gets Ankylosing Spondylitis?

A

Young Men

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11
Q

What is the diagnositc criteria for Ankylosing Spondylitis?

A

Sacroiliitis on X-ray plus at least one of:

  1. Limited Lumber Motion
  2. Lower back pain for 3 months
  3. Reduced Chest expansion
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12
Q

What are the extra articular features of Ankylosing Spondylitis?

A

Eyes and midline

Anterior Uveitis

CVS - aortic valve/root

RSP- Fibrosis of upper lobes

Mucosal inflamation

Amyloidosis

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13
Q

Why is Ankylosing Spondylitis known as the A disease?

A

Axial arthritis

Anterior Uveitis

Aortic Regurgitation

Apical Fibrosis

Amyloidosis

Achilles Tendinitis

Plantar Fasciitis

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14
Q

What happens to the spine in Ankylosing Spondylitis? (image)

A
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15
Q

What would you want to look at in the patient to diagnose Ankylosing Spondylitis?

A

Occiput to wall

Chest expansion

Schober’s test

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16
Q

What blood tests would you do in suspected Ankylosing Spondylitis?

A

HLA B27

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17
Q

What can you see here which is classic of Ankylosing Spondylitis?

A

Change in bone density - Shiny corners

18
Q

Whats going on here and why?

A

Bamboo spine due to Fusion

19
Q

What would you classicly see on a Xray of a spine with Ankylosing Spondylitis

A

Bamboo spine

Fusion

Decreased bone density in late diease

Flowing Syndesmophytes

20
Q

How do you treat Ankylosing Spondylitis?

A

NSAIDS

DMARDS

Anti TNF

21
Q

What DMARDs would you use in Ankylosing Spondylitis?

A

Sulfasalazine

Methotrexate

22
Q

Define Psoriatic Arthritis

A

Inflammatory Arthritis associated with Psoriasis

23
Q

Is psoriatic arthritis rheumatoid factor positive or negative?

A

Negative

24
Q

What are the 5 clincial features of Psoriatic Arthritis?

A

Sacroiliitis

Nail involvement

Dactylitis

Enthesitis

Eye disease

25
Q

What would you find in the blood tests of someone with Psoriatic Arthritis?

A

Negative Rheumatoid Factor

Inflammatory permaeters raised

26
Q

What are the classic X-ray signs of Psoriatic Arthrits?

A

Marginal erosions and whiskering

Pencil in cup deformity

Osteolysis

Enthesitis

27
Q

What drugs do you use to treat psoriatic arthritis?

A

NSAIDs

Steroids

DMARDs

Anti TNF

28
Q

Define Reactive Arthritis

A

Infection induced systemic illness

29
Q

When do symptoms usually begin in reactive Arthritis?

A

1-4 weeks post infection

30
Q

What the most common infections which cause reactive arthritis?

A

Urogenital:- Chlamydia

Enterogenic:- Shigella, Salmonella, Versinia

31
Q

Who gets Reactive Arthritis?

A

20-40yr olds

Equal Sex distribution

32
Q

What’s up with Reiter?

A

He cant pee

He cant move

and he cant see

33
Q

What is Reiter’s Syndrome?

A

A form of Reactive Arthtitis with:

Urethritis

Conjuctivitis

Arthritis

34
Q

How do you treat reactive arthritis?

A

NSAIDs

Corticosteroids

Antibiotics

DMARDs - if chronic

35
Q

What is the prognosis for Reactive Arthritis?

A

Generally good

90% resolves within 6 months

36
Q

What is Enteropathic Arthritis?

A

Associated with IBD

37
Q

What precentage of patiets with Crohns also have Sarcoiliitis?

A

20%

38
Q

What are the clincial features of Enteropathic arthritis?

A

IBD GI symptoms

Weight loss

Fever

Uveitis

Pyoderma Gangrenosum

Enthesitis

Apthous Ulcers

39
Q

What investigations would you consider doing for Enteropathic Arthritis?

A

GI endoscioy to confirm IBD

Joint aspiration should find no organisims or crystals

X-ray showing sarcoillitis

40
Q

How do you treat Enteropathic arthritis?

A

Treat IBD

No NSAIDs parcetamol or Cocodamol instead

Steroids

DMARDs

Biologics - Infiximab

41
Q

How do you qualify for Anti-TNF?

A

Need to already have tried two DMARDs without success

MSK- Rheumatology (8 decks)

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