Spondyloarthropathies Flashcards
Define Spondyloarthropathy
Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed individuals
What predisposes you to Spondyloarthropathy?
HLA B27
What other disease is HLA B27 associated with?
Reactive Arthritis
Chron’s disease
Uveitis
What is the background prevelance of HLA-B27
around 25% so it is not useful to screen for.
What are the four Spondyloarthritis Disease subgroups?
REAP
Reactive Arthritis
Enteropathic Arthrisis
Ankylosing Spondylitis
Psoriatic Arthritis
What clincial feautes do all Spondyloarthropathies share?
Sacroiliac and spinal involvement
Enthesists
Dactylitis
Ocular inflamation
Mucocutaneous lesion
What is going on here?
Enthesitis
What is Ankylosing Spondylitis?
Chronic systemic inflammatory disorder primarily affecting the spine?
What is the hallmark of Ankylosing Spondylitis?
Sacroiliac joint involvement
Who gets Ankylosing Spondylitis?
Young Men
What is the diagnositc criteria for Ankylosing Spondylitis?
Sacroiliitis on X-ray plus at least one of:
- Limited Lumber Motion
- Lower back pain for 3 months
- Reduced Chest expansion
What are the extra articular features of Ankylosing Spondylitis?
Eyes and midline
Anterior Uveitis
CVS - aortic valve/root
RSP- Fibrosis of upper lobes
Mucosal inflamation
Amyloidosis
Why is Ankylosing Spondylitis known as the A disease?
Axial arthritis
Anterior Uveitis
Aortic Regurgitation
Apical Fibrosis
Amyloidosis
Achilles Tendinitis
Plantar Fasciitis
What happens to the spine in Ankylosing Spondylitis? (image)
What would you want to look at in the patient to diagnose Ankylosing Spondylitis?
Occiput to wall
Chest expansion
Schober’s test
What blood tests would you do in suspected Ankylosing Spondylitis?
HLA B27
What can you see here which is classic of Ankylosing Spondylitis?
Change in bone density - Shiny corners
Whats going on here and why?
Bamboo spine due to Fusion
What would you classicly see on a Xray of a spine with Ankylosing Spondylitis
Bamboo spine
Fusion
Decreased bone density in late diease
Flowing Syndesmophytes
How do you treat Ankylosing Spondylitis?
NSAIDS
DMARDS
Anti TNF
What DMARDs would you use in Ankylosing Spondylitis?
Sulfasalazine
Methotrexate
Define Psoriatic Arthritis
Inflammatory Arthritis associated with Psoriasis
Is psoriatic arthritis rheumatoid factor positive or negative?
Negative
What are the 5 clincial features of Psoriatic Arthritis?
Sacroiliitis
Nail involvement
Dactylitis
Enthesitis
Eye disease
What would you find in the blood tests of someone with Psoriatic Arthritis?
Negative Rheumatoid Factor
Inflammatory permaeters raised
What are the classic X-ray signs of Psoriatic Arthrits?
Marginal erosions and whiskering
Pencil in cup deformity
Osteolysis
Enthesitis
What drugs do you use to treat psoriatic arthritis?
NSAIDs
Steroids
DMARDs
Anti TNF
Define Reactive Arthritis
Infection induced systemic illness
When do symptoms usually begin in reactive Arthritis?
1-4 weeks post infection
What the most common infections which cause reactive arthritis?
Urogenital:- Chlamydia
Enterogenic:- Shigella, Salmonella, Versinia
Who gets Reactive Arthritis?
20-40yr olds
Equal Sex distribution
What’s up with Reiter?
He cant pee
He cant move
and he cant see
What is Reiter’s Syndrome?
A form of Reactive Arthtitis with:
Urethritis
Conjuctivitis
Arthritis
How do you treat reactive arthritis?
NSAIDs
Corticosteroids
Antibiotics
DMARDs - if chronic
What is the prognosis for Reactive Arthritis?
Generally good
90% resolves within 6 months
What is Enteropathic Arthritis?
Associated with IBD
What precentage of patiets with Crohns also have Sarcoiliitis?
20%
What are the clincial features of Enteropathic arthritis?
IBD GI symptoms
Weight loss
Fever
Uveitis
Pyoderma Gangrenosum
Enthesitis
Apthous Ulcers
What investigations would you consider doing for Enteropathic Arthritis?
GI endoscioy to confirm IBD
Joint aspiration should find no organisims or crystals
X-ray showing sarcoillitis
How do you treat Enteropathic arthritis?
Treat IBD
No NSAIDs parcetamol or Cocodamol instead
Steroids
DMARDs
Biologics - Infiximab
How do you qualify for Anti-TNF?
Need to already have tried two DMARDs without success
