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MSKJaz > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

spondyloarthropathies = (4)

overlap and ass with HLA ___

A 
ank spond
enteropathic
reactive 
psoriatic arthritis
HLA B27
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2
Q

HLA B27 ass with (4)

inheritance =

A 
Crohns
uveitis
ank spond
reactive arthritis
auto dom
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3
Q

shared rheum features of spondyloarthropathies (6)

A 
SI and spinal involvement
enthesitis
oligoarticular inflam arthritis
asymmetrical
predominantly lower limb
dactylitis
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4
Q

sausage fingers =

A

dactylitis

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5
Q

shared extra art features of spondyloarthropathies (4)

A

ant uveitis, conjunctivitis
mucocutaneous lesions
aortic incompetence and heart block (rare)
no rheum nodules

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6
Q

ank spond is a ___ condition that primarily affects ___

A

chronic systemic inflammatory

spine

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7
Q

hallmark of ank spond =

A

sacroiliitis

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8
Q

ank spond
M:F
age

A

M3.5:1F

late adolescence/early adulthood

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9
Q

diagnosis of ank spond

A

> =3months back pain and <45yo onset

HLA B27 +ve/sacroiliitis on imaging and >=2 features of ank spond

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10
Q

Imaging used to detect early and late changes in ank spond

A 
early = MRI
late = xray
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11
Q

features of ank spond (10)

A 
back pain
enthesitis
peripheral arthritis (rare)
ant uveitis
CV involvement
neuro
upper lung lobe fibrosis
asympt neteric mucosal inflam
amyloidosis
plantar fasciitis
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12
Q

examination of ank spond = (3)

A

chest expansion (decreased)
Schobers test
tragus/occiput to wall (difficult if neck fusion)

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13
Q

blood results in ank spond

A

inflam markers increased

HLA B27 +ve in 90%

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14
Q

xray findings of late ank spond

A

bamboo spine
sacroiliitis
syndesmophytes
bone density becomes reduced

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15
Q

MRI-STIR early findings in ank spond

A

bone marrow oedema

enthesitis

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16
Q

treatment of ank spond

A 
physio (most important)
OT
NSAIDs (niproxin in Tayside)
\+ DMARDs (if peripheral arthritis)
anti-TNF (if severe)
anti-IL17(secukinumab)
17
Q

psoriatic arthritis
10-15% have it ___
__ -ve and no ___

A

without psoriasis
RF -ve
no rheumatoid nodules

18
Q

features of psoriatic arthritis: (6)

A 
inflammatory arthritis
sacroiliitis (usually asymmetrical)
nail pitting/onycholysis
dactylitis
achilles tendonitis/plantar fasciitis
eye disease
19
Q

5 subgroups of psoriatic arthritis

1) confined to __
2) symmetrical __
3) __ +/- peripheral joint involvement
4) asymmetrical __ with __
5) arthritis __

A 
DIPJ
polyarthritis
spondylitis
oligoarthritis - dactylitis
mutilans
20
Q

blood results of psoriatic arthritis (2)

A

increased inflam markers

no RF

21
Q

xray findings in psoriatic arthritis (4)

A

“pencil in cup” of thumb
enthesitis
osteolysis
marginal erosions and “whiskering”

22
Q

drug treatment of psoriatic arthritis

A

NSAIDs, steroids

may add DMARDs => anti TNF if severe and unresponsive => secukinumab

23
Q

reactive arthritis occurs __ after ___

characterised primarily by ___ which has a -ve __

A

1-4wks ; infection induced systemic illness

inflammatory synovitis ; culture

24
Q

common infections that cause a reactive arthritis

A

urogential eg. chlamydia

enterogenic (salmonella, shigella, yersinia)

25
Q

reactive arthritis
age:
M:F
+ve HLA ___

A

20-40yo
M=F
B27

26
Q

features of reactive arthritis

A

asymmetrical mono/oligoarthritis
enthesitis
keratoderma blenorrhagia, circinate balanitis, painless oral ulcers, hyperkeratinous nails
conjunctivitis, iritis

27
Q

Reiter’s syndrome = a form of __

triad =

A

reactive arthritis
urethritis
arthritis
conjunctivitis/uveitis/iritis

28
Q

Ix for reactive arthritis

A 
inflam markers
FBC
U+E
culture
aspirate joint
xray joints
ophthalmology
29
Q

treatment of reactive arthritis

A 
90% resolve spontaneously in 6 months
physio and OT
NSAIDS - first line
Steroids
Abx if underlying infection
if resistant = DMARDs - usually sulfasalizine
30
Q

enteropathic arthritis = 9-20% of __ patients

20% of ___ = sacroiliitis

A

IBD

Crohns

31
Q

features of enteropathic arthritis =

A 
arth esp knees ankle, elbow wrists
IBD GI symptoms
uveitis
pyoderma gangrenosum
enthesitis
aphthous ulcers
WORSE during IBD FLARE
32
Q

Ix of enteropathic arthritis:

A 
upper and lower endoscopy and biopsy
joint aspirate
increased CRP and PV
xray and MRI (sacroiliitis)
US (synovitis/tenosynovitis)
33
Q

Rx of enteropathic arthritis

A 
treat IBD
paracetamol / co codamol
steroids
DMARDS
anti TNF
34
Q

no __/___ in enteropathic arthritis as __

A

NSAIDs
secukinumab
exacerbate

MSKJaz (28 decks)

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