Spondyloarthropathies Flashcards
spondyloarthropathies = (4)
overlap and ass with HLA ___
ank spond enteropathic reactive psoriatic arthritis HLA B27
HLA B27 ass with (4)
inheritance =
Crohns uveitis ank spond reactive arthritis auto dom
shared rheum features of spondyloarthropathies (6)
SI and spinal involvement enthesitis oligoarticular inflam arthritis asymmetrical predominantly lower limb dactylitis
sausage fingers =
dactylitis
shared extra art features of spondyloarthropathies (4)
ant uveitis, conjunctivitis
mucocutaneous lesions
aortic incompetence and heart block (rare)
no rheum nodules
ank spond is a ___ condition that primarily affects ___
chronic systemic inflammatory
spine
hallmark of ank spond =
sacroiliitis
ank spond
M:F
age
M3.5:1F
late adolescence/early adulthood
diagnosis of ank spond
> =3months back pain and <45yo onset
HLA B27 +ve/sacroiliitis on imaging and >=2 features of ank spond
Imaging used to detect early and late changes in ank spond
early = MRI late = xray
features of ank spond (10)
back pain enthesitis peripheral arthritis (rare) ant uveitis CV involvement neuro upper lung lobe fibrosis asympt neteric mucosal inflam amyloidosis plantar fasciitis
examination of ank spond = (3)
chest expansion (decreased)
Schobers test
tragus/occiput to wall (difficult if neck fusion)
blood results in ank spond
inflam markers increased
HLA B27 +ve in 90%
xray findings of late ank spond
bamboo spine
sacroiliitis
syndesmophytes
bone density becomes reduced
MRI-STIR early findings in ank spond
bone marrow oedema
enthesitis
treatment of ank spond
physio (most important) OT NSAIDs (niproxin in Tayside) \+ DMARDs (if peripheral arthritis) anti-TNF (if severe) anti-IL17(secukinumab)
psoriatic arthritis
10-15% have it ___
__ -ve and no ___
without psoriasis
RF -ve
no rheumatoid nodules
features of psoriatic arthritis: (6)
inflammatory arthritis sacroiliitis (usually asymmetrical) nail pitting/onycholysis dactylitis achilles tendonitis/plantar fasciitis eye disease
5 subgroups of psoriatic arthritis
1) confined to __
2) symmetrical __
3) __ +/- peripheral joint involvement
4) asymmetrical __ with __
5) arthritis __
DIPJ polyarthritis spondylitis oligoarthritis - dactylitis mutilans
blood results of psoriatic arthritis (2)
increased inflam markers
no RF
xray findings in psoriatic arthritis (4)
“pencil in cup” of thumb
enthesitis
osteolysis
marginal erosions and “whiskering”
drug treatment of psoriatic arthritis
NSAIDs, steroids
may add DMARDs => anti TNF if severe and unresponsive => secukinumab
reactive arthritis occurs __ after ___
characterised primarily by ___ which has a -ve __
1-4wks ; infection induced systemic illness
inflammatory synovitis ; culture
common infections that cause a reactive arthritis
urogential eg. chlamydia
enterogenic (salmonella, shigella, yersinia)
reactive arthritis
age:
M:F
+ve HLA ___
20-40yo
M=F
B27
features of reactive arthritis
asymmetrical mono/oligoarthritis
enthesitis
keratoderma blenorrhagia, circinate balanitis, painless oral ulcers, hyperkeratinous nails
conjunctivitis, iritis
Reiter’s syndrome = a form of __
triad =
reactive arthritis
urethritis
arthritis
conjunctivitis/uveitis/iritis
Ix for reactive arthritis
inflam markers FBC U+E culture aspirate joint xray joints ophthalmology
treatment of reactive arthritis
90% resolve spontaneously in 6 months physio and OT NSAIDS - first line Steroids Abx if underlying infection if resistant = DMARDs - usually sulfasalizine
enteropathic arthritis = 9-20% of __ patients
20% of ___ = sacroiliitis
IBD
Crohns
features of enteropathic arthritis =
arth esp knees ankle, elbow wrists IBD GI symptoms uveitis pyoderma gangrenosum enthesitis aphthous ulcers WORSE during IBD FLARE
Ix of enteropathic arthritis:
upper and lower endoscopy and biopsy joint aspirate increased CRP and PV xray and MRI (sacroiliitis) US (synovitis/tenosynovitis)
Rx of enteropathic arthritis
treat IBD paracetamol / co codamol steroids DMARDS anti TNF
no __/___ in enteropathic arthritis as __
NSAIDs
secukinumab
exacerbate
