Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK week 2 > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What is spondyloarthopathy?

A

family of inflammatory arthritis characterised by involvement of both the spine and joints, principally in genetically predisposed (HLA b27 positive) individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is HLA b27 associated with (not useful unless patients also have symptoms)

A

ankylosing spondylitis, reactive arthiritis, Crohn’s disease, uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the Spondyloarthritis Disease Subgroups

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between mechanical and inflammatory back pain?

A

Mechanical-worsened by activity, typically worst at the end of the day, better with rest
Inflammatory- worse with rest, better with activity, significant early morning stiffness (>30 mins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the shared rheumatological features

of the Spondyloarthropathies

A

Sacroiliac and spinal involvement
Enthesitis-inflammation at insertion of tendons into bones e.g. Achilles tendinitis, plantar fasciitis
Inflammatory arthiritis- Oligoarticular,asymmetric,predominantly lower limb
Dactylitis - inflammation of entire digit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the shared extra-articular features

of the Spondyloarthropathies

A

Ocular inflammation (anterior uveitis, conjunctivitis)
Mucocutaneous lesions
Rare Aortic incompetence or heart block
no rheumatoid nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is ankylosing spondylitis?

A

Chronic systemic inflammatory disorder that primarily affects the spine

  • peripheral arthritis uncommon
  • sacroiliac joint involvement
  • late adolescence or early adulthood
  • more common in men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is MRI such a good test to use

A

MRI can pick up inflammation much earlier- can see the bone marrow oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the ASAS classification criteria for Axial Spondyloarthritis (SpA)

A

In patients with > 3 months back pain and age of onset <45 years

Sacroillitis on imaging and >=1 SpA feature
OR
HLA-B27 positive and >=2 other SpA features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical features of ankylosing spondylitis

A

Back pain ( neck, thoracic, lumbar)
enthesitis
Peripheral arthritis (shoulder, hips)-rare
Extra articular features
Anterior uveitis
Cardiovascular involvement (aortic valve/root )
Pulmonary involvement (fibrosis upper lobes)
Asymptomatic enteric mucosal inflammation
Neurological involvement (Rarely A-A subluxation)
Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a helpful way to remember features of ankylosing spondylitis

A

“A” disease

Axial Arthritis
Anterior Uveitis
Aortic Regurgitation
Apical fibrosis
Amyloidosis/ Ig A Nephropathy
Achilles tendinitis
Plantar Fasciitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

With ankylosing spondylitis what shows on examination?

A

Tragus/occiput to wall
Chest expansion
Modified Schober test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

With ankylosing spondylitis what shows in the bloods

A 
HLA B27
Inflammatory parameters (ESR,CRP,PV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

With ankylosing spondylitis what is shown on X-ray

A

Sacroillitis
Syndesmophytes
“Bamboo” spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With ankylosing spondylitis what changes magic the seen on x-ray

A

Changes over a long period of time

e.g. sacroiliac sclerosis/ vertebral fusion/erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the difference between the spine in AS and OA

A 
AS
beone density-normal in early disease, reduced in late
shiny comers
Flowing syndesmophwytes
Fusion (Bamboo spine)
OA
Normal bone density
reduced joint space
subchondral sclerosis
Subcondral scyst formation
osteophyte formation associated with neural foramina narrowing
17
Q

What treatment can be used in ankylosing spondylitis

A 
physiotherapy
occupational therapy
NSAID
disease modifying drugs e.g. SPZ, MTX
Anti TNF treatment- Infliximab , Certolizumab, Adalimumab and Etanercept in severe AS
Secukinumab
18
Q

What is Psoriatic Arthritis

A

Inflammatory arthritis associated with psoriasis but 10-15% of patients have PsA without psoriasis
No rheumatoid nodules
Rheumatoid factor negative

19
Q

What are the clinical features of psoriatic arthritis

A

inflammatory arthritis
Sactoilliitis
- often asymmetrical, may be associated with spondylitis
Nail involvement (pitting,onycholysis)
Dactylitis
Enthesitis - Achilles tendinitis, plantar fasciitis
Extra articular features (eye disease)

20
Q

What are the clinical subgroups of psoriatic arthritis

A
  • Confined to DIP hands/feet
  • Symmetrical polyarthritis (similar to RA)
  • Spondylitis (spine involvement) with or without peripheral joint involvement
  • Asymmetric oligoarthiritis with dactylitis
  • Arthritis mutilans
21
Q

Aside from History and Examination what helps with diagnosis?

A

Bloods- inflammatory parameters(raised) and negative RF

X-rays - marginal erosions and “whispering” , “pencil in cup” deformity, osteolysis and enthesitis

22
Q

What is enthesitis?

A

inflammation of the entheses, the sites where tendons or ligaments insert into the bone

23
Q

Treatment of psoriatic arthritis?

A

Medical-NSAIDs, corticosteroids/joint injections. DMARDs, Anti TNF if unresponsive to NSAIDs and methotrexate, Secukinumab (anti-IL17)
Non medical- physiotherapy, OT, orthotics , Chiropodist

24
Q

What is reactive arthritis?

A

Infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
In young adults (20-40) and equal sex distribution

25
Q

Reactive arthritis- How common after infection does symptoms appear and what are the common infections?

A

Symptoms 1-4 weeks after infection
More common infections
-Urogenital e.g. Chlamydia
-Enterogenic e.g. salmonella, Shigella, Yersinia

26
Q

Reactive arthritis is HLA B27 positive

A

true

27
Q

What is Reiter’s syndrome?

A 
A form of Reactive arthiritis
triad of 
-Urethritis
-Conjunctivitis/Uveitis/Iritis
-Arthiritis
28
Q

What are the clinical features of reactive arthritis?

A

General features ( fatigue, fever,malaise)

Aysmmetrical monoarthiritis or oligoarthiritis

Enthesitis

Mucocutaneous lesions

  • Keratodema Blenorrhagica
  • Circinate balanitis
  • painless oral ulcer
  • Hyperkeratotic nails
Ocular lesions (unilateral or bilateral)
-Conjunctivitis or iritis

Visceral manifestations

  • mild renal disease
  • carditis
29
Q

What is used to rule out infection in arthiritis?

A

joint fluid analysis

30
Q

Why may you not treat reactive arthritis?

A

90% resolve spontaneously within 6 months

31
Q

What medical/ non-medical treatment could be used in reactive arthritis?

A

Medical- NSAIDs ( Corticosteroids, antibiotics for underlying infection and DMARDs if resistant/chronic)

Non-medical –> Physiotherapy and OT

32
Q

What is the prognosis of reactive arthritis?

A

generally good, recurrences not uncommon, some develop a chronic form

33
Q

What is Enteropathic Arthritis associated with?

A

IBD e.g. Crohn’s, UC

34
Q

What do patients with Enteropathic Arthritis present with?

A

Arthritis in several joints, especially the knees, ankles, elbows and wrists, and sometimes in the spine, hips and shoulders

35
Q

What are the clinical symptoms of Enteropathic arthritis?

A

GI-loose, watery stool with mucous and blood)

  • Weight loss, low grade fever
  • Eye involvement (uveitis)
  • Skin involvement (pyoderma gangrenosum)
  • Enthesitis ( Achilles tendonitis, plantar fasciitis, lateral epicondylitis)
  • Oral-apthous ulcers
36
Q

Investigations for enteropathic arthritis?

A
  • Upper and lower GI endoscopy with biopsy showing ulceration/colitis
  • Joint asperate- no organisms or crystals
  • Raised inflammatory markers-CRP,PV
  • X ray/MRI showing sacroiliitis
  • USS showing synovitis/tenosynovitis
37
Q

Treatment of enteropathic arthritis?

A 
Treat IBD in order to control arthritis
NOT NSAIDs as can exacerbate IBD
Normal analgesia e.g. paracetamol, Cocodamol
Steroids (oral,IA,IM)
DMARDs
Anti-TNF

MSK week 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions