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2 MSK > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

what are spondyloarthropathies

A

family of inflammatory arthratides involving the spine and joints especially in genetically predisposed patients

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2
Q

what is the gene that predisposes someone to spondyloarthropathy?

A

HLAB27 +ve

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3
Q

what other conditions are HLA B27 +ve people at risk of?

A

crohns disease

uveitis

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4
Q

4 types of spondyloarthritis

A

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

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5
Q

what is an enthesis

A

site of insertion of a tendon/ligament/articular capsule into bone

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6
Q

name rheumatological clinical features of spondyloarthropathies

A

sacroiliac and spinal involvement
enthesitis
inflammatory arthritis
digit inflammation

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7
Q

can spondyloarthropathies cause:

  1. ocular inflammation
  2. rheumatoid nodules
  3. heart block
A

T
F
T

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8
Q

what is dactylitis

A

inflammation of tendons

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9
Q

what is ankylosing spondylitis

A

chronic systemic inflammation of the spine, with the sacroiliac joint being involved

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10
Q

who gets ankylosing spondylitis typically

A

young people

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11
Q

why would an ankylosing spondylitis patient get impaired chest expansion

A

if thoracic spine is involved

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12
Q

does back pain associated with AS improve with exercise?

A

yes

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13
Q

name the 7 A’s of AS and why they are relevant

A 
axial arthritis
anterior uveitis
aortic regurgitation
apical fibrosis
amyloidosis
achilles tendonitis
plAntar fasciitis

commonly present with AS

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14
Q

what are the pathological effects of AS on the spine

A

causes vertebrae to fuse together forming a “bamboo spine”

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15
Q

what happens to the spine’s shape and curvature?

A

straightening of lumbar lordosis and pronounced thoracic kyphosis

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16
Q

typical examinations done in suspected AS patients?

A

schober test
chest expansion
x ray

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17
Q

what is the schober test

A

measures the degree of lumbar forward flexion as the patient bends over as though touching their toes.

18
Q

is bone density affected in AS?

A

gets worse over time

19
Q

what are the shiny corners on x ray of AS?

A

thickening of desmophytes

20
Q

clearest imaging to use for AS and why

A

MRI

shows early radiological images

21
Q

treatment for AS

A

NSAIDs
DMARDS eg szp
anti TNF

22
Q

does inflammatory arthritis test positive for RF?

A

no

23
Q

clinical presentation of inflammatory arthritis?

A 
asymmetric sacroiliitis
psoriatic nail involvement
dactylitis
enthesitis
eye disease
24
Q

which condition is inflammatory arthritis associated with?

A

psoriasis

25
Q

x ray presentation of inflammatory psoriasis

A

marginal erosions
pencil in cup deformity
osteolysis
enthesitis

26
Q

treatment for inflammatory arthritis

A

NSAIDs
corticosteroids
DMARDs eg methotrexate
anti-TNF only if unresponsive

27
Q

what is reactive arthritis

A

infection induced illness characterised by an inflammatory synovitis

28
Q

when do symptoms typically start in reactive arthritis

A

1-4 weeks

29
Q

name some typical infections that trigger reactive arthriis

A

STIs eg chlamydia

Enteric eg salmonella, shigella

30
Q

who tends to get reactive arthritis?

A

20-40 yr olds

31
Q

what is reiters syndrome and what makes up the triad of symptoms it presents with

A

a form of reactive arthritis that presents with:
uveitis
conjunctivitis
arthritis

32
Q

does reactive arthritis present asymmetrically?

A

yes

33
Q

accompanying clinical features to reactive arthritis

A 
oral ulcers
hyperkeratotic nails
fever
enthesitis
circinate balanitis
renal disease
ocular lesions
34
Q

investigations for reactive arthritis

A

stool culture for enterics
fbc, u+es
inflam markers
joint aspirate

35
Q

treatment for reactive arthritis?

A

NSAIDs
ABs if infection
DMARDs (SZP) if unresponsive

36
Q

most common associated symptom of enteropathic arthritis?

A

IBD especially crohns

37
Q

most common areas of arthritis in enteropathic arthritis?

A

knees
ankles
elbows
wrists

38
Q

symptoms of enteropathic arthritis?

A

IBD symptoms eg loose stool, weight loss, pyoderma gangrenosum etc

enthesitis
sacroiliitis
synovitis

39
Q

investigations for enteropathic arthritis?

A 
upper and lower GI endoscopy
joint aspirate
CRP/PV
x ray/MRI
USS
40
Q

which imaging would show synovitis

A

USS

41
Q

which imaging would show sacroiliitis

A

x ray/MRI

42
Q

treatment for enteropathic arthritis?

A 
treat IBD first
not NSAIDs
analgesia
steroids
DMARDS (ask GI doctor)
anti-TNF

2 MSK (61 decks)

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