Spondyloarthropathies Flashcards
what are spondyloarthropathies
family of inflammatory arthratides involving the spine and joints especially in genetically predisposed patients
what is the gene that predisposes someone to spondyloarthropathy?
HLAB27 +ve
what other conditions are HLA B27 +ve people at risk of?
crohns disease
uveitis
4 types of spondyloarthritis
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
what is an enthesis
site of insertion of a tendon/ligament/articular capsule into bone
name rheumatological clinical features of spondyloarthropathies
sacroiliac and spinal involvement
enthesitis
inflammatory arthritis
digit inflammation
can spondyloarthropathies cause:
- ocular inflammation
- rheumatoid nodules
- heart block
T
F
T
what is dactylitis
inflammation of tendons
what is ankylosing spondylitis
chronic systemic inflammation of the spine, with the sacroiliac joint being involved
who gets ankylosing spondylitis typically
young people
why would an ankylosing spondylitis patient get impaired chest expansion
if thoracic spine is involved
does back pain associated with AS improve with exercise?
yes
name the 7 A’s of AS and why they are relevant
axial arthritis anterior uveitis aortic regurgitation apical fibrosis amyloidosis achilles tendonitis plAntar fasciitis
commonly present with AS
what are the pathological effects of AS on the spine
causes vertebrae to fuse together forming a “bamboo spine”
what happens to the spine’s shape and curvature?
straightening of lumbar lordosis and pronounced thoracic kyphosis
typical examinations done in suspected AS patients?
schober test
chest expansion
x ray
what is the schober test
measures the degree of lumbar forward flexion as the patient bends over as though touching their toes.
is bone density affected in AS?
gets worse over time
what are the shiny corners on x ray of AS?
thickening of desmophytes
clearest imaging to use for AS and why
MRI
shows early radiological images
treatment for AS
NSAIDs
DMARDS eg szp
anti TNF
does inflammatory arthritis test positive for RF?
no
clinical presentation of inflammatory arthritis?
asymmetric sacroiliitis psoriatic nail involvement dactylitis enthesitis eye disease
which condition is inflammatory arthritis associated with?
psoriasis
x ray presentation of inflammatory psoriasis
marginal erosions
pencil in cup deformity
osteolysis
enthesitis
treatment for inflammatory arthritis
NSAIDs
corticosteroids
DMARDs eg methotrexate
anti-TNF only if unresponsive
what is reactive arthritis
infection induced illness characterised by an inflammatory synovitis
when do symptoms typically start in reactive arthritis
1-4 weeks
name some typical infections that trigger reactive arthriis
STIs eg chlamydia
Enteric eg salmonella, shigella
who tends to get reactive arthritis?
20-40 yr olds
what is reiters syndrome and what makes up the triad of symptoms it presents with
a form of reactive arthritis that presents with:
uveitis
conjunctivitis
arthritis
does reactive arthritis present asymmetrically?
yes
accompanying clinical features to reactive arthritis
oral ulcers hyperkeratotic nails fever enthesitis circinate balanitis renal disease ocular lesions
investigations for reactive arthritis
stool culture for enterics
fbc, u+es
inflam markers
joint aspirate
treatment for reactive arthritis?
NSAIDs
ABs if infection
DMARDs (SZP) if unresponsive
most common associated symptom of enteropathic arthritis?
IBD especially crohns
most common areas of arthritis in enteropathic arthritis?
knees
ankles
elbows
wrists
symptoms of enteropathic arthritis?
IBD symptoms eg loose stool, weight loss, pyoderma gangrenosum etc
enthesitis
sacroiliitis
synovitis
investigations for enteropathic arthritis?
upper and lower GI endoscopy joint aspirate CRP/PV x ray/MRI USS
which imaging would show synovitis
USS
which imaging would show sacroiliitis
x ray/MRI
treatment for enteropathic arthritis?
treat IBD first not NSAIDs analgesia steroids DMARDS (ask GI doctor) anti-TNF
