Spondyloarthropathies Flashcards
What are the two main core clinical issues associated with the spondyloarthropathies?
- Back pain
- Joint pain and swelling
Where does the spondyloarthropathies mainly affect?
The spine
Spondyloarthropathies have a degree of genetic involvement. What is the gene responsible for increasing an individual’s risk of developing an associated condition?
HLA-B27
What are the 4 spondyloarthritis subgroups?
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- Enteropathic arthritis
How does inflammatory back pain differ from mechanical back pain?
- Onset is usually < 35 years of age and is insidious
- Pain persists longer than 3 months (chronic)
- Worsens with immobility (at night and early morning)
- Pain/stiffness eases with physical activity and exercise
- NSAIDs are very effective
The spondyloarthropathies share many rheumatological features, what are some of these?
- Enthesitis (inflammation at insertion of tendons onto bones)
- Inflammatory arthritis which is oligoarticular, asymmetrical, and predominatly lower limb
- Sacroiliac and spinal involvement
- Dactylitis (inflammation of an entrire digit)
Give an example of enthesitis
- Plantar fasciitis
- Achilles tendinitis
What are the shared extra-articular features of the spondyloarthropathies?
- Ocular inflammation (anterior uveitis, conjunctivitis)
- Mucocutaneous lesions
- Aortic incompetence or heart block (rare)
- No rheumatoid nodules
What is ankylosing spondylitis?
A chronic systemic inflammatory disorder primarily affecting the spine
What is the hallmark of ankylosing spondylitis?
Sacroiliac involvement
(sacroiliitis)
When will ankylosing spondylitis often present?
Late adolescence
Early adulthood
In which sex is ankylosing spondylitis more common?
Males
What classification criteria is used for axial ankylosing spondyloarthritis?
ASAS
(assessment of spondyloarthritis international society)
What is the term given to bony outgrowths which cause the fusion of vertebrae in anyklosing spondyloarthritis?
Syndesmophytes
Ankylosing spondylitis is often referred to as “A” disease due to the amount of clinical features which begin with A.
List as many as you can
- Anterior uveitis (also conjunctivitis)
- Aortic valve involvement (leads to aortic regurgitation)
- Apical pulmonary fibrosis
- Asymptomatic enteric mucosal inflammation
- Amyloidosis
- Achilles tendinitis (also plantar fasciitis)
- Atlanto-axial subluxation leading to neurological involvement
Which three useful clinical examinations can be used to diagnose ankylosing spondylitis?
- Occiput/tragus to wall
- Chest expansion
- Schober’s test
In ankylosing spondylitis, the fusion of spinal vertebrae creates which appearance on X-ray?
Bamboo spine
(due to syndesmophytes)
Why are X-rays not so useful in preventing the long term effects of ankylosing spondylitis?
They usually cannot show the early stages/changes of the disease and only the late presentations
How are the best early radiological changes seen in ankylosing spondylitis?
MRI
What are the treatment options for ankylosing spondylitis?
- Physiotherapy
- Occupational therapy
- NSAIDs
- Disease modifying drugs e.g. salazopyrin or methotrexate when there are peripheral joint involvement (rare)
- Anti-TNF treatment (in severe AS)
What is psoriatic arthritis?
Inflammatory arthritis associated with psoriasis
N.b - not all patients with psoriatic arthritis have psoriasis
Is rheumatoid factor present in psoriatic arthritis?
No
What are the main clinical features of psoriatic arthritis?
- Sacroiliitis (often asymmetrical and potentially associated with spondylitis)
- Nail involvement (pitting/onycholysis)
- Dactylitis
- Enthesitis
- Extra-articular features such as eye disease
How many clinical subgroups of psoriatic arthritis are there?
5
