Spondyloarthropathies Flashcards
what is spondyloarthropathy?
family of inflammatory arthritides
what characterizes spondyloarthropathy?
involvement of spine and joints
what can cause a predisposition to spondyloarthropathy?
HLA B27 gene
what is HLA B27 associated with?
doesn’t directly cause anything
assoc with ankylosing spondylitis, reactive arthritis, crohns, uveitis
is HLA B27 used as a screening tool?
not really
only if patients have symptoms
name 4 subgroups of spondyloarthropathy
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
mechanical vs inflammatory pain?
mechanical = worse on activity and at end of the day, better with rest inflammatory = worse with rest, better with activity, significant early morning stiffness (>30 mins)
list some shared features of spondyloarthropathy
sacroiliac and spinal involvement
enthesitis (inflammation at site of tendon insertion)
inflammatory arthritis
dactylitis (inflammation of digits)
example of enthesitis
plantar fascitis
name some shared extra articular features of spondyloarthropathy
ocular inflammation (uveitis, conjunctivitis)
mucocutaneous lesions
rare aortic incompetence or heart block
no rheumatoid nodules
what is ankylosing spondylitis (AS)?
chronic systemic inflammatory disorder that primarily affects the spine
what does AS cause?
hallmark = sacroiliac joint involvement (sacroiliitis) enthesopathy sparing of peripheral arthritis more common in men onset in late adolescence
ASAS classification criteria for AS?
Sacroiliitis imaging + 1 or more SpA feature
OR
HLA B27 positive + 2 or more SpA features
what are the SpA features?
inflammatory back pain arthritis enthesitis uveitis dactylitis psoriasis IBD NSAIDs response FH HLA B27 raised CRP
sacroliliitis imaging?
active inflammation on MRI suggesting sacroiliitis associated with SpA
definite sacroiliitis according to modified new York criteria
what are the clinical features of AS?
back pain enthesitis extra articular features - anterior uveitis - cardiovascular involvement - pulmonary involvement - asymptomatic enteric mucosal inflammation - neurological involvement - amyloidosis
“A Disease”?
Axial arthritis anterior uveitis Aortic regurgitation Apical fibrosis Amyloidosis/IgA nephropathy Achilles tendinitis PlAnter fascitis
how does AS affect the spine over time?
can cause it to fuse
deforms posture
how is AS diagnosed?
history
examination
bloods
X rays
AS examination?
tragus/occiput to wall
chest expansion
modified Schober test
AS blood tests?
raised inflammatory markers
HLA B27
can AS be present without HLA B27?
yes
AS imaging?
can be normal in early stages
later = SIJ fusion/sclerosis, sacroiliitis, syndesmophytes, bamboo spine, vertebral fusion, erosions
AS spine features?
normal bone density (reduced in late disease) shiny corners flowing syndesmophytes fusion (bamboo spine)
OA spine features?
normal bone density reduced joint space subchondral cysts subchondral sclerosis osteophyte formation - assoc with neural foraminal narrowing
early sign of sacro iliac inflammation?
bone marrow oedema on MRI
white parts
AS treatment?
physio occupational therapy NSAIDs DMARDs Anti TNF if severe Secukinumab?
what is psoriatic arthritis?
inflammatory arthritis assoc with psoriasis
but can appear without psoriasis
what are the clinical features of psoriatic arthritis?
no rheumatoid nodules rheumatoid factor -ve inflammatory arthritis sacroiliitis nail involvement dactylitis extra articular features (eyes)
what are the 5 subgroups of psoriatic arthritis?
- DIP joints of hands/feets
- symmetrical polyarthritis
- spondylitis (spinal) with or without peripheral involvement
- asymmetrical olioarthritis with dactylitis
- arthritis mutilans
psoriatic arthritis diagnosis?
history (FH of psoriasis etc)
examination
bloods
X rays
psoriatic arthritis bloods?
raised inflammatory markers
negative RF
X rays of psoriatic arthritis?
marginal erosions and (whiskering)
Pencil in cup
osteolysis
enthesitis
psoriatic arthritis treatment?
medical
- NSAIDs
- steroids
- DMARDs
- Anti TNF if severe
- Secukinumab
non-medical
- physio
- Occ therapy
- Orthotics, chiropodist
what is reactive arthritis?
infection induced systemic illness
- chlamydia
- salmonella, shigella etc
what are the characteristics of reactive arthritis?
inflammatory synovitis from which organisms cant be cultured
arthritis symptoms 1-4 weeks after infection
who is reactive arthritis common in?
young adults
both genders
HLA B27 positive
what is Reiter’s syndrome?
form of reactive arthritis triad: - urethritis - conjunctivitis etc - arthritis
reactive arthritis clinical features?
general - fever, fatigue, malaise asymmetrical monoarthritis or oligoarthritis enthesitis mucocutaneous lesions ocular lesions visceral manifestations (heart, kidney)
reactive arthritis diagnosis?
history examination bloods cultures joint fluid analysis X ray opthamology
septic joint vs reactive arthritis?
septic = there are organisms in joint fluid
joint fluid is sterile in reactive
reactive arthritis bloods?
raised inflammatory markers
FBC
U&Es
HLA B27 if needed
reactive arthritis treatment?
most resolve within 6 months medical - NSAIDs - steroids - antibiotics for infection - DMARDs
non medical
- physio
- occ therapy
prognosis of reactive arthritis?
generally good
can recur and become chronic
what is enteropathic arthritis?
assoc with inflammatory bowel disease
how does enteropathic arthritis present?
arthritis in several joints
can be better and worse with IBD flares etc
clinical symptoms of enetropathic arthritis?
loose watery stool with mucous/blood weight loss low fever eye involvement skin involvement enthesitis oral apthous ulcers
how is enteropathic arthritis investigated?
upper and lower GI endoscopy with biopsy (for IBD) joint aspirate raised inflammatory markers X ray/MRI showing sacroiliitis US showing synovitis
how is enteropathic arthritis treated?
treat IBD don't use NSAIDs (can affect IBD) Normal analgesia steroids DMARDs Anti TNF
what non medical therapies can help spondyloarthropathies?
physiotherapy
occ therapy
orthotics
chiropodist
most useful investigation?
MRI
shows earlier disease than X ray
