Spondyloarthropathies Flashcards
Dr S Tan
define spondyloarthropathy
Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed individuals
what is the genetically predisposed individuals buzz word in spondyloarthropathy?
HLA B27
name the spondyloarthritis disease subgroups
Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis
what word defines inflammation of entire digit?
dactylics - sausage fingers
where is the main area of involvement in spondyloarthropathies?
sacroiliac and spinal
define Enthesitis
inflammation at insertion of tendons into bones eg Achilles tendinitis, plantar fasciitis
what is the hallmark in ankylosing spondylitis?
sacroiliac joint involvement (sacroiliitis)
what sex is ankylosing spondylitis more common in?
male
3-5:1
worsened by activity, typically worst at end of day, better with rest
mechanical or inflammatory?
mechanical
worse with rest, better with activity, significant early morning stiffness (>30 minutes)
mechanical or inflammatory?
inflammatory
name the shared extra-articular features in spondyloarthritis
Ocular inflammation (Anterior uveitis, conjuntivitis)
Mucocutaneous lesions
Rare Aortic incompetence or heart block
No rheumatoid nodules
what does anklosing spondylitis primarily affect?
spine
when does ankylosing spondylitis usually present?
late adolescence or early adulthood
name some points in the modified New York criteria for diagnosis of analysing spondylitis
- Limited lumbar motion
- Lower back pain for 3 months
Improved with exercise
Not relieved by rest - Reduced chest expansion
- Bilateral, Grade 2 to 4, sacroiliitis on X ray
- Unilateral, Grade 3 to 4, sacroiliitis on X ray
Definite AS if Criterion 4 or 5, plus 1,2 or 3
what are the clinical features seen in AS?
back pain enthesitis peripheral arthritis uveitis CVS involvement pulmonary involvement
what letter is important in AS?
A!
Axial Arthritis Anterior Uveitis Aortic Regurgitation Apical fibrosis Amyloidosis/ IgA Nephropathy Achilles tendinitis PlAntar Fasciitis
what are the 3 things you should cover in an examination in someone with suspected AS?
Tragus/occiput to wall
Chest expansion
Modified Schober test
what 2 things are you looking for in the bloods of someone with suspected AS?
Inflammatory parameters (ESR, CRP, PV) HLA B27
what is seen on x ray in someone with AS?
Sacroiliitis
Syndesmophytes
“Bamboo” spine
shiny corners
what is the treatment in AS?
physiotherapy occupational health NSAID MTX anti TNF Secukinumab
define psoriatic arthritis
Inflammatory arthritis associated with psoriasis
No Rheumatoid nodules
Rheumatoid factor negative
what are the clinical features seen in PA?
inflammatory arthritis sacroiliitis nail involvement dactylitis enthesitis eye disease
how many clinical subgroups of psoriatic arthritis are there?
5
what 2 things are you looking for in the bloods of someone with suspected PA?
Inflammatory parameters (raised)
Negative RF
what is seen n x ray of someone with suspected PA?
Marginal erosions and “whiskering”
“Pencil in cup” deformity
Osteolysis
Enthesitis
what is the treatment in PA?
NSAIDs Corticosteroids/joint injections Disease Modifying Drugs Anti TNF in severe disease Secukinumab (anti-IL17)
what are the most common infections responsible for reactive arthritis?
chlamydia
salmonella
shigella
yersinia
when do you get symptoms in reactive arthritis?
4 weeks post infection
what is Reiter’s syndrome?
a form of reactive arthritis
outline the triad in Reiter’s Syndrome
Urethritis
Conjuntivitis/Uveitis/Iritis
Arthritis
what are the clinical features of reactive arthritis?
general asymmetrical arthritis enthesitis mucocutaneous lesions ocular lesions visceral manifesations
what is the treatment in reactive arthritis?
NSAIDS
antibiotics
DMARDs
what is enteropathic arthiritis associated with?
Crohn’s
UC
IBD
what are the clinical symptoms in enteropathic arthiritis?
GI problems
weight loss
eye and mouth involvement
what are the investigations in enteropathic arthiritis?
endoscopy
joint aspirate
x ray showing sacroiliitis
what do you want to avoid in the treatment of enteropathic arthritis?
NSAIDs - exacerbate IBD
what is the treatment of enteropathic arthritis?
steroids
MTX
anti-TNF
secukinumab
things to remember in spondyloarthropathies…
Associated with HLA B27
Affect Spine/Joints
Enthesitis
Extra articular features
what is the main treatment in AS?
NSAID
MTX
Anti TNF
Secukinumab
what is ben porters reply when you ask him to lend you £5?
sorry im a little short
