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MSK > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What are spondyloarthropathies?

A

Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically and predisposed (HLA B-27) individuals

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2
Q

What is HLA B-27 associated with?

A

Ankylosing spondylitis
Reactive arthritis
Crohn’s disease
Uveitis

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3
Q

What are the different types of spondyloarthritis disease subgroups?

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis

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4
Q

What are the sympotms of mechanical back pain?

A

Worsened by activity
Typically worst at the end of the day
Better with rest

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5
Q

What are the symptoms of inflammatory back pain?

A

Worse with rest
Better with activity
Significant early morning stiffness that lasts more than 30mins

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6
Q

What are some rheumatological features that are present in all spondyloarthropathies?

A

Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthrtisi
Dactylitis

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7
Q

What is enthesitis?

A

Inflammation at insertion of tendons into bones e.g. achilles tenson causing plantar fasciitis

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8
Q

What are the characteristics of inflammatory arthritis?

A

Oligoarticular
Asymmetric
Predominantly lower limbs

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9
Q

What are some extr-articular features that can present in all spondyloarthropathies?

A

Ocular inflammation (anterior uveitis, conjunctivitis)
Mucotaneous lesions
Rare aortic incompetence or heart block

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10
Q

What is ankylosing spondylitis?

A

Chronic systemic inflammatory disorder that primarly affects the spine

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11
Q

What is the hallmark of ankylosing spondylitis?

A

Sacroiliac joint involvement (sacroiliitis)

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12
Q

What is the ASAS classification for ankylosing spondylitis?

A

In patients with more than 3 months back pain and under 45:
Sacroilits imaging and one spondyloarthritis feature
OR
HLA-B27 positive and 2 spondyloarthritis features

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13
Q

What are the spondyloarthritis features in the ASAS classification?

A 
Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriasis 
Crohn's 
Good response to NSAIDs
Family history of SpA
HLA-B27
Elevated CRP
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14
Q

How will sacroiliitis show in images?

A

Active inflammation on MRI highly suggestive of sacroiliitis associated with SpA

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15
Q

What are the clinical features of AS?

A 
Back pain (neck, thoracic, lumbar) 
Enthesitis
Peripheral arthritis (RARE)
Extra articula: anterior uveitis, CV involvement (aortic valve/root), pulmonary fibrosis (upper lobes), asymptomatic enteric mucosal inflammation, neurological involvement (rarely A A subluxation), amyloidosis
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16
Q

What is a way to remeber the symptoms of AS?

A 
Remeber as the A disease: 
Axial arthritis
Anterior uveitis 
Aortic regurgitation
Apical fibrosis 
Amyloidosis 
Achilles tendinitis
PlAntar fasciitis
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17
Q

What do syndesmophytes cause?

A

Fusion of vertebrae

18
Q

What examinations can be performed to diagnose AS?

A

Tragus to wall
Chest expansion
Modified Schober test

19
Q

What bloods can be done to diagnose AS?

A 
Inflammatory parameters (ESR, CRP, PV)
HLA B-27
20
Q

What can be seen on radiological images of AS?

A 
Sacroiliitis
Syndesmophytes
Bamboo spine
Osteopenia 
Shiny corners
21
Q

What can be seen on radiological images of OA?

A 
Normal bone density 
Reduced joint space
Subchondral sclerosis
Subchondral cysts 
Oosteophyte
22
Q

What will an MRI of AS show?

A

Early radiological changes: bone marrow oedema and enthesitis

23
Q

What is psoriatic arthritis?

A

Inflammatory arthritis associated with psoriasiss, but 10-15% of patients can have PsA without psoriasis cutaneously

24
Q

How will PsA present?

A 
Sacroiliitis (asymmetric) 
Nail involvement (pitting, onycholysis)
Dactylitis
Enthesitis 
Extra articular features (eye disease)
25
Q

What are the different clinical subgroups of psoriatic arthritis?

A 
Confined to DIP joints 
Symetric polyarthritis
Spondylitis 
Asymmetric oligoarthritis with dactylitis
Arthritis mutilans
26
Q

What bloods can be done to diagnose PsA?

A

Inflammatory parameters raised

Negative RF

27
Q

What radiographic findings can be seen in PsA?

A

Marginal erosions and whiskering
Pencil in cup deformity
Osteolysis
Enthesitis

28
Q

What is reactive arthritis?

A

Infection induced systemic illness characterized primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured

29
Q

What are the most common infections to cause reactive arthrtitis?

A

Urogenital: clamydia
Enterogenic: salmonella, shigella, yersinia

30
Q

When will reactive arthritis occur after an infection?

A

1-4 weeks after the infection has cleared up

31
Q

What makes up reiter’s syndrome?

A

Urethritis
Conjuctivitis/ uveitis/ iritis
Arthritis

32
Q

What are the clinical features of reactive arthritis?

A

Fever, fatigue, malaise
Asymmetrical monoarthritis/ oligoarthritis
Enthesitis
Mucotaneous lesions: keratoderma blenorrhagica, circinate balnitis, painless oral ulcers, hyperkeratotic nails
Ocular lesions - conjuctivitis, iritis
Visceral manifestations - mild renal disease, carditis

33
Q

How is reactive arthritis diagnosed via blood tests?

A

Inflammatory parameters
FBC, U&Es
HLA B27
Cultures (usually negative)

34
Q

Why is a joint fluid analysis done?

A

To rule out septic arthritis

35
Q

Why is an x-ray of the affected joints undertaken?

A

Due to acute nature, need to rult out osteonecrosis or osteomyelitis

36
Q

What is enteropathic arthritis?

A

Associated with inflammatory bowel disease e.g. crohn’s and UC

37
Q

Where will enteropathic arthritis affect?

A

Several joints, especially knees, ankles, elbows and wrists

Sometimes the spine, hips or shoulders

38
Q

What are the clinical symptoms of enteropathic arthritis?

A

GI - loose, watery stool with mucous and blood
Weight loss, low grade fever
Eye involvement (uveitis)
Skin involvement (pyoderma gangrenosum)
Enthesitis (achilles tendonitis, plantar fasciitis, lateral epicondylitis)
Oral - apthous ulcers

39
Q

How is enteropathic arthritis diagnosed?

A 
Upper and lower GI endoscopy 
Joint aspirate - no organisms or crystals
Raised inflammatory markers 
MRI showing sacroiliitis 
USS showing tenosynovitis
40
Q

How is enteropathic arthritis treated?

A

Treat IBD
DONT GIVE NSAID
Normal analgesia - paracetamol, cocodamol

41
Q

How are spondyloarthridites treated medically?

A 
NSAIDs
Corticosteroids
Topical steroid eyedrops
DMARDs - methotrexate, sulfasalazine, lefunomide
Biologics - anti-TNF 
Secukinumab (anti IL-17) for PsA and AS
42
Q

What are the non medical treatments for spondyloarthridites?

A

Physiotherapy
OT
Orthotics, chiropodist

MSK (34 decks)

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