Spondyloarthropathies

Question 1

What are the three main features that define spondyloarthopathies?

Answer 1

Inflammation of the spine
Sacroilitis (fusion of SI joint)
Enthesitis (inflammation of attachment of tendon to bone)
All have association with HLA-B27

Question 2

What are some other features of spondyloarthropathies?

Answer 2

Large joint involvement in an asymetrical pattern
Dactilitis - inflammation of whole digit
Ocular inflammation -Uveitis and episcleritis are common
skin lesions e.g. psoriasis

Question 3

What are the signs and symptoms of ankylosing spodylitis?

Answer 3

Typically male <30
Lower back pain that is worse at night with morning stiffness
Pain radiates to hip or buttocks
Pain gets better throughout day
This causes progressive loss of spinal movement

Question 4

How is ankylosing spondylitis diagnosed?

Answer 4

It is diagnosed clinically but supported by imaging
MRI can show active inflammation
Radiographs are useful and show sacroilitis (subchondral erosions and sclerosis), Syndesmophytes (ossification of annulus fibrosus)

Question 5

What is the managemnt of ankylosing spondylitis?

Answer 5

Encourage regular exercise such as swimming
Benefit from physiotherapy
NSAIDs can be used for symptomatic relief
DMARDs not useful
TNF alpha blockers such as etanercept are indicated for severe AS
Risk of osteoporotic fractures so give bisphosphonates

Question 6

What percentage of psoriasis patients develop arthritis?

Answer 6

10-40%

Question 7

What are the patterns of psoriatic arthritis?

Answer 7

Symmetrical polyarthritis (like RA)
DIP joints
Asymmetrical oligoarthritis
Spinal (similar to AS)
Arthritis mutilans

Question 8

What are the imaging changes seen in psoriatic arthritis?

Answer 8

It shows a pencil in cup deformity with erosive changes

Question 9

What is the management of psoriatic arthritis?

Answer 9

It is managed in the same way as RA

Question 10

What is Reiter’s syndrome?

Answer 10

This is the triad of urethritis, conjunctivitis and arthritis that is seen in reactive arthritis

Question 11

What are the main causes of reactive arthritis?

Answer 11

It is an autoimmune reaction to infection elsewhere in the body, this is typically GI or GU infection

• STI - chlamydia
• Dysentry - campylobacter or salmonella

Question 12

What are the investigations for reactive arthritis?

Answer 12

ESR, CRP
Culture of stool
Infectious serology
Sexual history and swabs etc.

Question 13

What is the management of reactive arthritis?

Answer 13

Splint the affected joints
Symptomatic - NSAIDs or local steroid injections
Sulphasalazine or methotrexate can be used in persistent disease