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Rhematology > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What are spondyloarthropathies

A

Group of related inflammatory arthropathies

  • inflamm of the spine - axial inflammation
  • sacro iliac joint involvement
  • enthesis
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2
Q

Association with spondyloarthropathy

What isn’t associated with spondyloarthropathy

A

HLA B27
No association with RhF
FHx - psoriasis, IBS, inflam spine condition

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3
Q

What is enthesopathy/enthesitis

A

Inflam of the enthesis which is the point of attachment of a ligament or tendon to bone - this is the feature that distinguishes this group from the conditions which mainly affect the synovium - RA

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4
Q

What are the principle spondyloarthropathies

A 
Ank spondylitis 
Psoriasis 
Reactive arthritis 
Enteropathic spondyloarthropathy 
- IBD related arthritis 
Undifferentiated spondylarthrpathy
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5
Q

Common features of spondyloarthropathies

A

Sacroiliac and spinal involvement
Enthesis
Peripheral asymmetrical arthroscopic, oligoarthritis, mainly in the lower limb
Dactylitis - inflammation of the whole digit not just the joint
Ocular involvement- anterior uveitis
Skin lesions - psoriasis, balantis, keratoderma blenorrhagica.

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6
Q

Symptoms of sacroiliac and spinal involvement

A 
Young <50 
Chronic pain
Morning stiffness >30 min 
Rest does not alleviate the pain 
Improved by movement
Night pain 
Buttock pain - radiate to the legs
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7
Q

Enthesis symptoms

A

Common sites of involvement - achilles, plantar fascia, infrapatella poles,ASIS, lateral epicondyle
Need to ask about other sites of pain - heel pain, ankle pain, tennis elbow?

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8
Q

Peripheral asymmetric arthritis

A

Not always a feature, synovitis not always present
- assymetrical
Large joint
Lower limb
Could be a monoarthritis -need to rule out, septic, crystal

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9
Q

Dactylitis what is it

A

Whole digit pain swollen - inflamm, joint, tendon, periarticular all involved
Sausage digit common is psoriatic and reactive

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10
Q

Ocular inflamm

A

Ask about painful red eye +photophobia

- recurrent

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11
Q

Skin involvement

A

Search for psoriasis
Scaly plaque - pit, onycholysis, - reactive
Keratoderma blenorrhagica
Psoriaisis - DIP

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12
Q

Ank spond epidemiology and symptoms

A

Inflamm back pain and stiffness. - worse in morn, wake up at night with pain , lasts >30 min stiffness
Young adults average age 27 years
Systemic symptoms - fatigue and weight loss
Can get peripheral synovitis = hip and shoulder
Chest wall pain - costovertebal, costchondral pain can also get reduced chest expansion because of this
Uveitis, enthesitis, aortitis, plum fibrosis - hypoventilation due to defect in the chest wall

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13
Q

How to diagnose ank spond - criteria

A 
Inflamm back pain >3 months +1 more 
- buttock pain 
-sacroilitis XR
- enterosopathy 
- +ve FHx
- IBD
- urethritis, cervicitis, diarrhoea 
NEW YORK CRITERIA 
1) limited lumbar motion 
2) low back pain 3 months - improved by exercise not relieved by rest 
3) dec chest expansion
4) bilateral 2-4  grade S1 x ray 
5) unilateral 3-4 grade SI XR
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14
Q

What is the Schoenberg manoeuvre

A

Find the PSIS draw a line 10 cm above and 5 cm below
Flex the lumbar spine, knees and hips straight, if the distance inc by 5 cm or above this is normal if it doesn’t abnormal
Shows spine flexibility is impaired

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15
Q

SI grades on XR

A

0 - normal
1 - suspicious
2 -minimal change with small areas of erosion/ sclerosis with normal SI width
3-definite mod - advanced SI+erosion, sclerosis, and partial ankylosis
4- total ankylosis of SI

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16
Q

Signs of spondyloarthropathy on XR

A

Squaring of the vertebrae
Bamboo spine
- gradual interosseous bridging and joint ossification
- syndesmophytes = join 1 vertebra to the body of the next - bamboo spine
Can also get - ligament ossification

17
Q

Ix ank spond

A 
Inflamm marker CRP, ESR inc 
FBC normocytic anaemia - chronic disease 
Elevated IgA
Inc ALK
HLA B27 
Plain x ray 
Isotope bone can 
MRI 
CT
US - enthesitis
18
Q

What imaging is used as early markers may not be picked up with the other imaging

A

MRI

XR

19
Q

Mx ank spond

A

Con - physio,OT, hydrotherapy,, education,support groups - NASS
Med - Analgesia, NSAIDS
NO ROLE FOR DMARDS
BIOLIGICS

20
Q

What is used to asses the severity of the ank spond

A

BASDAI
Bath ank spond disease activity index
0-10 score based on the answers provided by the patient

21
Q

What is psoriatic arthritis

A

Chronic inflamm arthritis found in approx 5% of psoriasis patients
50% have spondyloarthropathy, enthesis, axial disease

22
Q

What are the patterns of psoriatic arthritis

A
  • predominant spondylitis
  • predominant DIP
  • oligoarthrits asymmetrical large joint
  • predominant plyarticular symmetrical large and small - mimic RA
  • Arthritis mutilans
23
Q

Clinical characteristics of psoriatic arthritis

A 
Inflam arth DIP
Asymmetrical 
Dactylitis 
Nail - pitting, onycholysis
No rhem factor, no nodules
Erosive arthritis without osteopenia - rule out RA
Sacroilitis  - asymptomatic 
Syndesmophytes
Paravertenral assification
Enthesopathy
24
Q

Classic XR findings - psoriatic arthritis

A

Erosion, - penicil in a cup

25
Q

Mx - psoriatic arthritis

A

Con - physio, OT, hydrotherapy, orthotics
Med - analgesia, NSAIDS, DMARDS - ciclosporin, methotrexate
Biological - anti TNF alpha
Corticosteroid - oral IM intrarticular
Skin psoriasis - if steroid stopped suddenly - pustular psoriasis

26
Q

Reactive arthritis what is it

A

Inflam arthritis 2-4 weeks post GI, GU infection

27
Q

How does reactive arthritis happen

A

Immunological phenomenon

- there is no inoculation of the joint itself - it is always sterile

28
Q

Common GI GU infections in relative arthritis

A

GI - shigella, salmonella, campylobacter
GU - <35 yrs - STI - chlamydia, gonorrhoea
Over 35 - UTI , urethritis

29
Q

Presentation

A

Lower limb arthritis
Oligoarthrits = knee ankle hip
Lower back and buttock pain
Systemic features - unwell, temp conjunctivitis, skin - keratoderma blenorrhagica

30
Q

Ix reactive

A

GI - stool culture
GU - GUM clinic as may be asymptomatic
Routine blood CRP, joint aspiration -esp if mono rule out septic,gout
XR, MRI SIJ

31
Q

Mx reactive

A

Self limiting
Tx underlying
Symptoms - NSAIDS, analgesia, drain or corticosteroid
DMARDS - depends on severity

32
Q

Triad reactive arthritis

A

Urethritis
Conjunctivitis
Reactive arthritis

33
Q

What is enteropathic arthritis

A

Arthritis associated with IBD - UC and crohns

34
Q

How does enteropathic arthritis present

A

Axial involvement
SI joint
peripheral arthritis lowerlimb

35
Q

What does the peripheral arthritis in enteropathic symptoms correlate with
What is it not associated with

A

Develops in 20% of IBD
Activity of bowel disease
No HLA B27

36
Q

Spondylitis in enteropathic arthritis

A

Sacroilitis and spondylits develops in 10%
Clinically indistinguishable from ank spon
Spondylitis - no correlation with boweldisease
HLA B27 present in 50% of patients

37
Q

Tx enteropathic

A

DMARDS - bowel and joint- sulphasaizine antiTNF alpha

Rhematology (6 decks)

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