Spondyloarthropathies Flashcards by Hannah Farquhar

Define spondyloarthropathies

Family of inflammatory arthritis characterised by involvement of spine and joints

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What conditions come under spondyloarthropathies?

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

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What are the two types of back pain?

Mechanical and Inflammatory

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How do you distinguish between mechanical and inflammatory arthritis?

Mechanical - worsened by activity

Inflammatory - worse with rest, early morning stiffness >30mins

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What is enthesitis?

Inflammation at insertion of tendons to bones

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What is dactylitis?

Inflammation of entire digit `

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What are common extra-articular features of spondyloarthropathies?

Ocular inflammation
Mucocutaneous lesions
Cardiology problems (rare)

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What is ankylosing spondylitis?

Chronic inflammation at sites of insertion of ligaments into bone/joint/capsule/annulus fibrosus

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Describe the pathogenesis of ankylosing spondylitis

Inflammation - fibrosis - ossification

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What is meant by ossification?

Formation of bridging spots of bone known as syndesmophytes

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What gene is associated with spondyloarthropathies?

HLA B27

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What are the two criteria used to diagnose ankylosing spondylitis?

New York Criteria

ASAS classification

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Describe the New York Criteria for Ankylosing Spondylitis

Limited lumbar motion
Lower back pain for 3 months
Reduced chest expansion
Bilateral sacroilitis on x-ray (grade >2)
Unilateral sacroilitis (grade 2-4)
4/5 + 1,2, or 3 to confirm diagnosis

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Describe the ASAS classification for Ankylosing spondylitis

Sacroilitis + >1SpA feature
HLA B27 positive + 2SpA features
In patients with >3months back pain <45 years old

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What are the clinical features of Ankylosing spondylitis?

Back pain, enthesitis, peripheral arthritis

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Name the extra articular features associated with ankylosing spondylitis

Anterior uveitis, cardio involvement, pulmonary fibrosis, mucosal inflammation, neurological involvement, amyloidosis

State the investigations used in suspected ankylosing spondylitis

Bloods (inflammatory markers and HLA B27)
X-ray (bamboo spine, sacroilitis, syndesmophytes)
Clinical tests (Schooner & occiput to wall)
MRI (shows early disease - bone marrow oedema and enthesitis)

How is ankylosing spondylitis treated?

Physiotherapy, occupational therapy, NSAIDs, disease modifying drugs, anti-TNF, anti IL17 (after at least two NSAIDs)

What is psoriatic arthritis?

Inflammatory arthritis associated with psoriasis

What are the clinical features of psoriatic arthritis?

Sacroilitis - often asymmetric and may be associated with spondylitis 
Nail involvement 
Dactylics 
Enthesitis 
Extra- articular features

Name the five subgroups of psoriatic arthritis

confined to DIP
symmetric polyarthritis
spondylitis
asymmetric oligoarthritis with dactylitis
arthritis mutilans

How is psoriatic arthritis diagnosed?

Bloods - raised inflammatory markers, negative rheumatoid factor
X-ray - marginal erosions and whiskering with pencil cup deformity - osteolysis and enthesitis

How is psoriatic arthritis treated?

NSAIDs, steroids, disease modifying drugs, anti-TNF, anti IL17

What is reactive arthritis?

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

How long after the initial infection do symptoms occur?

1-4 weeks

Which infections commonly cause reactive arthritis?

Urogenital - chlamydia | Enterogenic - salmonella

Who is mostly affected by reactive arthritis?

HLA B27 young adults

What is Reiter's syndrome?

Can't pee, can't see, can't climb a tree - urethritis - conjunctivitis/uveitis/iritis - arthritis

What are the clinical features of reactive arthritis?

General symptoms of infection Asymmetrical mono arthritis/oligo arthritis Enthesitis Mucocutaneous lesions Ocular lesions Visceral manifestations (renal/cardiac problems)

How is reactive arthritis diagnosed?

Bloods - inflammatory markers, FBC/UandEs, HLA B27 Cultures & joint fluid analysis X-ray

How is reactive arthritis treated?

NSAIDs, steroids, antibotics, DMARDs if resistant and physiotherapy

What disease is enteropathic arthritis associated with?

IBD

What are the clinical features of enteropathic arthritis?

``` GI symptoms Weight loss Eye involvement e.g uveitis Skin involvement (pyoderma gangrenosum) Enthesitis Oral apthous lesions ```

What investigations are required in enteropathic arthritis?

``` Endoscopy Joint aspiration Bloods - CRP and plasma volume X-ray/MRI for sacroilitis USS showing synovitis/tenosynovitis ```

How is eneteropathic arthritis treated?

Need to treat IBD to control the arthritis, analgesia (not NSAIDs) for pain, steroids, DMARDs (azathioprine), anti-TNF may help to treat both