Spondyloarthropathies Flashcards
Define spondyloarthropathies
Family of inflammatory arthritis characterised by involvement of spine and joints
What conditions come under spondyloarthropathies?
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
- enteropathic arthritis
What are the two types of back pain?
Mechanical and Inflammatory
How do you distinguish between mechanical and inflammatory arthritis?
Mechanical - worsened by activity
Inflammatory - worse with rest, early morning stiffness >30mins
What is enthesitis?
Inflammation at insertion of tendons to bones
What is dactylitis?
Inflammation of entire digit `
What are common extra-articular features of spondyloarthropathies?
Ocular inflammation
Mucocutaneous lesions
Cardiology problems (rare)
What is ankylosing spondylitis?
Chronic inflammation at sites of insertion of ligaments into bone/joint/capsule/annulus fibrosus
Describe the pathogenesis of ankylosing spondylitis
Inflammation - fibrosis - ossification
What is meant by ossification?
Formation of bridging spots of bone known as syndesmophytes
What gene is associated with spondyloarthropathies?
HLA B27
What are the two criteria used to diagnose ankylosing spondylitis?
New York Criteria
ASAS classification
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
Describe the ASAS classification for Ankylosing spondylitis
- Sacroilitis + >1SpA feature
- HLA B27 positive + 2SpA features
In patients with >3months back pain <45 years old
What are the clinical features of Ankylosing spondylitis?
Back pain, enthesitis, peripheral arthritis
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
