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MSK > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

Define spondyloarthropathies

A

Family of inflammatory arthritis characterised by involvement of spine and joints

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2
Q

What conditions come under spondyloarthropathies?

A
  • ankylosing spondylitis
  • psoriatic arthritis
  • reactive arthritis
  • enteropathic arthritis
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3
Q

What are the two types of back pain?

A

Mechanical and Inflammatory

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4
Q

How do you distinguish between mechanical and inflammatory arthritis?

A

Mechanical - worsened by activity

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

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5
Q

What is enthesitis?

A

Inflammation at insertion of tendons to bones

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6
Q

What is dactylitis?

A

Inflammation of entire digit `

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7
Q

What are common extra-articular features of spondyloarthropathies?

A

Ocular inflammation
Mucocutaneous lesions
Cardiology problems (rare)

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8
Q

What is ankylosing spondylitis?

A

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

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9
Q

Describe the pathogenesis of ankylosing spondylitis

A

Inflammation - fibrosis - ossification

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10
Q

What is meant by ossification?

A

Formation of bridging spots of bone known as syndesmophytes

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11
Q

What gene is associated with spondyloarthropathies?

A

HLA B27

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12
Q

What are the two criteria used to diagnose ankylosing spondylitis?

A

New York Criteria

ASAS classification

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13
Q

Describe the New York Criteria for Ankylosing Spondylitis

A
  1. Limited lumbar motion
  2. Lower back pain for 3 months
  3. Reduced chest expansion
  4. Bilateral sacroilitis on x-ray (grade >2)
  5. Unilateral sacroilitis (grade 2-4)
    4/5 + 1,2, or 3 to confirm diagnosis
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14
Q

Describe the ASAS classification for Ankylosing spondylitis

A
  1. Sacroilitis + >1SpA feature
  2. HLA B27 positive + 2SpA features
    In patients with >3months back pain <45 years old
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15
Q

What are the clinical features of Ankylosing spondylitis?

A

Back pain, enthesitis, peripheral arthritis

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16
Q

Name the extra articular features associated with ankylosing spondylitis

A

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

17
Q

State the investigations used in suspected ankylosing spondylitis

A

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)

18
Q

How is ankylosing spondylitis treated?

A

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

19
Q

What is psoriatic arthritis?

A

Inflammatory arthritis associated with psoriasis

20
Q

What are the clinical features of psoriatic arthritis?

A 
Sacroilitis - often asymmetric and may be associated with spondylitis 
Nail involvement 
Dactylics 
Enthesitis 
Extra- articular features
21
Q

Name the five subgroups of psoriatic arthritis

A
  • confined to DIP
  • symmetric polyarthritis
  • spondylitis
  • asymmetric oligoarthritis with dactylitis
  • arthritis mutilans
22
Q

How is psoriatic arthritis diagnosed?

A

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

23
Q

How is psoriatic arthritis treated?

A

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

24
Q

What is reactive arthritis?

A

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

25
Q

How long after the initial infection do symptoms occur?

A

1-4 weeks

26
Q

Which infections commonly cause reactive arthritis?

A

Urogenital - chlamydia

Enterogenic - salmonella

27
Q

Who is mostly affected by reactive arthritis?

A

HLA B27 young adults

28
Q

What is Reiter’s syndrome?

A

Can’t pee, can’t see, can’t climb a tree

  • urethritis
  • conjunctivitis/uveitis/iritis
  • arthritis
29
Q

What are the clinical features of reactive arthritis?

A

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

30
Q

How is reactive arthritis diagnosed?

A

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

31
Q

How is reactive arthritis treated?

A

NSAIDs, steroids, antibotics, DMARDs if resistant and physiotherapy

32
Q

What disease is enteropathic arthritis associated with?

A

IBD

33
Q

What are the clinical features of enteropathic arthritis?

A 
GI symptoms 
Weight loss 
Eye involvement e.g uveitis 
Skin involvement (pyoderma gangrenosum)
Enthesitis 
Oral apthous lesions
34
Q

What investigations are required in enteropathic arthritis?

A 
Endoscopy 
Joint aspiration 
Bloods - CRP and plasma volume 
X-ray/MRI for sacroilitis 
USS showing synovitis/tenosynovitis
35
Q

How is eneteropathic arthritis treated?

A

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

MSK (22 decks)

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