define spondyloarthropathies
inflammatory arthritis characterised by involvement of spine and joints (HLA B27 association)
which conditions encompass this?
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
define ankylosing spondylitis
chronic inflammation that primarily affects the spine
when does ankylosing spondylitis present?
late adolescence or early adulthood
presentation of ankylosing spondylitis
sacroiliitis and back pain due to fused vertebrae
enthesitis
peripheral arthritis
extra- articular features e.g. uveitis (A disease)
diagnosis of ankylosing spondylitis
- examination (occiput to wall, chest expansion and Schober’s test)
- question mark spine- thoracic kyphosis and loss of lumbar lordosis
- bloods for inflammatory markers and HLAB27
- XR (sacroillitis, syndesmophytes and bamboo spine)
- MRI
management of ankylosing spondylitis
physiotherapy and occupational therapy
DMARDs make NO difference to spinal disease
anti-TNF and secukinumab
define psoriatic arthritis
inflammatory arthritis associated with psoriasis
presentation of psoriatic arthritis
- sacroillitis
- DIP joints affected first due to enthesis being affected
- nail involvement (pitting, onycholysis and dactylitis)
- enthesitis e.g. achilles tendonitis and plantar fasciitis
- sausage fingers
diagnosis of psoriatic arthritis
- bloods: raised inflammatory markers
- XR: marginal erosions and whiskering, pencil in cup, osteolysis and enthesitis
management of psoriatic arthritis
- NSAIDs, corticosteroids and DMARDs
- anti-TNF if unresponsive
- physiotherapy, occupational therapy, orthotics and chiropodist
define reactive arthritis
inflamed joint following infection
what does Reiter’s syndrome present with?
triad:
- urethritis
- uveitis
- arthritis
buzzword for Reiter’s syndrome
can’t see, can’t pee, can’t bend the knee/climb a tree
presentation of reactive arthritis
- fever, fatigue and malaise
- asymmetrical monoarthritic or oligoarthritic
- enthesitis, mucocutaenous lesions
diagnosis of reactive arthritis
- bloods: inflammatory markers, FBCs, U and Es
- joint fluid aspiration (organism shouldn’t be cultured, if it is then septic)
management of reactive arthritis
- most resolve within 6 months
- NSAIDs and corticosteroids
- antibiotics for underlying infection
- DMARDs if resistant or chronic
define enteropathic arthritis
arthritis associated with IBD
presentation of enteropathic arthritis
- joint inflammation worsened during IBD flare up
- weight loss and low grade fever
- multisystem involvement
diagnosis of enteropathic arthritis
- IBD diagnosis= colonoscopy, raised inflammatory markers
- joint aspiration to rule out septic arthritis
management of enteropathic arthritis
- analgesics
- anti-TNF for both Crohn’s and inflammatory arthritis
