Spondyloarthropathies

Question 1

define spondyloarthropathies

Answer 1

inflammatory arthritis characterised by involvement of spine and joints (HLA B27 association)

Question 2

which conditions encompass this?

Answer 2

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

Question 3

define ankylosing spondylitis

Answer 3

chronic inflammation that primarily affects the spine

Question 4

when does ankylosing spondylitis present?

Answer 4

late adolescence or early adulthood

Question 5

presentation of ankylosing spondylitis

Answer 5

sacroiliitis and back pain due to fused vertebrae
enthesitis
peripheral arthritis
extra- articular features e.g. uveitis (A disease)

Question 6

diagnosis of ankylosing spondylitis

Answer 6

• 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

Question 7

management of ankylosing spondylitis

Answer 7

physiotherapy and occupational therapy
DMARDs make NO difference to spinal disease
anti-TNF and secukinumab

Question 8

define psoriatic arthritis

Answer 8

inflammatory arthritis associated with psoriasis

Question 9

presentation of psoriatic arthritis

Answer 9

• 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

Question 10

diagnosis of psoriatic arthritis

Answer 10

• bloods: raised inflammatory markers

- XR: marginal erosions and whiskering, pencil in cup, osteolysis and enthesitis

Question 11

management of psoriatic arthritis

Answer 11

• NSAIDs, corticosteroids and DMARDs
• anti-TNF if unresponsive
• physiotherapy, occupational therapy, orthotics and chiropodist

Question 12

define reactive arthritis

Answer 12

inflamed joint following infection

Question 13

what does Reiter’s syndrome present with?

Answer 13

triad:

• urethritis
• uveitis
• arthritis

Question 14

buzzword for Reiter’s syndrome

Answer 14

can’t see, can’t pee, can’t bend the knee/climb a tree

Question 15

presentation of reactive arthritis

Answer 15

• fever, fatigue and malaise
• asymmetrical monoarthritic or oligoarthritic
• enthesitis, mucocutaenous lesions

Question 16

diagnosis of reactive arthritis

Answer 16

• bloods: inflammatory markers, FBCs, U and Es

- joint fluid aspiration (organism shouldn’t be cultured, if it is then septic)

Question 17

management of reactive arthritis

Answer 17

• most resolve within 6 months
• NSAIDs and corticosteroids
• antibiotics for underlying infection
• DMARDs if resistant or chronic

Question 18

define enteropathic arthritis

Answer 18

arthritis associated with IBD

Question 19

presentation of enteropathic arthritis

Answer 19

• joint inflammation worsened during IBD flare up
• weight loss and low grade fever
• multisystem involvement

Question 20

diagnosis of enteropathic arthritis

Answer 20

• IBD diagnosis= colonoscopy, raised inflammatory markers

- joint aspiration to rule out septic arthritis

Question 21

management of enteropathic arthritis

Answer 21

• analgesics

- anti-TNF for both Crohn’s and inflammatory arthritis