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Rhematology > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What is ankylosing spondylitis?

A

A chronic inflammatory disease of the spine and sacroilliac joints

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2
Q

What antigen is associated with ankylosing spondylitis?

A

HLA-B27

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3
Q

Who does ankylosing spondylitis usually present in?

A

Males aged 20-30 years old

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4
Q

What does seronegative mean?

A

No rheumatoid factor in the blood

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5
Q

What is a spondyloarthropathy

A

An autoimmune disease that affects the joints

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6
Q

What does ankylosis mean?

A

Abnormal stiffening and immobility of joint due to new bone formation

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7
Q

What does HLA-B7 stand for?

A

Human leukocyte antigen 27

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8
Q

What are the 3 theories that link B27 with the disease?

A
  • Molecular mimicry
  • Mis-folding theory
  • HLA B27 heavy chain homodimer hypothesis
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9
Q

Where does the inflammation occur in ankylosing spondylitis?

A

The site where the ligament, tendom and capsule insert into the bone. The enthesitis

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10
Q

What areas do infiltration and erosion occur?

A
  • Intervertebral joints
  • Facet joints
  • Sacroilliac joints
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11
Q

What is a syndesmophyte and how does it form?

A

A small bone outgrowth at the joint edges which is caused by ossification of fibrous tissue resulting in new bone formation

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12
Q

What are the extra articular features of ankylosing spondylitis?

A

The ‘A’s

  • Anterior uveitis
  • Amyloidosis
  • Apical lung fibrosis
  • Aortic regurgitation
  • AV node block
  • Achilles tendonitis
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13
Q

What are the risk factors for ankylosing spondylitis?

A
  • Male
  • HLA-B27
  • Bacterial environment
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14
Q

What is the typical presentation of ankylosing spondylitis?

A

Typically a young man who presents with lower back pain and stiffness

  • Stiffness - worse in the morning and improves with exercise
  • Pain at night which improves on getting up
  • Pain radiates from sacroilliac joints to the hips/buttocks
  • Progressional kyphosis
  • Relapsing and remitting
  • Asymmetrical joint pain
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15
Q

What are the signs of ankylosing spondylitis?

A
  • Loss of lumber lordosis
  • reduced lateral flexion
  • Reduced forward flexion - Schobers test
  • Reduced chest expansion due to progressive loss of spinal movements
  • Enthesitis
  • 5 As
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16
Q

What are the SPINEACHE signs?

A 
S - sausage digit (dactylitis)
P - psoriasis
I - inflam back pain
N - NSAIDs good response
E - enthesitis (heel)
A - arthritis 
C - crohns/ colitis
H - HLA B27
E - eye (uveilitis)
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17
Q

What would you see on a blood test in ankylosing spondylitis?

A
  • Inflammatory markers (ESR, CRP) are typically raised although normal levels do not exclude ankylosing spondylitis.
  • Normocytic anaemia
  • HLA-B27 positive
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18
Q

What genetic testing would you do in ankylosing spondylitis?

A

HLA-B27 but this is normal in 10% of patients

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19
Q

What would you radiography show in ankylosing spondylitis?

A
  • Bamboo spine
  • Fusion of the sacroiliac joints
  • Syndesmophytes
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20
Q

What non-pharmalogical treatment can you use in ankylosing spondylitis?

A
  • Encourage regular exercise

- Physio and occupation therapy

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21
Q

What pharmalogical treatments can you use in ankylosing spondylitis?

A
  • NSAIDs
  • DMARDs (disease-modifying drugs)
  • Anti-TNF therapy
22
Q

What surgical treatment can be used in ankylosing spondylitis

A
  • Surgery to straighten the spine

- Hip replacement to improve pain and mobility

23
Q

What is psoriatic arthritis?

A

A chronic inflammatory joint disease which develops in patients with psoriasis

24
Q

What group of conditions does psoriatic arthritis fit into?

A

Seronegative spondyloarthropathies

25
Q

What are the 5 types of psoriatic arthritis?

A
  1. Symmetrical seronegative polyarthritis
  2. Asymmetrical oligoarthritis
  3. Sacroilitis
  4. DIP joint disease
  5. Arthritis mutilans
26
Q

What is the most common form of psoriatic arthritis and what does it resemble?

A

Symmetrical seronegative and its like rheumatoid arthritis

27
Q

What signs are seen in DIP joint disease?

A
  • DIP joint involvement only
  • Adjacent nail dystrophy
  • Dactylitis
28
Q

What signs are seen in arthritis mutilans?

A
  • Telescoping fingers
  • Periarticular osteolysis
  • Bone shortening
  • Pencil in cup xray changes
  • Rare
29
Q

Does all psoriatic arthritis present with psoriasis?

A

No, can present with or without skin changes

30
Q

How does the psoriatic plaque form in psoriatic arthritis?

A

Inflammation leads to cytokine production which leads to proliferation of keratinocytes and fibroblasts leading to formation of the psoriatic plaque

31
Q

How do the bone deformities in psoriatic arthritis form?

A

T cells activate OB and OC in joint spaces

32
Q

Where does psoriasis mainly occur?

A

Over extensor surfaces

33
Q

What is the presentation of psoriatic arthritis?

A
  • Inflammatory pain - red, warm, painful, stiffness and swelling
  • Psoriatic Arthritis Mutilans - marked bony resorption and the consequent collapse of soft tissue, can cause a phenomenon sometimes referred to as “telescoping fingers”.
  • Associated nail changes in 80% - Nail pitting and
  • Onycholysis
  • Psoriatic rash
  • Dactylitis
34
Q

What investigations would you do in psoriatic arthritis?

A
  • Bloods

- X-ray

35
Q

What would you see on the blood test in psoriatic arthritis?

A

RF negative and ESR often normal

36
Q

What would you see on the X-ray in psoriatic arthritis?

A
  • DIPs are predominantly affected
  • Central erosions
  • Pencil in cup changes
37
Q

What are the 4 treatment options for psoriatic arthritis?

A
  1. NSAIDs
  2. DMARDs
  3. INtra articular steroid injections
  4. Anti-TNF
38
Q

What is reactive arthritis?

A

Inflammation of a joint after an infection usually presenting 2-3 weeks after infection

39
Q

What category of diseases does reactive arthritis fit into?

A

Seronegative spondyloarthropathy

40
Q

What syndrome does reactive arthritis encompass?

A

Reiter’s syndrome

41
Q

What are the triad of symptoms seen in Reiter’s syndrome?

A
  • Conjunctivitis/uveitis
  • Urethritis
  • Arthritis following a dysenteric illness
42
Q

What is the saying for this triad of symptoms seen in Reiter’s syndrome?

A

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

43
Q

What are the three main GI infection causes for reactive arthritis?

A

Salmonella
Shigella
Yersinia enterocolitica

44
Q

What sexually acquired causes are there of reactive arthritis?

A
  • Urethritis from chlamydia trachomatis

- Ureaplasma urealyticum

45
Q

What are the risk factors for reactive arthritis?

A

Unprotected sex

46
Q

Which gender are less commonly affected

A

Women

47
Q

How does reactive arthritis present?

A
  • Asymmetrical joint pain: Warm, Red, Sudden onset.
  • Symptoms generally last around 4-6 months
  • Arthritis is typically an asymmetrical oligoarthritis of lower limbs
  • Dactylitis - inflammation of a digit
  • Mouth ulcers
48
Q

What investigations would you do in reactive arthritis?

A
  • Bloods
  • Culture stool if diarrhoea is present
  • GUM referral
  • Aspirated synovial fluid
  • Xrays
49
Q

What would you see on the blood test in reactive arthritis?

A
  • ESR, CRP - raised in acute phase

- HLA-B27 genetic test

50
Q

What does the synovial fluid look like in reactive arthritis?

A

Sterile with a high neutrophil count

51
Q

What is the non-pharmalogical treatment in reactive arthritis?

A

Splint the affected joint

52
Q

What is the pharmalogical treatment for reactive arthritis?

A
  • NSAIDs
  • Antibiotics
  • Methotrexate

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