spondyloarthropathies Flashcards
what are spondyloarthropathies?
a group of conditions that affect the spine and peripheral joints and are associated with the presence of HLA-B27
what do spondyloarthropathies comprise of?
- ankylosing spondylitis
- enteropathic arthritis
- psoriatic arthritis
- reactive arthritis
what are the common clinical features of spondyloarthropathies?
- sacroiliac/axial disease (back/buttock pain)
- inflammatory arthropathy of peripheral joints
- enthesitis (inflammation at tendon insertions)
- extra-articular features (skin/gut/eye)
what is ankylosing spondylitis?
Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae to fuse.
This fusing makes the spine less flexible and can result in a hunched-forward posture (kyphosis)
can also affect SI joint
how does ankylosing spondylitis present?
pain worse at night with spinal morning stiffness, relieved by exercise
Can radiate from SI joint, causing bilateral buttock pain
loss of spinal movement so get reduced thoracic expansion
can also get enthesitis, especially achilles tendonitis and plantar fascitis
what is observed on examination of ankylosing spondylitis?
often normal
later, can see loss of lumbar lordosis and exaggerated thoracic kyphosis
Schober test (mark skin 10cm above and 5cm below PSIS, bend forward with straight legs, distance increase to >20cm is normal)
reduced chest expansion
what investigations are done into ankylosing spondylitis?
investigate with
- CRP (may be raised but usually normal)
- MRI spine and SI joints
how is ankylosing spondylitis treated?
treatment:
- NSAIDs
- physio
- TNF inhibitors
- IL-17 inhibitors
what is psoriatic arthritis?
in 10% of patients with psoriasis
what is usually found on examination of a patient with psoriatic arthritis?
- oligo arthritis
- dactylitis/’sausage’ digit (inflammed digit)
- can be symmertrical or mono arthritis
what do investigations into psoriatic arthritis show?
- CRP often raised
- central joint erosion seen early on US or MRI leading to ‘pencil in cup’ x ray appearance
how is psoriatic arthritis treated?
- NSAIDs
- DMARDs
- TNF inhibitors
- IL-17 inhibitors
- IL 12/23 inhibitors
what is reactive arthritis?
Sterile synovitis developing after a distant infection either post dysentery (Salmonella / Shigella / Campylobacter) or following urethritis/cervicitis (Chlamydia trachomatis)
aka infection is typically in GI or GU tract
how do patients with reactive arthritis present?
few days - 2 weeks post infection, acute asymmetrical lower limb arthritis develops
may also have
- skin changes (circinate balanitis, keratoderma blennorrhagica)
- eye (conjunctivitis, uveitis)
- enthesitis (inflammation where a tendon or ligament attaches to bone)
what do investigations into reactive arthritis show and how is it treated?
- raised inflammatory markers
- may need joint aspirate to rule out septic/crystal
- treat infection, can use NSAIDs and joint injections. Most will resolve within 2 years. Those that do not may need DMARDs.
what is enteropathic arthritis?
10 - 20% of those with IBD develop arthropathy. Of these 2/3 = peripheral arthritis and 1/3 develop axial disease.
what are the two types of peripheral disease in enteropathic arthritis?
Type 1 = oligoarticular, asymmetric and has a correlation with IBD flares
Type 2 = polyarticular symmetrical and less correlation with IBD flares
how is enteropathic arthritis treated?
- DMARDs
- (remember NSAIDs may flare up IBD)
- TNF inhibitors will treat bowel disease and arthritis
what are some extra articular manifestations of ankylosing spondylitis?
Anterior uveitis
Aortic incompetence
AV block
Apical lung fibrosis Amyloidosis
what are the features of inflammatory back pain?
Insidious onset
Pain at night (with improvement on getting up)
Age at onset <40
Improvement with exercise
No improvement with rest
what rhyme can be used to remember the features of reactivearthritis?
cant see (conjunctivitis/uveitis)
cant wee
urethritis
