Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3M - Rheumatology > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

Give examples of spondyloarthrites.

A

Axial spondyloarthritis (AxSpa) such as ankylosing spondylitis

Psoriatic arthritis

Reactive arthritis

Post-dysenteric reactive arthritis

Enteropathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the spondyloarthropathies?

A

A group of related chornic inflammatory conditions.

They usually affect the axial skeleton.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Shared clinical features of spondyloarthropathies.

A

Seronegativity (RhF -ve)

HLA-B27 associated

Axial arthritis and sacroiliac joints

Assymetrical large-joints oligoarthritis or monoarthritis.

Entehsitis

Dactylitis

Extra-articular manifestations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is enthesitis?

A

Inflammation of the site of insertion of tendon or ligament into bone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give examples of enthesites.

A

Plantar fasciitis

Achilles tendonitis

Costochondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common spondyloarthropathy.

A

Axial spondyloarthritis and ankylosing spondylitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between axial spondyloarthritis and ankylosing spondylitis?

A

Axial spondyloarthritis is an inflammatory disorder primarily affecting the sacroiliac joints or fibrous and synovial joints of the spine, so is ankylosing spondylitis.

AxSpA can be seen on MRI, so can ankylosing spondylitis.

However Ankylosing spondylitis can also be seen on X-ray.

When the radiographic changes occur in AxSpA it is then termed ankylosing spondylitis.

AS forms part of the spectrum of AxSpA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Epidemiology of ankylosing spondylitis. AS.

A

Usually in young men where symptoms start to occur in late teens to early thirties.

Male to female 3:1

Women present later and are under-diagnosed.

There is a strong association with HLA-B27.

95% carry HLA-B27 gene.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical presentation of AS.

A

Bilateral buttock pain, chest wall and thoracic pain

There is an insidious onset of the pain.

It is worse during the night and spinal morning stiffness that is relieved by exercise.

The pain usually improves by the end of the day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features on examination of AS.

A

Often normal

However in late disease there might be loss of lumb lordosis and exaggerated thoracic kyphosis.

Schober’s test

Reduced chest expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain Schober test.

A

Mark the skin 10cm above and 5 cm below PSIS.

This gives a 15cm distance between the two marks.

Ask the patient to bend forward with straight legs.

The distance should now be > 20 cm for the spine to be normal.

If it is 20 cm or less there is loss oof lumbar lordosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other features in AS.

A

Enthesitis - particularly Achilles tendonitis and plantar fasciitis

Acute iritis

Osteoporosis

Acute anterior uveitis

Costochondritis

AV block

Aortic incompetence

Apical lung fibrosis

Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations of AS.

A

CRP - raised or normal

MRI spine and SI joints (more sensitive than X-ray)

HLA-B27 testin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

X-ray and MRI findings in AS.

A

Bamboo spine is a typical appearance in later stages.

Squaring of the vertebral bodies

Subchondral sclerosis and erosions

Syndesmophytes

Ossification of the ligaments, discs and joints.

Fusion of the facet, sacroiliac and costovertebral joints

Medial and lateral cortical margins of both sacroiliac joints lose their definition due to erosions.

They will eventually become sclerotic.

There is blurring of the upper or low vertebral rims at the thoracolumbar junction due to enthesitis at the insertion of the interverebral ligaments.

Bony spurs may be present

Sacroiliac joints eventually fuse as may the costovertebral joints leading to reduced chest expansion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Blood findings in AS.

A

Normocytic anaemia

ESR raised

CRP raised

HLAB27 positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Back pain criteria for diagnosing axial/ankylosing spondylitis.

A

Age of onset < 45 years

Insidious onset of pain

Improvement of back pain with exercise

No improvement of back pain with rest

Pain at night with improvement of getting up.

Presence of four of five criteria suggests AS with 80% sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

General management of AS.

A

Exercise instead of rest to relieve the pain.

Work hard to maintain posture and mobility.

18
Q

Treatment algorithm for AS.

A

NSAIDs and analgesics like paracetamol

If there is local intra-articular inflammation or enthesitis give intra-articular corticosteroid injections.

If there is peripheral joint involvement give sulfasalazine.

19
Q

Treatment algorithm for AS refractory to 2 NSAIDs.

A

Straight to TNF-alpha blockers

20
Q

An easy way to remember extra-articular manifestations of AS.

A

All the As.

Anterior uveitis

Aortic incompetence

AV block

Apical lung fibrosis

Amyloidosis

21
Q

Clinical features of psoriatic arthritis.

A

Mono or oligoarthritis.

Polyarthritis in a asymmetrical pattern going symmetrical and can become indistinguishable to RA. This is more common in women and MCPJ are not normally affected.

Spondylitis that is unilateral or bilateral sacroiliitis and early cervical spine involvement.

Distal interphalangeal arthritis

Dactylitis

Arthritis mutilans causing marked periarticular osteolysis and bone shortening.

Onycholysis

Pitting of nails

Enthesitis

Synovitis

Acneiform rashes

22
Q

Investigations in PA + screening tool

A

CRP often raised.

X-ray

MRI

Psoriasis Epidemiological Screening Tool (PEST)
NICE recommend patients with psoriasis complete the PEST tool to screen for psoriatic arthritis. This involves several questions asking about joint pain, swelling, a history of arthritis and nail pitting. A high score triggers a referral to a rheumatologist.

23
Q

X-ray findings in PA.

A

Periostitis is inflammation of the periosteum causing a thickened and irregular outline of the bone

Ankylosis is where bones joining together causing joint stiffening

Osteolysis is destruction of bone

Dactylitis is inflammation of the whole digit and appears on the xray as soft tissue swelling

Pencil-in-cup appearance central erosion of the bone

24
Q

What is dactylitis?

A

Uniform swelling of a finger

25
Q

Criteria for diagnosis of psoriatic arthritis.

A

CASPAR (ClASsification of Psoriatic ARthritis) criteria

Inflammatory articular disease (joint, spine, or entheseal) with ≥3 points from the following 5 categories (current psoriasis score 2 points; all others 1 point):

1 - Evidence of current psoriasis, a personal history of psoriasis, or a family history of psoriasis in a first- or second-degree relative

2 - Psoriatic nail dystrophy

3 - RhF -ve

4 - Current or historical dactylitis

5 - Radiographical evidence of juxta-articular new-bone formation appearing as ill-defined ossification near joint margins (periostitis) on plain films of the hand or foot.

26
Q

What is arthritis mutilans?

A

This is the most severe form of psoriatic arthritis.

This occurs in the phalanxes. There is osteolysis (destruction) of the bones around the joints in the digits.

This leads to progressive shortening of the digit. The skin then folds as the digit shortens giving an appearance that is often called a “telescopic finger”.

27
Q

Treatment of PA.

A

NSAIDs

DMARDs

TNF inhibitors

IL-17 inhibitors

IL12/23 inhibitors

28
Q

What is reactive arthritis? ReA

A

Arthritis and other clinical manifestations occur as an autoimmune response to infection elsewhere in the body, this is typically GI or GU like an STI.

It is a sterile synovitis that develop post dysentery like Salmonella, Shigella or Campylobacter or following urethritis/cervicitis by Chlamydia trachomatis.

29
Q

Clinical features of ReA.

A

Acute asymmetrical lower limb arthritis develops few days - 2 weeks post infection

30
Q

Associations with ReA.

A

Bilateral conjunctivitis (non-infective)

Anterior uveitis

Circinate balanitis is dermatitis of the head of the penis

Iritis

Keratoderma blennorrhagica

Enthesitis

“can’t see, pee or climb a tree”.

31
Q

What is Keratoderma blennorrhagica?

A
32
Q

What is circinate balanitis?

A
33
Q

Investigations of ReA.

A

Elevated ESR and CRP

Culture stool if diarrhoea

Infectious serology

Sexual health review

Joint aspiration might need to be done to rule of septic/crystal arthritis.

X-ray

34
Q

What might X-ray show in ReA?

A

Enthesitis with periosteal reaction

35
Q

Treatment of ReA.

A

Treat infection

NSAIDs and joint injections of steroids.

Most will resolve within 2 years but if they don’t the may need DMARDs.

36
Q

Treatment algorithm of ReA.

A
37
Q

What is enteropathic arthritis? EA.

A

10-20% of those with IBD develop arthritis.
Of these 2/3 are peripheral and 1/3 are axial.

Associated with IBD, GI bypass, coeliac and Whipple’s disease.

38
Q

Two types of peripheral EA.

A

Type 1 - oligoarticular, asymmetric and correlated with IBD flares.

Type 2 - Polyarticular symmetrical and less correlation with IBD flares.

39
Q

Treatment of enteropathic arthritis.

A

NSAIDs to help with IBD flares.

Consider DMARDs.

TNF inhibitors will treat both the bowel disease and the arthritis.

Treat the IBD and the EA will get better as well.

40
Q

Features of inflammatory back pain mnemonic.

IPAIN

A

Insidious onset

Pain at night improving on getting up

Age at onset < 40

Improvement with exercise

No improvement with rest

41
Q

Handy rhyme for remembering features of ReA.

A

Can’t see (conjunctivitis/uveitis)

Can’t wee (urethritis)

Y3M - Rheumatology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions