Spondyloarthropathies Flashcards
What is the definition of spondyloarthropathy
a family of inflammatory arthritides characterized by involvement of both the spine and joints, mainly in genetically predisposed (HLAB27) individuals
What are the 4 subgroups of the spondyloarthropathies
Ankylosing spondylitis, psoariatic, reactive and enteropathic arthritis
What is HLA B27 associated with
ankylosing spondylitis, reactive arthritis, crohns and uveitis
What’s a typical description of mechanical back pain
Worsened by activity, typically worst at end of day, better with rest
What’s a typical description of inflammatory back pain
Worse with rest, better with activity, significant early morning stiffness - more than 30 minutes
What main joints are involved
Sacroiliac and spinal joints
What is enthesitis
inflammation at insertion of tendons into bones
What are some examples of enthesitis
Achilles tendinitis, plantar fasciitis
What is dactylitis
Inflammation of entire digit - sausage digits
What are some shared extra articular features of SA
occular inflammation (anterior uveitis, conjuctivitis), skin lesions, no rheumatoid nodules
What is a rare extra articular feature of SpAs
aortic incompetence or heart block
Sum up of ankylosing spondylitis
Chronic systemic inflammatory disorder, primarily affecting the spine
Who does AS affect and when does it come on
More common in men 3.5:1, comes in late adolescene/ early adulthood
Whats the two criteria used for SpA
ASAS Classification Criteria and Modified New York Criteria 1992
How come SpA is the A disease
Axial Arthritis Anterior Uveitis Aortic Regurgitation Apical fibrosis Amyloidosis/ Ig A Nephropathy Achilles tendinitis Plantar Fasciitis
What are 3 main exam findings in SpA patients
Occiput to wall, chest expansion, Schobers test
What are some features in a SpA Xray
Sacroilitis, syndesmophytes and ‘bamboo’ spine, shiny corners
What are syndesmophytes and bamboo spine showing
the fusion of the spine - alters posture!!
What is the best imaging to show early changes in SpA
MRI
What is psoriatic arthritis (PsA)
Inflammatory arthritis associated with psoriasis, but 10 -15% of patients can have PsA without psoriasis
What is arthritis mutilans
Really bad arthritis
What are the clinical features of PsA
Nail involvement (Pitting, onycholysis)
Dactylitis
Enthesitis: Achilles tendinitis, Plantar fasciitis
Extra articular features (eye disease)
What are the Xray features of PsA
Marginal erosions and “whiskering”
“Pencil in cup” deformity
Osteolysis
Enthesitis
What is reactive arthritis
Infection induced systemic illness characterized primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
