Spondyloarthropathies

Question 1

Spondyloarthropathies

Answer 1

Any sero-negative arthritis that is characterised by the presence of tissue-type antigen HLA-B27

Question 2

Spondyloarthropathies main issues

Answer 2

Back pain

Joint pain and swelling

Question 3

Spondyloarthropathies Main area affected

Answer 3

Spine

Question 4

Spondyloarthropathy associations

Answer 4

HLA-B27

Question 5

Spondyloarthropathy sub-groups (4)

Answer 5

Ankylosing spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

Question 6

Inflammatory Back pain (5)

Answer 6

Onset is usually <35 years of age and is usually insidious.

Pain persists longer than 3 months (chronic)

Worsens with immobility

Pain/stiffness ease with physical activity

NSAIDs are very effective

Question 7

Spondyloarthropathy Common Manifestations (8)

Answer 7

Enthesis (inflammation at insertion of tendons onto bones)

• Plantar Fasciitis
• Achilles tendonitis

Inflammatory Arthritis

• Oligoarticular
• Assymetrical
• predominaantly lower limb

Sacroilitis

Spinal Involvement

Ocular Inflammation

• Anterior uveitis
• COnjunctivitis

Mucocutaneous Lesions

Aortic incompetence or heart block

No rheumatoid nodules

Question 8

Ankylosing Spondylitis

Answer 8

Chronic systemic inflammatory disorder primarily affecting the spine

Question 9

Ankylosing Spondylitis Hallmark

Answer 9

Sacroiliac involvement

Question 10

Ankylosing Spondylitis Epidemiology

Answer 10

late Adolescents

Males

Question 11

Ankylosing Spondylitis Classification

Answer 11

ASAS

Question 12

Ankylosing Spondylitis Characteristics (7 A’s)

Answer 12

Anterior Uveitis
Aortic Valve Involvement
Apical Pulmonary Fibrosis
Asymptomatic enteric mucosal Inflammation 
Amyloidosis
Achilles Tendonitits
Antalo-axial subluxation

Question 13

Ankylosing Spondylitis Investigations

Answer 13

Occiput/Tragus to wall
Chest Expansion
Schober's Test
Bamboo Spine on X-ray- advanced
MRI can show early stages

Question 14

Ankylosing Spondylitis Treatment

Answer 14

Physio
Occupational Therapy
NSAIDs
DMARDs
- Salazopyrin
-Methotrexate
Anti-TNF

Question 15

Psoriatic Arthritis

Answer 15

Inflammatory arthritis associated with psoriasis

Question 16

Psoriatic arthritis features

Answer 16

Sacroilitis (asymmetrical)
Nail involvement (pitting& onycholysis)
Enthesitis
Extra-articular-> Eye disease

Question 17

Psoriatic Arthritis Subgroups (5)

Answer 17

Psoriatic arthritis confined to DIPS

Symmetric Psoriatic Polyarthritis

Psoriatic Spondylitis

Asymmetric Psoriatic Oligoarthritis with dactylitis

Psoriatic Arthritis Mutilans

Question 18

Psoriatic Arthritis Main X-ray findings (4)

Answer 18

Marginal Erosions

pencil in cup deformity

Osteolysis

Enthesitis

Question 19

Psoriatic Arthritis Treatment

Answer 19

Physiotherapy
Occupational THerapy
Orthotics
Podiatry
NSAIDs 
Corticosteroid Drug Injections 
DMARDs
-Sulfasalazine
-Methotrexate
-Leflunomide 
Anti-TNF

Question 20

Reactive Arthritis

Answer 20

Systemic illness induced by infection and characterised primarily by inflammatory synovitis

Question 21

Reactive Arthritis Aetiology

Answer 21

Urogenital
- Chlamydia

Enterogenic

• Salmonella
• Shigella

Question 22

Reactive Arthritis Epidemiology

Answer 22

20-40

Equal male to female ratio

Question 23

Reactive arthritis Features

Answer 23

Reiters Syndrome
General Malaise
Fever
Fatigue
Asymmetrical mono arthritis or oligoarthritis
Enthesitis
Mucocutaneous Lesions
Keratoderma Blennorhagicum
Vesico-pustular waxy skin lesions 
Circinate Balanitis (dermatitis of glans penis)

Question 24

Reiters Syndrome (3)

Answer 24

Uveitis
Conjunctivitis
Arthritis

Question 25

Reactive Arthritis Diagnosis

Answer 25

``` History and examination Bloods - Inflammatory markers (FBC, U&E, HLA-B27) Cultures of blood,urine or stool Joint fluid analysis X-ray of affected joints Ophthalmology opinion ```

Question 26

Reactive Arthritis Treatment

Answer 26

``` Most resolve spontaneously NSAIDs Corticosteroids Antibiotics DMARDs -Salazopyrin Physio Occupational Therapy ```

Question 27

Enteropathic Arthritis

Answer 27

Arthritis associated with UC and Crohn's disease

Question 28

Enteropathic Arthritis Common Sites

Answer 28

``` Knees Ankles Elbows Wrists Spine Hip Shoulder ```

Question 29

Enteropathic Arthritis Symptoms

Answer 29

``` Loose watery stools (with blood and mucus) Weight loss Low-grade fever Pyoderma Gangrenosum Enthesitis Apthous Ulcers Arthritis in several joints ```

Question 30

Enteropathic Arthritis Investigations

Answer 30

``` GI endoscopy Joint aspirate Raised inflammatory markers X-ray/ MRI to show sacroilitis US - synovitis/tenosynovitis ```

Question 31

Enteropathic Arthritis Treatment

Answer 31

``` Treat IBD No NSAID use Analgesia Steroids DMARDs -methotrexate -Sulfasalazine -Azathioprine Anti-TNF -Infliximab -Adalumimab ```