Spondyloarthropathies and HLA-B27 Flashcards
What is the definition of a spondyloarthropathy
A group of related/overlapping inflammatory joint disorders of the spine/vertebral column.
Commonly referred to as axial spondyloarthritis
What forms of spondyloarthritides do you know?
Ankylosing spondylitis
Psoriatic arthropathy
Reactive arthritis
Enteropathic arthritis
Undifferentiated spondyloarthropathy.
Which groups are ank spond most common in
men, presents under 45. Also more severe
What are the musculoskeletal features of ankylosing spondylitis?
Gradual onset of lower back/gluteal pain and stiffness. Sacro-iliac pain
Loss of anterior and lateral flexion, extension of spine.
Limited by early diagnosis
When are msk symptoms of ank spond worst
The morning, improving with exercise
What are the 4 criteria for inflammatory back pain (>3 months)
Morning stiffness >30 mins
Improves with exercise but not rest
Back pain awakens patient in second half of night
Alternating buttock pain
(2/4 means inflammatory)
How does the spine deform as the disease progresses
The spine stiffens, lumbar lordosis lost, cervical and thoracic and cervical spines become increasingly kyphotic.
What are the four As of extraskeletal features of ank spond
Acute anterior uveitis (eye red, blurred vision)
Aortic incompetence
Apical lung fibrosis
Amyloidosis
What would the blood tests of an ankylosing spondylitis patient show
FBC may show anaemia of chronic disease
ESR & CRP may be raised.
Rheumatoid factor negative
HLA B27 serotyping not needed but can be useful
Which imaging type is preferred when looking for inflammatory arthritis?
MRI, detects what X-rays may see to be normal. Also no need for ionising radiation
What roles do physiotherapists play in treating AS
Sets regeimes of long term exercise to maintain posture
What is the main drug type used for treating AS?
NSAIDs, continous therapy. COX 1 and 2 inhibitors both have been shown to benefit patients, and may limit radiological progression
Other than NSAIDs, what drugs are used to treat AS?
DMARDs when a con-comitant peripheral arthritis occurs
Anti-TNF therapy works excellently in treating active axial disease and preventing AS progression
What is psoriatic arthritis
Arthritis associated with psoriasis
What is the pattern of joint disease for psoriatic arthritis
Distal arthritis of DIPJs, Asymmetrical oligoarthritis
Symmetrical polyarthritis indistinguishable from RA,
Arthritis mutilans
Whais dactylitis?
Inflammation of a finger/toe
Seen in psoriatic arthritis
What is arthritis mutilans
An extremely destrictive pattern of joint destruction mainly of thr hands and feet.
How can fingernails be affected by Psoriatic arthritis
Pitting or onycholysis (separation from nail bed)
What is the CASPAR criteria (>3)
Psoriasis or family history of it (2)
Nail dystrophy (Onycholysis, pitting, hyperkeratosis) (1)
Negative rheum. factor (1)
Dactylitis/history (1)
Radiographic signs of juxta-articular bone formation as ill-defined joint ossification near joint margins (1)
What do psoriatic arthritis blood tests show?
Similar to AS, ESR, CRP raised. Rheumatoid factor usually absent
What will radiological investigations show?
Asymmetrical targeting small joints of hands and feet.
Erosions with proliferation of adjacent bone Resorption of terminal phalanges Pencil-in-cup deformity Periostitis ANkylosis New bone formation at entheses Sacroiliitis
How is peripheral psoriatic arthritis treated?
NSAIDs, methotrexate, lefluenomide, sulfasalazine. anti-tnf when DMARDs fail
How is axial psoriatic arthritis treated
like AS, physio, NSAIDs, anti-tnf
What is enteropathic arthritis?
Arthritis occurring with inflammatory bowell disease (IBD). Occurs in 10-20% of patients with Crohns or ulcerative colitis
Describe enteropathic peripheral arthritis
Mono or oligo, worsens with flaring of bowel disease, inproves of bowel removed
Describe enteropathic spondylitis/sacroiliitis
Not related to activity of bowel disease, often predates crohns or ulcerative colitis
Describe radiological presentation of enteropathic arthritis
Most x-ray images normal, spinal imaging can resemble AS.
Describe bloods for enteropathic arthritis
Generally unhelpful unless inflammaoty markers correlate to disease activity
how is enteropathic arthritis managed
Focus on treating IBD.
Corticosteroids and sulfasalazine help. Anti-tnf useful against axial disease.
