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Different types of arthritis > Spondyloarthropathies and HLA-B27 > Flashcards

Spondyloarthropathies and HLA-B27 Flashcards

1
Q

What is the definition of a spondyloarthropathy

A

A group of related/overlapping inflammatory joint disorders of the spine/vertebral column.

Commonly referred to as axial spondyloarthritis

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2
Q

What forms of spondyloarthritides do you know?

A

Ankylosing spondylitis

Psoriatic arthropathy

Reactive arthritis

Enteropathic arthritis

Undifferentiated spondyloarthropathy.

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3
Q

Which groups are ank spond most common in

A

men, presents under 45. Also more severe

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4
Q

What are the musculoskeletal features of ankylosing spondylitis?

A

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

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5
Q

When are msk symptoms of ank spond worst

A

The morning, improving with exercise

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6
Q

What are the 4 criteria for inflammatory back pain (>3 months)

A

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)

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7
Q

How does the spine deform as the disease progresses

A

The spine stiffens, lumbar lordosis lost, cervical and thoracic and cervical spines become increasingly kyphotic.

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8
Q

What are the four As of extraskeletal features of ank spond

A

Acute anterior uveitis (eye red, blurred vision)

Aortic incompetence

Apical lung fibrosis

Amyloidosis

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9
Q

What would the blood tests of an ankylosing spondylitis patient show

A

FBC may show anaemia of chronic disease

ESR & CRP may be raised.

Rheumatoid factor negative

HLA B27 serotyping not needed but can be useful

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10
Q

Which imaging type is preferred when looking for inflammatory arthritis?

A

MRI, detects what X-rays may see to be normal. Also no need for ionising radiation

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11
Q

What roles do physiotherapists play in treating AS

A

Sets regeimes of long term exercise to maintain posture

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12
Q

What is the main drug type used for treating AS?

A

NSAIDs, continous therapy. COX 1 and 2 inhibitors both have been shown to benefit patients, and may limit radiological progression

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13
Q

Other than NSAIDs, what drugs are used to treat AS?

A

DMARDs when a con-comitant peripheral arthritis occurs

Anti-TNF therapy works excellently in treating active axial disease and preventing AS progression

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14
Q

What is psoriatic arthritis

A

Arthritis associated with psoriasis

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15
Q

What is the pattern of joint disease for psoriatic arthritis

A

Distal arthritis of DIPJs, Asymmetrical oligoarthritis
Symmetrical polyarthritis indistinguishable from RA,
Arthritis mutilans

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16
Q

Whais dactylitis?

A

Inflammation of a finger/toe

Seen in psoriatic arthritis

17
Q

What is arthritis mutilans

A

An extremely destrictive pattern of joint destruction mainly of thr hands and feet.

18
Q

How can fingernails be affected by Psoriatic arthritis

A

Pitting or onycholysis (separation from nail bed)

19
Q

What is the CASPAR criteria (>3)

A

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)

20
Q

What do psoriatic arthritis blood tests show?

A

Similar to AS, ESR, CRP raised. Rheumatoid factor usually absent

21
Q

What will radiological investigations show?

A

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
22
Q

How is peripheral psoriatic arthritis treated?

A

NSAIDs, methotrexate, lefluenomide, sulfasalazine. anti-tnf when DMARDs fail

23
Q

How is axial psoriatic arthritis treated

A

like AS, physio, NSAIDs, anti-tnf

24
Q

What is enteropathic arthritis?

A

Arthritis occurring with inflammatory bowell disease (IBD). Occurs in 10-20% of patients with Crohns or ulcerative colitis

25
Q

Describe enteropathic peripheral arthritis

A

Mono or oligo, worsens with flaring of bowel disease, inproves of bowel removed

26
Q

Describe enteropathic spondylitis/sacroiliitis

A

Not related to activity of bowel disease, often predates crohns or ulcerative colitis

27
Q

Describe radiological presentation of enteropathic arthritis

A

Most x-ray images normal, spinal imaging can resemble AS.

28
Q

Describe bloods for enteropathic arthritis

A

Generally unhelpful unless inflammaoty markers correlate to disease activity

29
Q

how is enteropathic arthritis managed

A

Focus on treating IBD.

Corticosteroids and sulfasalazine help. Anti-tnf useful against axial disease.

Different types of arthritis (5 decks)

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