Spondyloarthropathies Lecture Powerpoint

Question 1

Spondyloarthropathies definition

Answer 1

Family of inflammatory arthropathies characterized by axial skeletal involvement, peripheral arhtropathy, enthesitis, dactylitis, and extra articular manifestations in genetically predisposed individuals

Question 2

Common features of the spondyloarthropathies (5)

Answer 2

• association with the HLA-B27 gene
• Enthesitis
• inflammatory back pain (gets better with exercise, stiff in morning, younger person)
• extra-articular manifestations
• family aggregation

Question 3

Ankylosing spondylitis clinical findings (3)

Answer 3

• age of onset late childhood to young adulthood
• long delay in diagnosis due to insidious onset of symptoms
• male predominant

Question 4

Ankylosing spondylitis physical exam findings (6)

Answer 4

• tenderness over sacroiliac joints
• restricted motion (schober’s maneuver)
• decreased chest expansion
• decreased cervical spine motion
• peripheral arthritis and enthesitis
• extra articular manifestations

Question 5

Schober’s maneuver

Answer 5

Test for ankylosing spondylitis, while standing, make a mark at sacral dimples and measure 10cm to make another mark, have patient bend forward and touch toes, measure distance between marks, >15cm is normal, excursion is decreased in ankylosing spondylitis

Question 6

Radiologic evals of ankylosing spondylitis (2)

Answer 6

• radiographs displaying sacroilitiis, spondylitis, bamboo spine (late stage, see squaring off of vertebrae) and entheses (periosteal new born formation and erosions)
• MRI scan if still uncertain

Question 7

Sacroilitis radiographic finding

Answer 7

See irregular border, sclerosis on either side of the joint indicating presence of sacroilitis (typically bilateral in ankylosing spondyliis)

Question 8

Areas where enthesopathies are more likely to occur (4)

Answer 8

• heel (achilles tendon insertion on calcaneous)
• knee (superior and inferior aspect of patella)
• foot
• back and buttocks (iliac spines and crest, ischial tuberosity)

Question 9

Extra-articular manifestations of ankylosing spondylitis (6)

Answer 9

• acute anterior uveitis
• apical pleural thickening and fibrosis
• aortic insufficiency (diastolic murmur)
• amyloidosis of kidney
• neurologic complications of severe spinal disease
• prostatitis or inflammatory bowel disease

Question 10

Psoriatic arthritis clinical manifestations (5)

Answer 10

• asymmetric oligoarthritis
• distal interphalangeal joints predominantly
• severe deforming arthritis (arthritis mutilans)
• rheumatoid like arthritis with negative RF
• spondylitis (large asymmetrical bulky syndesmophytes opposed to the thin symmetrical ones in ankylosing spondylitis)

Question 11

Reactive arthritis (reiter’s syndrome) diagnostic criteria (4)

Answer 11

• seronegative asymmetric oligoarticular arthritis as well as
• urethritis/cervicitis
• dysentary
• inflammatory eye disease conjunctivitis or uveitis

Question 12

Possible infectious etiologies of reactive arthritis (3)

Answer 12

• genitourinary dz
• GI disease
• lyme disease
• genetically predisposed individuals often with HLAB27

Question 13

Musculosekeltal manifestations of reactive arthritis (3)

Answer 13

• Asymmetric oligoarthritis predominantly of lower extremities
• sacroilitis usually asymmetric
• enthesitis

Question 14

Extra-articular manifestations of reactive arthritis (4)

Answer 14

• urethritis
• conjunctivitis or uveitis
• aortic insufficiency
• pleuritis and infiltrates

Question 15

Management of spondyloarthropathies (8)

Answer 15

• NSAIDS and cox2 inhibitors effective for inflammatory symptoms
• sulfasalazine
• corticosteroids
• methotrexate
• apremilast
• bDMARDS
• PT
• orthopedic surgery