Spondyloarthropathies (mind-maps)

Question 1

Examples

Answer 1

PEAR:
Psoriatic arthritis
Enteropathic arthropathies
Ankylosing spondylitis
Reactive arthritis

Question 2

What is reactive arthritis?

Answer 2

This is an asymmetrical arthritis that occurs post gastrointestinal or urogenital infection

Question 3

Causes of reactive arthritis

Answer 3

The exact cause and pathophysiology of this condition is not known
However, it often occurs after an infection, typically, a sexually transmitted infection or an infection of the gastrointestinal tract

Question 4

Signs and symptoms of reactive arthritis

Answer 4

Urethritis
Arthritis: pain and stiffness
Uveitis/conjunctivitis

Question 5

Investigations of reactive arthritis

Answer 5

Bloods

Radiology - X-ray of infected joint (assesses severity)

Question 6

Investigations of reactive arthritis - what is looked for with bloods

Answer 6

Seronegative for rheumatoid factor
Blood cultures
Look for infectious cause

Question 7

Conservative treatment of reactive arthritis

Answer 7

Patient education

Refer to physiotherapy

Question 8

Medical treatment of reactive arthritis

Answer 8

Analgesia
Non-steroidal anti-inflammatory drugs (NSAIDs)
Disease modifying anti-rheumatic drugs (DMARDs) e.g. sulphasalzine

Question 9

Complications of reactive arthritis

Answer 9

Arrhythmia
Uveitis
Aortic insufficiency

Question 10

What is psoriatic arthritis

Answer 10

Inflammatory arthritis that is associated with skin condition psoriasis. The signs and symptoms also depend on how and where the joints are affected.

Question 11

**5 subtypes of psoriatic arthtritis

Answer 11

Asymmetrical oligoarthritis (distal and proximal inter-phalangeal joints)
Symmetrical rheumatoid-like arthropathy
Ankylosing spondylitis variant
Polyarteritis with skin and naik changes

Question 12

Causes of psoriatic arthritis

Answer 12

Exact cause is unknown
Thought to be due to an inflammatory process coupled with genetic involvement of the HLA B27 gene
Family Hx of psoriasis

Question 13

What is greatest risk factor of psoriatic arthritis

Answer 13

Family Hx of psoriasis

Question 14

Signs and symptoms of psoriatic arthritis

Answer 14

Psoriasis
Joint pain and stiffness
Swelling of affected joints
Nail changes

Question 15

Describe the nail changes in psoriatic arthritid

Answer 15

Yellowing of the nail
Onycholysis (painless detachment of the nail from the nail bed)
Pitting
Subungal hyperkeratosis (buildup of soft yellow keratin in the space created by the onycholysis)

Question 16

What is psoriasis

Answer 16

Well-demarcated salmon-pink plaques with evidence of scalling
These plaques are usually present on the extensor surfaces (chronic plaque psoriasis), but sometimes smaller plaques may occur in a raindrop pattern over the torso
This is called guttate psoriasis and is often preceded by an upper respiratory tract infection/sore throat caused by Streptococcus

Question 17

Investigations of psoriatic arthritis

Answer 17

Psoriasis is a clinical diagnosis
Bloods - seronegative for Rheumatoid factor
Radiology - X- ray pf affected joints to assess severity

Question 18

What hand deformity is seen (also on X-ray) of psoriatic arthritis

Answer 18

‘Pencil-in-cup’ deformity

Question 19

Conservative treatment of psoriatic arthritis

Answer 19

Patient education
Refer to physiotherapy
Explain to patients that psoriasis does not have a cure and control of the disease is more realistic

Question 20

Medical treatment of psoriatic arthritis

Answer 20

Analgesia (nonsteroidal anti-inflammatory drugs - NSAIDs)
Disease modifying antirheumatic drugs (DMARDs) e.g. methotrexate (FIRST LINE)
Manage psoriasis

Question 21

Surgical treatment of psoriatic arthritis

Answer 21

Rarely joint placement

Question 22

Complications of psoriatic arthritis

Answer 22

Neurological manifestations if atlanto-axial joint involvement
Joint destruction

Question 23

What are enteropathic arthropathies

Answer 23

An arthritis that develops in association with inflammatory bowel disease (IBD)
It is indistinguishable from reactive arthritis

Question 24

Cause of enteropathic arthritis

Answer 24

Exact cause is unknown, however it is thought to be associated with HLA B27

Question 25

Signs and symptoms of enteropathic arthritis

Answer 25

Those of IBD
Spondylitis
Sacroiliitis
Peripheral arthritis - usually of large joints

Question 26

Investigations of enteropathic arthritis

Answer 26

Those for IBD

Radiology - X-ray of affected joint; assess severity

Question 27

Treatment of enteropathic arthritis

Answer 27

Analgesia (NSAIDs)

Treatment of IBD

Question 28

Complications of enteropathic arthritis

Answer 28

Severely decreased mobility with axial involvement

Question 29

What is ankylosing spondylitis

Answer 29

Chronic inflammatory disease of the spine and sacroiliac joints.
There is predominance in young males and the condition is associated with HLA B27 (positive in 95%)

Question 30

Causes of ankylosing spondylitis

Answer 30

Exact cause and pathophysiology of this condition are not known. However, it is thought to be associated with HLA B27

Question 31

Signs and symptoms of ankylosing spondylitis

Answer 31

Question mark posture
Bamboo spine - due to calcification of ligaments
Pain and stiffness - symptoms improve with exercise

Question 32

Investigations of ankylosing spondylitis

Answer 32

Bloods - seronegative for rheumatoid factor

Radiology - CXR and MRI scan assess changes in the spine

Question 33

Conservative treatment of ankylosing spondylitis

Answer 33

Patient education

Refer to physiotherapy

Question 34

Medical treatment of ankylosing spondylitis

Answer 34

Analgesia (NSAIDs) and DMARDs e.g. Sulphasalzine (FIRST LINE)

Question 35

Surgical treatment of ankylosing spondylitis

Answer 35

Corrective spinal surgery

Question 36

Complications of ankylosing spondylitis

Answer 36

Osteoporosis
Spinal fractures
Increased risk of cardiovascular disease e.g. stroke and myocardial infarction