Spondyloarthropathies (mind-maps) Flashcards
Examples
PEAR: Psoriatic arthritis Enteropathic arthropathies Ankylosing spondylitis Reactive arthritis
What is reactive arthritis?
This is an asymmetrical arthritis that occurs post gastrointestinal or urogenital infection
Causes of reactive arthritis
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
Signs and symptoms of reactive arthritis
Urethritis
Arthritis: pain and stiffness
Uveitis/conjunctivitis
Investigations of reactive arthritis
Bloods
Radiology - X-ray of infected joint (assesses severity)
Investigations of reactive arthritis - what is looked for with bloods
Seronegative for rheumatoid factor
Blood cultures
Look for infectious cause
Conservative treatment of reactive arthritis
Patient education
Refer to physiotherapy
Medical treatment of reactive arthritis
Analgesia
Non-steroidal anti-inflammatory drugs (NSAIDs)
Disease modifying anti-rheumatic drugs (DMARDs) e.g. sulphasalzine
Complications of reactive arthritis
Arrhythmia
Uveitis
Aortic insufficiency
What is psoriatic arthritis
Inflammatory arthritis that is associated with skin condition psoriasis. The signs and symptoms also depend on how and where the joints are affected.
**5 subtypes of psoriatic arthtritis
Asymmetrical oligoarthritis (distal and proximal inter-phalangeal joints) Symmetrical rheumatoid-like arthropathy Ankylosing spondylitis variant Polyarteritis with skin and naik changes
Causes of psoriatic arthritis
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
What is greatest risk factor of psoriatic arthritis
Family Hx of psoriasis
Signs and symptoms of psoriatic arthritis
Psoriasis
Joint pain and stiffness
Swelling of affected joints
Nail changes
Describe the nail changes in psoriatic arthritid
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)
What is psoriasis
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
Investigations of psoriatic arthritis
Psoriasis is a clinical diagnosis
Bloods - seronegative for Rheumatoid factor
Radiology - X- ray pf affected joints to assess severity
What hand deformity is seen (also on X-ray) of psoriatic arthritis
‘Pencil-in-cup’ deformity
Conservative treatment of psoriatic arthritis
Patient education
Refer to physiotherapy
Explain to patients that psoriasis does not have a cure and control of the disease is more realistic
Medical treatment of psoriatic arthritis
Analgesia (nonsteroidal anti-inflammatory drugs - NSAIDs)
Disease modifying antirheumatic drugs (DMARDs) e.g. methotrexate (FIRST LINE)
Manage psoriasis
Surgical treatment of psoriatic arthritis
Rarely joint placement
Complications of psoriatic arthritis
Neurological manifestations if atlanto-axial joint involvement
Joint destruction
What are enteropathic arthropathies
An arthritis that develops in association with inflammatory bowel disease (IBD)
It is indistinguishable from reactive arthritis
Cause of enteropathic arthritis
Exact cause is unknown, however it is thought to be associated with HLA B27
Signs and symptoms of enteropathic arthritis
Those of IBD
Spondylitis
Sacroiliitis
Peripheral arthritis - usually of large joints
Investigations of enteropathic arthritis
Those for IBD
Radiology - X-ray of affected joint; assess severity
Treatment of enteropathic arthritis
Analgesia (NSAIDs)
Treatment of IBD
Complications of enteropathic arthritis
Severely decreased mobility with axial involvement
What is ankylosing spondylitis
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%)
Causes of ankylosing spondylitis
Exact cause and pathophysiology of this condition are not known. However, it is thought to be associated with HLA B27
Signs and symptoms of ankylosing spondylitis
Question mark posture
Bamboo spine - due to calcification of ligaments
Pain and stiffness - symptoms improve with exercise
Investigations of ankylosing spondylitis
Bloods - seronegative for rheumatoid factor
Radiology - CXR and MRI scan assess changes in the spine
Conservative treatment of ankylosing spondylitis
Patient education
Refer to physiotherapy
Medical treatment of ankylosing spondylitis
Analgesia (NSAIDs) and DMARDs e.g. Sulphasalzine (FIRST LINE)
Surgical treatment of ankylosing spondylitis
Corrective spinal surgery
Complications of ankylosing spondylitis
Osteoporosis
Spinal fractures
Increased risk of cardiovascular disease e.g. stroke and myocardial infarction
