Spondyloarthropathies - workbook and lecture Flashcards
1
Q
What are spondyloarthropathies?
A
- Group of conditions that affect the spine and peripheral joints and are associated with presence of HLA-B27
2
Q
Examples of spondyloarthropathies
A
- Ankylosing spondylitis (most common)
- Enteropathic arthirits
- Psoriatic arthirits
- Reactive arthiritis
3
Q
Common clinical features of spondyloarthropathies
A
- Sacroiliac/axial disease (back/buttock pain)
- Inflammatory arthropathy of peripheral joints
- Enthesitis (inflammation at tendon insertions)
- Extra-articular features (skin, gut, eye)
4
Q
Who does ankylosing spondylitis often affect?
A
Young men - teens-mid thirties
5
Q
Presentation of AS
A
- Bilateral buttock pain
- Chest wall and thoracic pain
6
Q
Examination findings of AS
A
- Normal
- Later = loss of lumbar lordosis
- Exaggerated thoracic kyphosis
- Schobers test positive
- Reduced chest expansion
7
Q
What is Schobers test?
A
- Mark skin 10cm above and 5cm below PSIS (L3/L4)
- Bend forward with straight legs
- Normal is more 20cm distance between 2 original markings
- If less than 5cm increase than +ve
8
Q
Why do AS patients have reduced chest expansion?
A
Back pain
Pulmonary fibrosis
9
Q
Investigation for AS
A
- CRP raised but often normal
- MRI spine and SI joints (more sensitive than X-ray)
- Rh F -ve
- Can do X-ray - Bamboo sign
10
Q
Treatment for AS
A
- NSAIDs
- Physio
- TNF inhibitors eg infliximab
- IL-17 inhibitors
11
Q
Who does psoriatic arthiritis affect?
A
Male and female equally
12
Q
Typical exam findings for psoriatic arthirits
A
- Oligo arthritis with single digit dactilytis (sausage digit)
- Can be symmetrical like RA or monoarthiritis
- Severe deformites eg arthiritis mutilans
13
Q
Investigations for Psoriatic arthirits
A
- CRP often raised
- Central joint erosions seen early on USS or MRI
- Erosions leads to ‘pencil in cup’ deformity seen in x-ray
- Osteopenia - periarticular
14
Q
Treatment for psoriatic arthiritis
A
- NSAIDs
- DMARDs - for peripheral disease
- TNF inhibitors
- IL-17 inhibitors
- IL12/23 inhibitors
Can use biologics for axial disease + Rituximab sometimes
15
Q
What is reactive arthirits?
A
Sterile arthritis devloping after a distant infection either post dysentry eg salmonella/shigella/campylobacter or urethritis/cervicitis (via Chlamydia trachomatis)
