Spondyloarthropathy

Question 1

List 4 features that are typical on history that may suggest inflammatory arthritis?

Answer 1

Chronic back pain (> 3 months) in person younger than 50 years old should consider diagnosis of spondyloarthropathy
Symptoms of inflammatory arthritis include morning stiff lasting longer than 30minutes, back pain improved with rest but not rest (mechanical vs non mechanical)
awakes at second half of night
alternating buttock pain to suggest possible SIJ joint involvement.

Question 2

What would your advice be for a person who tests positive to HLA B27?

Answer 2

Human Leukocyte Antigen type of gene that may predispose a person to a Ankylosing spondylitis
90-95% of persons with Spondyloarthritis carry this gene
However, only 5% of persons who carry this gene actually get this type of arthritis.

Question 3

List 5 extra articular features of spondyloarthritis?

Answer 3

Anterior uveitis, inflammatory bowel disease
Psoriasis
Dactylitis
Genitourinary symptoms

Question 4

In spondyloarthrits, which joints are characteristically affected?

Answer 4

Axial skeleton
Entheses
Peripheral joints

Question 5

What beside tests can you do for ankylosing spondylitis?

Answer 5

Modified schobers test, normal > 15cm.
Occiput to wall test
Lumbar lateral flexion
chest expansion less than 2.5cm

Question 6

What baseline investigations should be done in person with suspected AS?

Answer 6

AP pelvis and Lumbar spine
Could consider HLAB27
EUC and LFT as most need NSAID
ESR, CRP