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Spondyloarthropathy Flashcards

1
Q

what is spondyloarthropathy

A

family of inflammatory arthritides characterised by involvement of both the spine and joints

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2
Q

what gene predisposes patients to all spondyloarthropathies

A

HLA B27

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3
Q

what is HLA B27 assocaited with

A

ankylosing spondylitis, reactive arthritis, crohns disease, uveitis

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4
Q

what are the four subgroups of spondyloarthritic diseases

A

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

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5
Q

describe mechanical back pain

A

worsened by activity, worst at end of the day, better with rest

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6
Q

describe inflammatory back pain

A

worse with rest, better with activity, significant early morning stiffness (>30 minutes)

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7
Q

what is enthesis

A

site of insertion of a tendon, ligament or articular capsule into bone

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8
Q

what is enthesopathy

A

alteration to enthesis

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9
Q

what is enthesitis

A

inflammation at enthesis

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10
Q

what are the common rheumatoid features of the spondyloarthopathies

A

sacroiliac and spinal involvement, enthesitis, inflammatory arthritis, dactylitis

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11
Q

what is dactylitis

A

inflammation of the entire digit

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12
Q

what is the inflammatory arthritis like in the spondyloarthropathies

A

oligoarticular (just a few joints)
asymmetric
predominantly lower limb

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13
Q

what are the shared extra articular features of the Spondyloarthropathies

A

occular inflammation (anterior uveitis, conjunctivitis)

mucocutaneous lesions (involvement of oral mucosa and genitals)

rare aortic incompetence or heart block

no rheumatoid nodules

inflammatory bowel disease symptoms

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14
Q

what is ankylosing spondylitis

A

chronic systemic inflammatory disorder that primary affects the spine

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15
Q

what is the hallmark and other common features of Ankylosing Spondylitis

A

hallmark- sacroiliac joint involvement (sacroiliitis)

peripheral arthritis uncommon

enthesopathy

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16
Q

who gets Ankylosing Spondylitis

A

more common in men, late adolescence or early adulthood

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17
Q

what are the main symptoms and signs of Ankylosing Spondylitis

A 
inflammatory back pain 
arthritis 
enthesitis 
anterior uveitis 
psoriasis 
crohns/ colitis 
good response to NSAIDs
family history 
HLA-B27
elevated CRP
cardiovascular, neurological and pulmonary involvement 
amyloidosis
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18
Q

what is seen on imagine in Ankylosing Spondylitis

A

sacrolitis

active (acute) -inflammation on MRI, bone marrow oedema, enthesitis

x-rays (late disease)- sacroiliac sclerosis, vertebral fusion, erosions

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19
Q

why is Ankylosing Spondylitis called the ‘A’ disease (7)

A 
Axial arthritis 
Anterior uveitis
Aortic regurgitation 
Apical fibrosis
Amyloidosis/ IgA nephropathy
Achilles tendinitis
plAntar fasciitis
20
Q

why can movement of spin become limited in Ankylosing Spondylitis

A

inflammation causes syndesmophytes (fusion of vertebrae)

21
Q

what posture is seen in Ankylosing Spondylitis

A

question mark spin; hip flexes, straightening if lumbar spine, thoracic kyphosis

22
Q

how do you diagnosis Ankylosing Spondylitis

A 
history 
exam;
-tragus/occiput to wall 
-chest expansion (reduced)
-modified schober test

bloods

  • inflammatory markers (ESR, CRP, PV) raised
  • HLA- B27

x-rays

  • sacroilitis
  • syndesmophytes
  • bamboo spine
23
Q

what is the occiput to wall test

A

when shoulder, bum and feet touching wall try to touch head to hall- people with Ankylosing Spondylitis cant

24
Q

what is the schober test

A

Distance between ASIS and 10cm above when standing, normal will increase by at least 5cm when bent over,
Ankylosing Spondylitis will be less

25
what happens to bone density in late Ankylosing Spondylitis
reduced
26
what does bamboo spine mean
in Ankylosing Spondylitis x ray in late disease will show shiny corners of vertebrae which suggests fusion
27
what is the treatment for Ankylosing Spondylitis
physiotherapy and occupational therapy NSAID DMARD (for peripheral joint involvement, doesnt work on spine) Anti TNF in severe
28
what is psoriatic arthritis
inflammatory arthritis associated with psoriasis (10-15% have no psoriasis)
29
is rheumatoid associated with psoriatic arthritis
psoriatic arthritis has no rheumatoid nodules and is rheumatoid factor negative
30
what are the clinical features of psoriatic arthritis
``` inflammatory arthritis sacroiliitis nail involvement (pitting, hyperkeratosis, onycholysis) dactylitis enthesitis extra articular features (eye disease) ```
31
what are the five clinical subgroups of psoriatic arthritis
1. confined to distal interphalangeal joints (DIP) on hands/feet 2. symmetric polyarthritis (similar to RA) 3. spondylitis (spine involvement) with/without peripheral joint involvement 4. asymmetric oligoarthritis with dactylitis 5. arthritis mutilans (fast progression)
32
how do you diagnose psoriatic arthritis
bloods -raised inflammatory markers negative RF x-rays - marginal erosions and whiskering - pencil in cup deformity - osteolysis - enthesitis
33
what is the medical treatment for psoriatic arthritis
``` NSAIDs corticosteroids/joint injections DMARDs anti TNF secukinumab (anti-IL17) ```
34
what is the non medical treatment for psoriatic arthritis
physiotherapy occupational therapy orthotics chiropodist
35
what is reactive arthritis
infection induced systemic illness characterised primarily by an inflammatory synovitis from which viable microorganisms cannot be cultured
36
when do you get symptoms in reactive arthritis
1-4 weeks after infection
37
what are the most common infections causing reactive arthritis
urogenital (chlamydia), enterogenic (salmonella, shigella, yersinia)
38
who gets reactive arthritis (what gene)
young adults (20-40) equal sex distribution HLA-B27 positive
39
what is reiters syndrome
``` a form of reactive arthritis triad of; -urethritis -conjunctivitis/ uveitis/iritis -arthritis ```
40
what are the general features of reactive arthritis
general symptoms (fever, fatigue, malaise) asymmetrical monoarthritis or oligoarthritis enthesitis mucocutaneous lesions occular lesions (conjunctivitis, iritis) visceral manifestations (mild renal disease, carditis)
41
how do you diagnose reactive arthritis
bloods: - inflammatory parameters (ESR, CRP, PV) - FBC, U&ES - HLA B27 (rarely necessary) cultures (blood, urine, stool) joint fluid (to rule out infections or crystal arthropathy) xray of affected joints ophthalmology opinion
42
what is the treatment for reactive arthritis
90% resolve within 6 months NSAIDs corticosteroids antibiotics (for underlying infection) DMARDs (in chronic) physiotherapy occupational therapy
43
what is enteropathic arthiritis
inflammatory arthritis associated with inflammatory bowel disease
44
how do patients with enteropathic arthiritis present
arthritis in several joints especially the knees, ankles, elbows, wrists, spine, hips or shoulders worsening symptoms during flare ups of inflammatory bowel disease GI-loose watery stool with mucous and blood, apthous ulcers weight loss, low grade fever, eye involvement, skin involvement, enthesitis
45
what investigations into enteropathic arthiritis can you do
upper and lower GI endoscopy joint aspirate raised inflammatory markers X-ray/MRI showing sacroilitis USS showing synovitis/ tenosynovitis
46
what is the treatment for enteropathic arthiritis
treat IBD not NSAIDs as may exacerbate IBD analgesia (e.g. paracetamol, cocodamol) steroids DMARDS Anti tnf physiotherapy, occupational therapy,orthotics
47
what is the treatment for ankylosing spondylitis
NSAIDs, physion, exercise | if this doesn't work anti TNF or anti IL 17

MSK (71 decks)

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