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Year 2: Block 2C: Rheumatology > Spondyloartnpathies > Flashcards

Spondyloartnpathies Flashcards

1
Q

definition

A

family of seronegative arthritis characterised by involvement of the spine and joints in genetically susceptible individuals (HLA-B27)

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2
Q

what does seronegative mean

A

rheumatoid factor negative

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3
Q

what do all people with spondyloarthropathies have in common

A

HLA-B27 positive, but only a minority of people with HLA-B27 get a spondyloarthropathy

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4
Q

4 types

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Reactive arthritis
  4. enteropathic arthritis
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5
Q

shared features of all 4 types of spondyloarthropathies

A

uveitis, enthesitis, dactylics and sacroilitis

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6
Q

ankylosing spondylitis definition

A

chronic inflammatory disease of the spine and sacroiliac joints

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7
Q

who is ankylosing spondylitis more common in

A

3x more common in men between 20-40 years

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8
Q

presentation of ankylosing spondylitis

A
  • back pain and stiffness
  • enthesitis
  • AXIAL ARTHRITIS
  • ANTERIOR UVEITIS+ CONJUNCTIVITIS
  • APICAL FIBROSIS
  • AORTIC REGURGITATION
  • ACHILLES TENDONITIS AND PLANTAR FASCIITS
  • AMYLOIDOSIS
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9
Q

what shape does the spine become in ankylosing spondylitis

A

question marks spine with loss of the lumbar lordosis and increased thoracic kyphosis

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10
Q

investigations for ank spond

A
  • SCHOBERS TEST: result less than 20cm
  • HLA-B27 positive
  • X-RAY
  • MRI best for detecting early change
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11
Q

what do x-rays show in ankylosing spondylitis

A

sclerosis and fusion of the sacroiliac joints and bony spurs from vertebral bodies called syndesmophwytes which bridge the intervertebral discs resulting in fusion and formation of a BAMBOO SPINE

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12
Q

management of ankylosing spondylitis

A
  • physiotherapy, NSAIDS and ANTI-TNF TREATMENT

- DMARD (methotrexate) not used unless there is peripheral joint involvement

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13
Q

psoriatic arthritis

A

inflammatory arthritis occurring in 30% of people with psoriasis BUT 15% of people who have psoriatic arthritis do NOT have psoriasis

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14
Q

presentation of psoriatic arthritis

A
  • usually an asymmetrical oligoarthritis
  • dactylics and enthesitis
  • nail pitting and onycholosis
  • 5% have a particulatrly aggressive arthritis of the DIPS called arthritis mutilans
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15
Q

whats the particularly aggressive arthritis of the DIP joints in psoriasis

A

arthritis mutilans

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16
Q

investigations for psoriatic arthritis

A
  • HLA-B27 positive
  • raised ESR, CRP and PV
  • X-rays
17
Q

what do x-rays show in psoriatic arthritis

A
  • marginal erosions and whispering

- pencil in cup deformity

18
Q

treatment of psoriatic arthritis

A

NSAIDS AND METHOTREXATE WITH STEROIDS INJECTIONS INITIALLY

- then anti-TNF therapy if this fails

19
Q

reactive arthritis also known as

A

reitters syndrome

20
Q

reactive arthritis defintion

A

infection induced systemic illness characterised by an inflammatory synovitis from which no viable organism can be cultured

21
Q

when do symptoms of active arthritis begin

A

1-4 weeks after initial infection

22
Q

most common infections causing reactive arthritis

A
  • chlamydia
  • neisseria gonorrhoea
  • campylobacter jejuni
  • salmonella
  • shigella
23
Q

which joints does it mostly affect

A

larger joints like the knee

24
Q

who’s it most common in

A

younger people between age of 20-40

25
Q

presentation of reinters syndrome (reactive arthritis) triad

A

can’t see can pee can’t bend da one

  • uveitis or conjunctivitis or iritis
  • urethritis
  • arthritis
26
Q

general presentation of reactive arthritis

A
  • fever, fatigue, malaise,
  • asymmetrical mono arthritis
  • keratoderma blennrhergium
  • circinate balonitis
  • painless mouth ulcers
  • hyperkeratotic nails
27
Q

what can reactive arthritis cause

A

mild renal disease and carditis

28
Q

investigations of reactive arthritis

A
  • raised ESR, CRP AND PV

- joint fluid analysis shows no MICRO-ORGANISM

29
Q

management

A

90% of cases resolve spontaneously within 6 months but give NSAIDS, corticosteroids, eyedrops until then

30
Q

enteropathic arthritis

A

occurs only in those with IBS i.e. crohns and ulcerative colitis

31
Q

presentation

A

large joint oligoarthritis which is asymmetrical

32
Q

20% of crowns patients have what

A

sacroillitis

33
Q

management

A

controlling IBD controls symtoms

34
Q

what should you not give in enteropathc arthritis

A

NSAIDS as it causes IBD flare ups use paracetamol instead

Year 2: Block 2C: Rheumatology (22 decks)

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