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
presentation of reinters syndrome (reactive arthritis) triad
can't see can pee can't bend da one - uveitis or conjunctivitis or iritis - urethritis - arthritis
26
general presentation of reactive arthritis
- fever, fatigue, malaise, - asymmetrical mono arthritis - keratoderma blennrhergium - circinate balonitis - painless mouth ulcers - hyperkeratotic nails
27
what can reactive arthritis cause
mild renal disease and carditis
28
investigations of reactive arthritis
- raised ESR, CRP AND PV | - joint fluid analysis shows no MICRO-ORGANISM
29
management
90% of cases resolve spontaneously within 6 months but give NSAIDS, corticosteroids, eyedrops until then
30
enteropathic arthritis
occurs only in those with IBS i.e. crohns and ulcerative colitis
31
presentation
large joint oligoarthritis which is asymmetrical
32
20% of crowns patients have what
sacroillitis
33
management
controlling IBD controls symtoms
34
what should you not give in enteropathc arthritis
NSAIDS as it causes IBD flare ups use paracetamol instead