Spondyloartnpathies Flashcards
definition
family of seronegative arthritis characterised by involvement of the spine and joints in genetically susceptible individuals (HLA-B27)
what does seronegative mean
rheumatoid factor negative
what do all people with spondyloarthropathies have in common
HLA-B27 positive, but only a minority of people with HLA-B27 get a spondyloarthropathy
4 types
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- enteropathic arthritis
shared features of all 4 types of spondyloarthropathies
uveitis, enthesitis, dactylics and sacroilitis
ankylosing spondylitis definition
chronic inflammatory disease of the spine and sacroiliac joints
who is ankylosing spondylitis more common in
3x more common in men between 20-40 years
presentation of ankylosing spondylitis
- back pain and stiffness
- enthesitis
- AXIAL ARTHRITIS
- ANTERIOR UVEITIS+ CONJUNCTIVITIS
- APICAL FIBROSIS
- AORTIC REGURGITATION
- ACHILLES TENDONITIS AND PLANTAR FASCIITS
- AMYLOIDOSIS
what shape does the spine become in ankylosing spondylitis
question marks spine with loss of the lumbar lordosis and increased thoracic kyphosis
investigations for ank spond
- SCHOBERS TEST: result less than 20cm
- HLA-B27 positive
- X-RAY
- MRI best for detecting early change
what do x-rays show in ankylosing spondylitis
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
management of ankylosing spondylitis
- physiotherapy, NSAIDS and ANTI-TNF TREATMENT
- DMARD (methotrexate) not used unless there is peripheral joint involvement
psoriatic arthritis
inflammatory arthritis occurring in 30% of people with psoriasis BUT 15% of people who have psoriatic arthritis do NOT have psoriasis
presentation of psoriatic arthritis
- usually an asymmetrical oligoarthritis
- dactylics and enthesitis
- nail pitting and onycholosis
- 5% have a particulatrly aggressive arthritis of the DIPS called arthritis mutilans
whats the particularly aggressive arthritis of the DIP joints in psoriasis
arthritis mutilans
investigations for psoriatic arthritis
- HLA-B27 positive
- raised ESR, CRP and PV
- X-rays
what do x-rays show in psoriatic arthritis
- marginal erosions and whispering
- pencil in cup deformity
treatment of psoriatic arthritis
NSAIDS AND METHOTREXATE WITH STEROIDS INJECTIONS INITIALLY
- then anti-TNF therapy if this fails
reactive arthritis also known as
reitters syndrome
reactive arthritis defintion
infection induced systemic illness characterised by an inflammatory synovitis from which no viable organism can be cultured
when do symptoms of active arthritis begin
1-4 weeks after initial infection
most common infections causing reactive arthritis
- chlamydia
- neisseria gonorrhoea
- campylobacter jejuni
- salmonella
- shigella
which joints does it mostly affect
larger joints like the knee
who’s it most common in
younger people between age of 20-40
presentation of reinters syndrome (reactive arthritis) triad
can’t see can pee can’t bend da one
- uveitis or conjunctivitis or iritis
- urethritis
- arthritis
general presentation of reactive arthritis
- fever, fatigue, malaise,
- asymmetrical mono arthritis
- keratoderma blennrhergium
- circinate balonitis
- painless mouth ulcers
- hyperkeratotic nails
what can reactive arthritis cause
mild renal disease and carditis
investigations of reactive arthritis
- raised ESR, CRP AND PV
- joint fluid analysis shows no MICRO-ORGANISM
management
90% of cases resolve spontaneously within 6 months but give NSAIDS, corticosteroids, eyedrops until then
enteropathic arthritis
occurs only in those with IBS i.e. crohns and ulcerative colitis
presentation
large joint oligoarthritis which is asymmetrical
20% of crowns patients have what
sacroillitis
management
controlling IBD controls symtoms
what should you not give in enteropathc arthritis
NSAIDS as it causes IBD flare ups use paracetamol instead
