Week 10 - Spondyloadrhropathies

Question 1

What is SpA

Answer 1

Family of disorders including anklylosing spondylitis - forms of athritis associated with psoriasis and with inflammatory bowel diseases and other conditions
- the different forms share a group of clinical features: inflammation of axial joints, asymetric oligoathrisits, dactylitis and enthesitis

Question 2

Major Msk features

Answer 2

• lower back pain
• peripheral arthritis (of lower extremities, especially knees and ankles, asymmetrical and only affects 1 to 3 joints)
• enthesitis - inflamattion around sight of insertion of ligaments, tendons, joint capsule, or facia to bone
• dactylitis - sausage toe

Question 3

Major exta-msk features

Answer 3

• inflammatory eye disease
• inflammation of the bowel mucosa
• psoriasis

Question 4

Types of spa

Answer 4

1. psoriatic arthritis
2. other seronegative spondyloathritides

Question 5

Psoriatic arthritis

Answer 5

inflammatory msk disease associated with psoraisis

Question 6

pathophysiology

Answer 6

no specific antibody linked to the condition
- MHC molecule sits on the cell - t-cell binds and immune system sees as normal

Question 7

Timing and onset of arthritis vs skin disease

Answer 7

• psoriasis appears before the onset of arthritis
• onset of arthritis following psoriasis diagnosis was more than 15 years

Question 8

Clinical manifestations of PsA

Answer 8

• severity of involvement ranges from mild to sever, some patients experiencing advanced joint damage and functional disability
• domains most commonly included:
  periphal joints
  axial skeleton
  skin
  entheses (areas where ligs, tendons and joint capsules attach to bone and st)
  dactylitis (diffuse swelling of a whole digit)

Question 9

Classification

Answer 9

CASPAR - scoring system to identify psoriatic arthritis to facilitate early diagnosis

Question 10

Radiographic features of PsA in the foot

Answer 10

• bone proliferation
• whiskering and the ivory phalanx
• enthescropathy
• erosion
• joint space narrowing
• joint space widening
• arthrisit mutilans
• bone denisty
• ankylosis

Question 11

Bone proliferation

Answer 11

several forms of new bone production may be seen
- may appear as ill defined increased bone density

Question 12

Whiskering and the ivory phalanx

Answer 12

sometimes found together, typically affect the hallux distal phalanx
- small spicules of bone arising perpendicular from the phalanx shaft

Question 13

Enthesopathy

Answer 13

Calcaneal changes

Question 14

Eroisions

Answer 14

loss of mariginal subchondral bone plate may appear no different from that seen in RA in the early stages
- as the disease progresses, the erosions become ill defined secondary to new bone formation adjacent to them
- affect medial and lateral margin joints

Question 15

Joint space widening and narrowing

Answer 15

narrowing - seen early in disease
widening - central erosion of an IPJ = relative widening of joint space = aggressive erosion along medial and lateral aspects

Question 16

Bone density

Answer 16

some aptients found to have OP, bone density = usually normal

Question 17

MRI

Answer 17

more sensitive than xray in detecting articular, periarticular and soft tissue inflammation
- enthroscopy - if other modes have not yeiled diagnosis or pt hasent improved

Question 18

Ultrasonography

Answer 18

utilised for patients with soft tissue inflammation

Question 19

Reactive arthritis

Answer 19

conventionally defined as an arthritis that arises following an infection
- form of SpA
after infection: STI or gastroenteritis (e.coli, salmonella)

Question 20

Clinical manifestation of reactive arthritis (4)

Answer 20

• arthritis (acute onset)
• enthesitis
• dactylitis
• back pain

Question 21

Radiographic findings

Answer 21

• primary: erosion
• joint space narrow and widen
• sausage toe
• periositiis adjacent to affected joint

Question 22

ankylosing spondylitis

Answer 22

enthesitis of the calc is a hallmark presentation, including ill defined production and erosion