Tutorial 2 - Spondyloarthropathies

Question 1

How would you ask about inflammatory back pain

Answer 1

Nocturnal pain - does it wake you up in the early morning?
Alternating buttock pain
Gets better with activity

Question 2

Where in the spine would you get symptoms if it’s a spondyloarthropathies

Answer 2

Restriction in movement at all levels of the spine

Question 3

What do you call the radiological sign when there are dermatophytes, joint fusion

Answer 3

Bamboo spine

Question 4

How would you differentiate between ank spond and psoriatic arthritis

Answer 4

SPA = Bilateral sacroiliac joint disease
Psoriatic = unilateral

note - spa can be axial or peripheral

Question 5

What do we see on a radiographic image

Answer 5

Widening
then narrowing
then ankylosis = bony fusion

Bamboo sign
Ank spond always starts in the SIJ and then travels up to spine
Whereas in DISH it is only the spine that is affected
Desmophyte fusion

Question 6

Hot swollen joint differential in someone who has come back from a holiday

Answer 6

Gonorrhoea - more systemically unwell
Chlamydia

Answer 7

Distal joints
Asymmetrical
Similar to OA
Nail signs

synovitis on USS - in PSA not OA

Pnecilin cup

Question 8

Features of rheumatoid arthritis

Answer 8

Symmetrical deforming polyarthropathy
MCP, PIP, spares DIP
Z deformity of thumb
Volar subluxation
Ulnar deviation

Question 9

How do you differentiate between RA and OA

Answer 9

RA - spares finger tip DIPs
OA doesn’t spare them

Question 10

SE of JAKinibs

Answer 10

JAKinibs - risk of shingle reactivation and DVTs

Question 11

Rheumatoid arthritis features

Answer 11

Volar subluxation - instability of the knuckles, then ulnar deviation due to
the nodules are actually not nodules - they are the heads of the metacarpals

Question 12

Features of psoriatic arthritis

Answer 12

Onycholysis - fungal infection that won’t get treated
Pitting
Hyperkeratosis
Ridging

Question 12

What deformity do you get in the thumbs of someone with rheumatoid athritis?

Answer 12

Z deformity of the thumb

Question 12

What do you call the condition where you get papules

Answer 12

Gotron’s papules - dermatomyositis - over the joints but not in between the joints.

Which is a type of inflammatory myositis, do exclude cancer because fifty percent of people have cancer.

ALT rise and CK rise in myositis as ALT

Question 13

Another differential for swan neck deformity of psoriatic arthritis

Answer 13

Hyperextension of PIP

Mallet finger - rupture of the attachment of the distal extensor tendor, causing a straight finger without hyperextension.

Question 14

Telescoping suggest

Answer 14

Arthritis mutilans - a form of peripheral SPA

Question 15

Why would you not amputate a necrotic joint

Answer 15

If autotermination was going to happen - if there was a clean line

Question 16

Splinter haemorrhages differential

Answer 16

Vasculitis disease

Question 17

What deformity of the fingers do you get in RA

Answer 17

Boutainnire - button hole

Question 18

Gout can present how? Where does it present?

Answer 18

Tophacious gout - macroscopic

Acute inflammatory hot swollen gout - microscopic

Kidney damage can happen with macroscopic gout

You get gout:
Elbows
Pinna of ears

Check kidney function to see if you are releasing enough urate

Question 19

red swollen all fingers etc

Answer 19

Sclerodactyly

Question 20

OA signs

Answer 20

Hebeden’s - DIP welling
Bouchards - PIP swelling

HD = high distinction

Question 21

Red spots on periungal region

Answer 21

Vaculitic nail sings - nail fold infarcts

Question 22

Ulnar neuropathy

Answer 22

Claw hand
Hypothenar muslce wasting