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Rheumatology > 2: Inflammatory Spondyloarthropathies > Flashcards

2: Inflammatory Spondyloarthropathies Flashcards

(60 cards)

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1
Q

What is an inflammatory spondyloarthropathy

A

chronic inflammatory arthritis disease that often affects joints and enthesis (where tendons + ligaments attach tot bone).

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2
Q

Name 4 inflammatory spondyloarthropathies

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

what are 4 over-arching features of inflammatory spondyloarthopathies

A
  • Affect 20-40y
  • More common in males
  • Genetic association HLAB27
  • often unilateral
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4
Q

What a mnemonic to remember conditions associated with HLAB27

A

A PAIR

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5
Q

What conditions are typically associated with HLAB27

A 
Acute anterior uveitis 
Psoriatic arthritis 
Ankylosing spondylitis 
Inflammatory bowel disease 
Reactive arthritis
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6
Q

What is ankylosing spondylitis

A

Chronic inflammatory disease of the axial skeleton that leads to partial or complete fusion of the spine

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7
Q

In which gender is ankylosing spondylitis more common

A

Male

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8
Q

What age does ankylosing spondylitis most commonly onset

A

20-30

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9
Q

What do 95% of individuals with ankylosing spondylitis have

A

HLAB27

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10
Q

Explain how ankylosing spondylitis may present

A
  • Gradual onset back and spine pain
  • Morning stiffness that improves with activity
  • Night pain
  • Tenderness over SI joints
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11
Q

How can the extra-articular manifestations of ankylosing spondylitis be remembered

A

A’s

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12
Q

What are the 8 extra-articular manifestations of ankylosing spondylitis

A 
Anterior uveitis 
Apical fibrosis 
Aortic regurgitation 
AV node block 
Achille's tendonitis 
Amyloidosis 
Peripheral Arthritis 
And cauda equina
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13
Q

How else may AS present

A

Malaise
Fever
Fatigue
Chronic IBD

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14
Q

What is the most common extra-articular manifestation of AS

A

Anterior uveitis (25%)

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15
Q

What are the signs of ankylosing spondylitis

A
  • Tenderness over SI joint
  • Limited spinal flexion (+ve schober’s test)
  • Reduced chest expansion
  • Dactylitis
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16
Q

What 3 signs may be positive in AS

A
  • Mennell
  • FABER
  • Schober
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17
Q

What is mennell sign

A

Pain on palpation over SI joint

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18
Q

What is FABER test

A

Pain on abduction, flexion and external rotation

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19
Q

What is schober’s test

A

Increase in less than 5cm on spinal flexion

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20
Q

What 4 investigations are used for ankylosing spondylitis

A
  1. Clinical
  2. CRP, ESR
  3. X-ray
  4. MRI
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21
Q

What is the criteria for referral the a rheumatologist for spondyloarthritis assessment

A

If an individual is under age 45, has had back pain for 3m and has 4 or more the the following criteria

  1. Lower back pain before age 35
  2. Symptoms that wake them up during second 1/2 of the night
  3. Buttock pain
  4. Improvement when walking
  5. Improve in 48h of NSAIDs
  6. Spondyloarthrosis in first-degree relative
  7. Current/previous arthritis
  8. Current/previous enthuses
  9. Current/past psoriasis
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22
Q

If an individual is positive on the clinical screen what should be done

A

HLAB27

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23
Q

If an individual is positive on HLA B27 what should be done

A

Refer to rheumatologist of spondylarthopathy screen

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24
Q

If ankylosing spondylitis is suspected but they do not meet the clinical criteria, what should be done

A

Advise individual to return if they develop new symptoms

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25
What may the rheumatologist do
X-Ray | CRP, ESR
26
How will CRP/ESR present in ankylosing spondylitis
May be raised. But if not, ankylosing spondylitis should not be excluded
27
Is an x-ray required for the diagnosis of AS
No
28
What is an x-ray in AS useful for
Assess severity
29
What may be seen on x-ray in AS
- Sacroillitis - Sclerosis - Partial/totoal fusion - Loss of lordosis - Sclerosis of vertebral ligaments - Syndesmophytes
30
What is a late stage of ankylosing spondylitis
syndesmophytes resulting in a bamboo spine
31
What is the best method for early detection of ankylosing spondylitis
MRI
32
When is MRI performed
If suspicion of sacroillitis but cannot be seen on x-ray
33
What is first-line management for ankylosing spondylitis
Exercise and stretching therapy
34
What is second line management for ankylosing spondylitis
Oral analgesia (NSAIDs, or paracetamol)
35
What is 3rd line management for ankylosing spondylitis
anti-TNFa
36
Name 3 anti-TNFa inhibitors
- Entarnercept - Adalimumab - Infliximab
37
Who is infliximab, etarnercept and adalimumab reserved for
Those with high disease activity despite conventional treatment
38
When may sulfasalazine be given in ankylosing spondylitis
If peripheral joint involvement
39
If suspect an individual has anterior uveitis what should be done
Same day referral to opthalmology
40
What are 4 complications of ankylosing spondylitis
- Increase risk stroke - Increase risk CVD - Reduced spinal mobility - Reduced chest expansion causing respiratory difficulties - Increased risk of osteoporotic fractures
41
What is reiter's syndrome also referred to as
Reactive arthritis
42
What is reactive arthritis
Arthritis that occurs following UTI, STI or gastroenteritis
43
What classification of arthritis is reactive arthritis and why
Spondyloarthopathy due to its association with HLA B27
44
What demographic is typically affected by reactive arthritis
Young Males
45
What are the two causes of reactive arthritis
Post-urethritis | Post-dysentry
46
What bacteria causes reiter's syndrome post-urethritis
Chlamydia
47
What 4 organisms cause reactive arthritis following gastroenteritis
- Salmonella - Yersinia - Shigella - Campylobacter
48
What are two risk factors for reactive arthritis
- HIV | - HLAB27
49
What is the typical latency period for reactive arthritis
2-4W
50
What is the triad seen in Reiter's syndrome
Urethritis Conjunctivits Arthritis (Can't see, pee or climb a tree)
51
What proportion of patients have the triad associated with Reiter's syndrome
1/3
52
How does arthritis in reactive arthritis present
- acute onset asymmetrical polyarthritis - predominantly affects lower extremities - sacroillitis - dactylitis
53
How does reactive arthritis present if associated with gonococcal infection
migratory character
54
What are possible other features of reactive arthritis
- Oral ulcers - Balantitis circinate = ring shaped lesions on the penis - Keratoderma blenorrhagia = hyperkeritinsation of palms and soles
55
How is reactive arthritis often diagnosed
Clinically
56
What investigations could be ordered for reactive arthritis
- ESR, CRP | - HLAB27
57
What is used to manage reactive arthritis
NSAIDs | Antibiotics
58
What is typical prognosis of reactive arthritis
6m
59
What percentage of reactive arthritis may become chronic
20-30%
60
What are two complications of reactive arthritis
Aortic insufficiency | Arrythmias

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