Axial spondyloarthritis Flashcards

1
Q

?What must you have to be dx

A

> 3 months of inflammatory back pain and age <45

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2
Q

What are the SpA features in the criteria?

A
Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriasis
Crohn's / colitis
Good response to NSAID
Family Hx of SpA
HLA-B27
Elevated CRP
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3
Q

What is required for ank spond dx?

A

Sacroiliitis on plain x-ray

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4
Q

What is peripheral spondyloarthritis?

A

Peripheral arthritis and/or enthesitis and/or dactylitis

Plus either one of the extra-articular, extra-spinal SpA features
Or >2 of the artricular manifestations

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5
Q

What conditions fall over the umbrella of spondyloarthritis (SpA)?

A
Ank spond
Juvenile SpA
Arthritis associated with UC or Crohn's
Reactive arthritis
Acute anterior uveitis
Psoriatic arthritis
Undifferentiated SpA
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6
Q

What are the features inflammatory back pain?

A
Aged at onset <40
Insidious onset
Improves with exercise
No improvement with rest
Pain at night (with improvement upon getting up)
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7
Q

What is the pathogenesis of axSpA and PsA?

A
HLA-B27 allele + environmental factors
> IL-23 production 
> Th-17 cells activated by IL-23
> STAT3 planway > IL-17 produced
> NFKB
> Proinflammatory cytokines - IL-6, TNF, endothelial activation + osteoclast + osteoblasts activation (bone remodelling)
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8
Q

What environment features play a roll?

A

Mechanical stress

Inflammation in gut - microbiome

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9
Q

What are some clinical features of Axial SpA?

A

Inflam back pain, buttock pain
Restriction of spinal movement (later)
Extra-axial - asymmetric oligoarthritis of lower limb, enthesitis
Extra-articular - anterior uveitis, IBD, psoriasis, apical fibrosis, AR

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10
Q

What percentage of HLA-B27+ people will develop AS

A

5%

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11
Q

What percentage of patients with AS are HLA-B27 positive?

A

90%

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12
Q

What percentage of people with AS have normal inflammatory markers?

A

25%

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13
Q

What percentage of non-radiographic ank spond don’t go onto develop AS?

A

10-15%

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14
Q

What are the x-ray signs of sacroiliitis?

A

Erosions and sclerosis at joint margins
Pseudo-widening
Joint space narrowing and ankylosis

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15
Q

What are the x-ray signs in the spine?

A

Squaring of vertebral
Romanus lesion - “Shiny corner”
Syndesmophyte

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16
Q

What are the MRI signs of sacroiliitis?

A

Sub-chondral bone marrow oedema - T2 weighted
Fatty lesions, erosions, sclerosis, ankylosis - T1 weighted
Synovitis enthesitis

17
Q

What is the first line Rx?

A

NSAIDs - symptomatic +/- disease modifying effect

18
Q

When are conventional DMARDs effective?

A

Peripheral arthritis only

19
Q

What factors predict response to biologic?

A
Younger
Higher baseline inflam markers
Worse inflammation on baseline MRI 
Less functional impairment
HLA-B27 positive
20
Q

How do you qualify for biologics in Australia?

A

Failed 12 weeks of NSAIDs and exercise and still have active disease

21
Q

Which biologics are useful in Ax SpA?

A

TNF-inhibitors - adalimumab, certolizumab, etanercept, golimumab, infliximab

IL-17A inhibitor - secukinumab

22
Q

Which biologic is available for nr-axSpA?

A

Golimumab

23
Q

How long do you need to be on biologics to get limitation of radiographic progression?

A

2 years