Flashcards in Ankylosing spondylitis Deck (32):
Where does ankylosing spondylitis affect?
Spine and sacro-iliac joints.
Can lead to fusion of these joints.
Which sex is more commonly affected?
At what age is this usually diagnosed
What are the usual symptoms?
Stiffness - especially in the morning which improves with exercise
Knee or hip arthritis
What spinal changes can occur over time?
Loss of lumbar lordosis
Increased thoracic kyphosis
"question mark spine"
Hunching over and loss of neck
How is lumbar spine flexion measured?
10cm mark above posterior superior iliac crests and 5 cm below.
This space should increase to 20cm on flexion.
What might you seen on x-ray?
Fusion of SI joints
Syndesmophytes- bony spurs from the vertebral bodies
Which immunological marker is positive in patients with spondyloarthropathies?
What is the recommended treatment for AS?
Physiotherapy, exercise, NSAIDs and anti-TNF inhibitors.
No role for DMARDs
What are spondyloarthropathies?
Group of inflammatory arthritides which affect the spine and joints.
What is mechanical pain?
Worsened on activity, worst at end of day, better with rest.
What is enthesitis?
Inflammation at insertion of tendons into bones
What is dactylitis?
Inflammation of entire digits- swollen, erythematous
What extra-articular features do all spondyloarthopathies have?
Why is ankylosing spondylitis known as the A disease?
How common is psoriatic arthritis in patients with psoriasis?
What is the pattern of this arthritis?
Asymmetrical oligoarthritis (1-4 joints).
Also affect the hands in a RA pattern.
What nail changes commonly occur?
Pitting and onycholysis
What treatment is recommended?
DMARDs- usually methotrexate
What would you see on X-ray?
Marginal erosions and whiskering
Pencil in cup deformity
What is Reiter's syndrome?
Reactive arthritis PLUS urethritis and conjunctivitis or similar
What is reactive arthritis?
Occurs in response to an infection in another part of the body- mostly GU or GI infections.
What is usually responsible for reactive arthritis?
Chlamydia, salmonella, shigella
What age group is most likely to develop reactive arthritis?
20-40 yr olds
What are the clinical features of reactive arthritis?
Mild renal disease
What is keratodema blenorrhagica?
Scaly patches/pustules, especially on the soles of feet and on hands
What treatment would you give for reactive arthritis?
90% resolve within 6/12
Steroids- intra-articular, oral and eye drops
What is the arthritis called in patients who have an IBD?
How common is enteropathic arthritis?
10-20% of IBD sufferers also have this
Also common to have sacroilitis
What is the presenting symptoms of enteropathic arthritis?
Knees, ankles, elbows and wrists.
Diarrhoea with mucous and blood
Weight loss and fever
What investigations would you do for enteropathic arthritis?
Upper and lower GI scope with biopsy
X-ray to show sacroilitis