Ankylosing spondylitis Flashcards Preview

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Flashcards in Ankylosing spondylitis Deck (32):
1

Where does ankylosing spondylitis affect?

Spine and sacro-iliac joints.
Can lead to fusion of these joints.

2

Which sex is more commonly affected?

Males

3

At what age is this usually diagnosed
?

20-40

4

What are the usual symptoms?

Spinal pain
Stiffness - especially in the morning which improves with exercise
Knee or hip arthritis

5

What spinal changes can occur over time?

Loss of lumbar lordosis
Increased thoracic kyphosis
"question mark spine"
Hunching over and loss of neck

6

How is lumbar spine flexion measured?

Schobers test.
10cm mark above posterior superior iliac crests and 5 cm below.
This space should increase to 20cm on flexion.

7

What might you seen on x-ray?

Sclerosis
Fusion of SI joints
Syndesmophytes- bony spurs from the vertebral bodies

8

Which immunological marker is positive in patients with spondyloarthropathies?

HLA- B27

9

What is the recommended treatment for AS?

Physiotherapy, exercise, NSAIDs and anti-TNF inhibitors.
No role for DMARDs

10

What are spondyloarthropathies?

Group of inflammatory arthritides which affect the spine and joints.

11

What is mechanical pain?

Worsened on activity, worst at end of day, better with rest.

12

What is enthesitis?

Inflammation at insertion of tendons into bones

13

What is dactylitis?

Inflammation of entire digits- swollen, erythematous

14

What extra-articular features do all spondyloarthopathies have?

Ocular inflammation
Mucocutaneous lesions

15

Why is ankylosing spondylitis known as the A disease?

Axial arthritis
Anterior uveitis
Amyloidosis
Achilles tendinitis
Apical fibrosis
Aortic regurgitation

16

How common is psoriatic arthritis in patients with psoriasis?

Around 30%

17

What is the pattern of this arthritis?

Asymmetrical oligoarthritis (1-4 joints).
Also affect the hands in a RA pattern.
Dactylitis
Enthesitis

18

What nail changes commonly occur?

Pitting and onycholysis

19

What treatment is recommended?

NSAIDs
Steroids
DMARDs- usually methotrexate

20

What would you see on X-ray?

Marginal erosions and whiskering
Pencil in cup deformity
Osteolysis
Enthesitis

21

What is Reiter's syndrome?

TRIAD
Reactive arthritis PLUS urethritis and conjunctivitis or similar

22

What is reactive arthritis?

Occurs in response to an infection in another part of the body- mostly GU or GI infections.

23

What is usually responsible for reactive arthritis?

Chlamydia, salmonella, shigella

24

What age group is most likely to develop reactive arthritis?

20-40 yr olds
M:F equal

25

What are the clinical features of reactive arthritis?

Constitutional symptoms
Asymmetrical monoarthritis
Enthesitis
Conjunctivitis
Mild renal disease
Oral ulcers
Hyperkeratotic nails
Keratodema blenorrhagica

26

What is keratodema blenorrhagica?

Scaly patches/pustules, especially on the soles of feet and on hands

27

What treatment would you give for reactive arthritis?

90% resolve within 6/12
NSAIDs
Steroids- intra-articular, oral and eye drops
Abx

28

What is the arthritis called in patients who have an IBD?

Enteropathic arthritis

29

How common is enteropathic arthritis?

10-20% of IBD sufferers also have this
Also common to have sacroilitis

30

What is the presenting symptoms of enteropathic arthritis?

Oligoarthritis.
Knees, ankles, elbows and wrists.
Diarrhoea with mucous and blood
Weight loss and fever
Pyoderma gangrenosum
Apthous ulcers

31

What investigations would you do for enteropathic arthritis?

Upper and lower GI scope with biopsy
X-ray to show sacroilitis

32

What is the treatment of enteropathic arthritis?

IBD must be managed and this will manage the arthritis.
Not NSAIDs.