Rheumatology: Spondyloarthropathy

Question 1

What is the HLA gene associated with spondyloarhropathies?

Answer 1

HLA B27

Question 2

Where does Spondyloarthropathy affect?

Answer 2

The spine and joints

Question 3

What are the disease subgroups?

Answer 3

Ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis

Question 4

What is the difference between mechanical and inflammatory back pain?

Answer 4

Mechanical: worsened by activity and better with rest
Inflammatory: worse with rest, better with activity and there is early morning stiffness

Question 5

What are the shared rheumatological features of the spondyloarthropathies?

Answer 5

Sacroiliac joints and spinal involvement
Enthesitis
Dactylitis

Question 6

What is Enthesitis?

Answer 6

Inflammation of the epicondyles e.g. at the insertion of tendons into bones e.g. plantar fasciitis

Question 7

What is Dactylitis?

Answer 7

“sausage” digits

-inflammation of the entire digit

Question 8

What are the shared extra-articular features of the spondyloarthropathies?

Answer 8

No rheumatoid nodules, achilles tendonitis, “cocktail sausage” finger toes, occular inflammation (emergency)

Question 9

What joints are typically affected first in ankylosing spondylitis?

Answer 9

Sacro-iliac joints

Question 10

What is the hallmark of ankylosing spondylitis?

Answer 10

Sacroiliac joint involvement

Question 11

When does ankylosing spondylitis typically present?

Answer 11

In the late teens- early 20s

Question 12

What is the treatment for ankylosing spondylitis?

Answer 12

Home exercises to maintain core muscle strength, occupational therapy, corticosteriods/anti TNF

Question 13

What are the clinical features of ankylosing spondylitis?

Answer 13

Sacroiliac back pain, enthesitis, peripheral arthritis

Question 14

What are the extra-articular features of ankylosing spondylitis?

Answer 14

Neurological, pulmonary, CV involvement, anterior uveitis

Question 15

Ankylosing spondylitis is often referred to as the “A” disease, what are some of the “A” features?

Answer 15

Atypical fibrosis, Anterior uveitis, Aortic Regurgitation, Achilles Tendonitis, Plantar Faciits, Amyloidosis, Axial (spine) arthritis

Question 16

What are some of the examinations of ankylosing spondylitis?

Answer 16

Schober’s test

Occiput to wall test

Question 17

How should ankylosing spondylitis be diagnosed?

Answer 17

Bloods: HLA B27
X ray
Examination

Question 18

What should be seen on an x-ray in ankylosing spondylitis?

Answer 18

Sacroilitis, “bamboo” spine, syndesmophytes

Question 19

What is Psoriatic Arthritis?

Answer 19

Inflammatory arthritis associated with psoriasis, but 10-15% can have Psoriatic Arthritis without psoriasis

Question 20

What is the measure of Rheumatic factor in Psoriatic Arthritis?

Answer 20

None

Question 21

What are the clinical features of Psoriatic Arthritis?

Answer 21

Nail involvement: pitting and oncholysis
Sacroilitis: asymmetric
Enthesitis
Dacylitis

Question 22

What is the difference in distribution of Psoriatic Arthritis compared to RA in the fingers?

Answer 22

PA in the inter pharyngeal

RA in the MCP

Question 23

Are there rheumatoid nodules in Psoriatic Arthritis?

Answer 23

No

Question 24

How is Psoriatic Arthritis diagnosed?

Answer 24

History of psoriasis, FHx of skin problems, bloods show negative RF, x ray

Question 25

How should Psoriatic Arthritis look on an x-ray?

Answer 25

Marginal erosions and "whiskering" "pencil in cup deformity" Osteolysis Enthesitis

Question 26

What is the medical and non medical treatments for Psoriatic Arthritis?

Answer 26

Medical: NSAIDs for pain relief, steroids for rescue, DMARs for long term to slow progression but not stop it, anti-TNG is severe Non medical: OT, Physiotherapy

Question 27

What is Reactive Arthritis?

Answer 27

Infection Induced systemic illness characterised primary by an inflammatory synovitis from which viable organisms cannot be cultured

Question 28

Can micro-organisms be cultured in Reactive Arthritis?

Answer 28

No

Question 29

When do the onset of symptoms of Reactive Arthritis first tend to occur?

Answer 29

1-4 weeks after an infection

Question 30

What is Reiter's syndrome?

Answer 30

Triad of reactive arthritis: - Urethritis - Arthritis - Conjunctivitis/Uveitis

Question 31

Who is usually affected by Reactive Arthritis?

Answer 31

Young adults 20-40

Question 32

What are the most common infections in Reactive Arthritis?

Answer 32

Urogenital, Chlamydia or Enterogenic: salmonella, shigella

Question 33

What are the clinical features of Reactive Arthritis?

Answer 33

- Assymmetrical monoarthritis or oglioarthritis - Enthesitis - Mucocutaneous lesions - Occular lesions

Question 34

How is Reactive Arthritis diagnosed?

Answer 34

Joint fluid aspirate to exclude septic arthritis

Question 35

What is the treatment of Reactive Arthritis?

Answer 35

90% will resolve spontaneously within 6 months Medical: steroid eye drops Non medical: Physiotherapy, OT

Question 36

What is the prognosis for Reactive Arthritis?

Answer 36

Generally good, recurrence not common, only some develop chronic form

Question 37

What is Enteropathic Arthritis associated with?

Answer 37

10-20% with IBD

Question 38

What is the typical presentation of Enteropathic Arthritis?

Answer 38

Arthritis in several joints, especially the knees, ankles, elbow and wrists

Question 39

Why should a full GI history be taken in Enteropathic Arthritis?

Answer 39

Patient might not have been diagnosed with IBD yet and have had symptoms such as loose watery stools with mucus/blood

Question 40

What are the clinical symptoms in Enteropathic Arthritis?

Answer 40

GI symptoms, uveitis, pyoderma gangrenosum, Enthesitis: achilles tendonitis/plantar faciiitis/lateral epicondylitis, oral: apthous ulcers

Question 41

What investigations should be conducted to confirm Enteropathic Arthritis?

Answer 41

- Upper and lower endoscopy with biopsy showing ulceration/colitis - No organisms or crystals in joint aspiration - sacroilitis

Question 42

What is the treatment in Enteropathic Arthritis?

Answer 42

Treat underlying IBD: - Steriod therapy in conjunction with gastroenterologists - Anti-TNF

Question 43

What drug shouldn't be given in Enteropathic Arthritis/

Answer 43

NSAIDs