Spondyloarthropathies 10/10/18

Question 1

What is spondyloarthropathy?

Answer 1

Family of inflammatory arthritides characterized by involvement of both the spine and joints principally in genetically predisposed individuals

Question 2

What can cause a predisposition to spondyloarthropathy?

Answer 2

HLA B27 gene

Question 3

What are the 4 main groups of spondyloarthropathy?

Answer 3

Ankyllosing spondylitis
Psoriatic arthritis
Rective arthritis
Enteropathic arthtitis

Question 4

What is mechanical back pain?

Answer 4

WOrsed by activity
Worse at end of day
Better with rest

Question 5

What is inflammatory back pain?

Answer 5

Worse with rest
Better with acivity
Signifigant early morning stiffness

Question 6

What are shared rheumatological features of the spondyloarthropathys?

Answer 6

Sacroiliac and spinal involvement
Enthesitis
Inflammatory arthritis
-oligoarticular
-Assymmetric
Lower limb
Dactylitis

Question 7

What are shared extra-articular features of the spondyloarthropathies?

Answer 7

Ocular inflammation
Mucocutaneous lesions
Aortic incompetence
No rheumatoid nodules

Question 8

Where does ankylosing spondylitis affect?

Answer 8

Spine

Sarcoiliac joint

Question 9

What gender does ankylosing spondylitis affect most?

Answer 9

Men

Question 10

What is the criteria for ankylosing spondylitis?

Answer 10

ASAS classification

Question 11

What are SpA features of the ASAS classification?

Answer 11

Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriaris
Chrohns
Response to NSAIDs
Family history
HLA-B27
Elevated CRP

Question 12

What would sacrolitis show on imaging?

Answer 12

Active inflammation on MRI highly suggestive of sacrolitis associated with spa
Definitie radiographic sacroilitis

Question 13

What is a must for ankylosing spondylitis?

Answer 13

> 3 months back pain

<45 years old

Question 14

What are the clinical features of ankylosing spondylitis?

Answer 14

Back pain
Enthesitis
Peripheral arthritis
Uvitis
Cardio involvement
Pulmonary involvement
Mucosal inflammation
Neuro involvement
Amyloidosis

Question 15

What are the As of ankylosing spondylitis?

Answer 15

Axial arthritis
Anterior Uveitis
Aortic regurg
Apical fibrosis
AMylodosis
Achilles tendinitis
plAntar fascitis

Question 16

How is ankylosing spondylitis diagnosed?

Answer 16

History
Examination
-Tragus to wall
-Chest expansion
- Modified Schober test
Bloods 
-Inflammatory
-HLA B27
X-rays
-Sacroilitis
-Syndesmop?ytes
-Bamboo spine

Question 17

What imaging is used for ankylosing spondylitis?

Answer 17

x-rays show changes after long period of time

MRI - Stir images shows changes in bone marrow, oedema, enthesitis

Question 18

Are normal SI joints reassuring?

Answer 18

No

Question 19

How are OA and AS differentiated?

Answer 19

AS
-Bone density reduced
Shiny corners
Syndesmophytes
Bamboo spine
OA
Normal bone density
Reduced joint space
Subchondral sclerosis
Subchondral cyst formation
Osteophyte formation

Question 20

What is the treatment for ankylosing spondylitis?

Answer 20

Physio
Occupational therapy
NSAID
SZP MTX
Anti-TNF
Secukinumab

Question 21

What is psoritatic arthritis?

Answer 21

Inflammatory arthritis associated with psoriasis

No rheumatoid factor or nodules

Question 22

What are the features of psoritatic arthritis?

Answer 22

Inflammatory
Sacroilitis
Nail involvement
Dactylitis
Enthesitis
Extra articular features

Question 23

What are the 5 subgroups of psoritatic arthritis?

Answer 23

confined to DIPs
Symmetric polyarthritis
Spondylitis
Asymmetric oligoarthritis
Arthritis mutilans

Question 24

How is psoritatic arthritis diagnosed?

Answer 24

History 
Family history
Bloods
-Raised inflammatory markers
-Negative RF
X-rays
-Marginal erosions and whiskering
Pencil in cup deformitu
Osteolysis
Enthesitis

Question 25

What is the treatment of psoritatic arthritis?

Answer 25

``` NSAIDs Corticosteroids Disease modifying drugs MTX Anti-TNF Secukinumab Physion Occupational therapy Orthotics ```

Question 26

What is reactive arthritis?

Answer 26

Infection induced systemic illness characterized primarily by inflammatory synovitis from which viable microorganisms cannot be cultures

Question 27

When do symptoms occur in reactive arthritis?

Answer 27

1-4 weeks after infection

Question 28

What are the most common infections in reactive arthritis?

Answer 28

Urogenital | Enterogenic

Question 29

Who gets reactive arthritis?

Answer 29

Young adults | Equal sex

Question 30

What is Reiter's syndrome?

Answer 30

``` A form of reactive arthritis Triad -Urethritis Conjunctivitis Arthritis ```

Question 31

What are the clinical features of reactive arthritis?

Answer 31

``` Fever Fatigue Malaise Monoarthritis Enthesitis Mucocutaneous lesions Ocular lesions Renal disease Carditis ```

Question 32

How is reactive arthritis diagnosed?

Answer 32

``` History Examination Bloods -Inflammatory -FBC -U and Es -HLAB27 Cultures Joint fluid analysis X-ray of affected joints Ophthalmology opinon ```

Question 33

What is the treatment of reactive arthritis?

Answer 33

``` Resolves spontaneously in 6 months NSAIDs Corticosteroids Antibiotics DMARDs Physiotherapy Occupational therapy ```

Question 34

What is enterohepatic arthritis associated with?

Answer 34

IBD

Question 35

What is the presentation of enterohepatic arthritis?

Answer 35

``` Several joint involvement Bowel disease Loose watery stools Weight loss Eye involvement SKin involvement Enthesitis Oral involvement ```

Question 36

What are the investigations for enterohepatic arthritis?

Answer 36

``` Upper and lower GI endoscopy Joint aspirate Raised inflammatory markers X-ray/MRI USS ```

Question 37

What is the treatment for enterohepatic arthritis?

Answer 37

``` Treat IBD No NSAIDs Normal analgesia Steroids Disease modifying drugs Anti-TNF ```

Question 38

What non-medical treatments can be used for Spondyloarthropathies?

Answer 38

Physiotherapy Occupational therapy Orthotics Chiropodist