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Clinical lectures > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

What are the spondyloarthropathies?

A

Heterogenous group of inflammatory musculoskeletal diseases that have similar features

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2
Q

What inflammatory marker is seronegative/absent in spondyloarthropathies?

A

Rheumatoid Factor

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3
Q

What does seronegative RF in spondyloarthropathies indicate about their pathology compared to RA?

A

Spondyloarthropathies have different underlying pathology to RA

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4
Q

What genetic marker is associated with spondyloarthropathies?

A

HLA B27 gene

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5
Q

Why do spondyloarthropathies have similar clinical features?

A

They share the HLA B27 gene, which causes them to express similar features

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6
Q

What is the HLA B27 associated feature, sacroiliitis?

A

Inflammation of sacroiliac joint

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7
Q

What is the HLA B27 associated feature, uveitis?

A

Inflammation of uvea/middle eye layer

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8
Q

What is the HLA B27 associated feature, spondylitis?

A

Inflammation of ligaments and joints in spine

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9
Q

What direction does spondylitis usually develop in, in spondyloarthropathies?

A

Usually ascending

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10
Q

What is the HLA B27 associated feature, enthesitis?

A

Inflammation of enthesis (area where tendon/ligament meets bone)

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11
Q

What is the HLA B27 associated feature, upper lobe fibrosis?

A

Lung diseases that occur due to thickening and scarring of upper lobes of lungs

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12
Q

Give 3 examples of skin diseases that are associated with HLA B27?

A

Psoriasis
Keratoderma
Balanitis

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13
Q

What are the axial joints?

A

Joints in chest, spine, pelvis

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14
Q

What are the peripheral joints?

A

Joints in limbs except from shoulder and pelvic joints

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15
Q

Does HLA B27 cause involvement of axial joints only in spondyloarthropathies?

A

No, HLA B27 can also cause involvement of peripheral joints

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16
Q

What are the 4 HLA B27 associated features involving the heart?

A

Aortitis: inflammation of aorta

Valve disease

Heart block: heart doesn’t pump properly

Aortic root lesions:

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17
Q

What 2 main groups are spondyloarthropathies classed as?

A

Axial spondyloarthritis (axSpA)

Peripheral spondyloarthritis (pSpA)

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18
Q

What are the 2 main groups of axSpA, and what determines the difference between the 2 groups?

A

If there is radiological evidence of sacroiliitis, it is classed as radiographic axSpA/Ankylosing spondylitis (AS)

If there isn’t radiological evidence of sacroiliitis, it is classed as non-radiographic axSpA (nr-axSpA)

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19
Q

What are the 4 main groups of pSpA?

A

psoriatic arthritis (PsA)

reactive arthritis (ReA)

IBD-associated arthritis/enteropathic arthritis,

undifferentiated spondyloarthritis

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20
Q

Why is there a small overlap between spondyloarthropathies classed as axSpA and pSpA?

A

A small percentage of pSpA can progress to become axSpA

21
Q

What percentage of individuals aged 10-20 have spondyloarthropathies?

A

10-20%

22
Q

What age range is most affected by spondyloarthropathies?

A

20-40

23
Q

What percentage of individuals over 45 have spondyloarthropathies?

A

less than 5%

24
Q

What is the ratio of males to females affected by spondyloarthropathies?

A

2:1

25
Q

What is the estimated prevalence of spondyloarthropathies worldwide?

A

close to 1%

26
Q

How many years can it take for spondyloarthropathy to progress until a diagnosis is made?

A

Up to 8 years

27
Q

Do spondyloarthropathies have familial aggregation, and why?

A

Yes, because the HLA B27 gene is inherited

28
Q

What is familial aggregation?

A

Clustering of certain traits, behaviours, or disorders within a given family, that can arise from genetic or environmental factors

29
Q

Are spondyloarthropathies usually directly inherited?

A

No, very few are directly inherited

30
Q

Why is HLA B27 presence not a screening test for spondyloarthropathies?

A

Only 5% of HLA B27 positive individuals develop MSK symptoms overall, which shows that having gene variant doesn’t mean that individual has the condition

31
Q

What percentage of individuals with AS are HLA B27 positive?

A

over 95%

32
Q

What percentage of the British Caucasian population is HLA B27 positive?

A

8%

33
Q

What 3 places is pain common in when an individual has axSpA?

A

Hip, buttock, lower back

34
Q

Does inflammatory back pain caused by axSpA have a sudden or insidious onset, and at what age does the onset begin?

A

Insidious (slow with no obvious symptoms at first) at approximately 40 years old

35
Q

Does inflammatory back pain caused by axSpA have an identifiable cause?

A

No

36
Q

What improves inflammatory back pain caused by axSpA, and what doesn’t improve it?

A

Only improved by activity/movement/exercise

Not improved by rest

37
Q

When is inflammatory back pain caused by axSpA worse in the day?

A

Worse at late night and causes early morning stiffness

38
Q

Is neck pain commonly presented in spondyloarthropathies, and is it equally as common in men and women?

A

Neck pain is a rare clinical feature that is more common in women

39
Q

In what 2 planes is there reduced range of spinal movements caused by spondyloarthropathies?

A

Frontal, sagittal

40
Q

What is the effect of fatigue caused by spondyloarthropathies?

A

Chronic sleep disturbance

41
Q

What extra-articular features are presented in spondyloarthropathies?

A

Usually features associated with HLA B27

42
Q

In AS, what 5 radiographic features indicate sacroiliitis?

A

Erosions (dark areas)
Narrow joint spaces
irregularity
sclerosis
spinal fusions

43
Q

What are syndesmophytes, and what imaging medium is used to see them?

A

bony outgrowths from the spinal ligaments as they attach to adjacent vertebral bodies and cause spine to fuse

Seen with MRI

44
Q

What 2 imaging mediums are used to see enthesitis?

A

MRI, ultrasound

45
Q

What is a bone marrow edema, and how is it seen with MRI?

A

fluid buildup inside bone marrow that indicates inflammation

White areas on MRI

46
Q

Why does ultrasound/MRI need to be used to identify nr-axSpA instead of x-ray?

A

X-ray won’t show signs of inflammation

47
Q

What are the 3 main aspects of acute spondyloarthropathy management?

A

Analgesia and NSAIDs are first-line therapies

physical therapy with mobilising exercises

occupational therapy

48
Q

What medications can be given for chronic spondyloarthropathy management, and why are they suitable?

A

DMARDs eg. methotrexate and sulfasalazine, as they don’t affect the disease progression or spinal symptoms

Biologics can be considered, but DMARDs should be tried first

49
Q

Give 3 examples of surgeries used to treat spondyloarthropathies?

A

total arthroplasty

ostectomy (correction of spinal abnormalities)

surgical spinal fusion using plates and screws

Clinical lectures (29 decks)

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