Spondyloarthropathies Flashcards
(25 cards)
What is a spondyloarthropathy
Inf arthropathy affecting axial skeleton and peripheral joints
What is the strongly associated gene?
HLA-B27
What are the 4 types?
Ankylosing Spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis
What are the common features of the 4 types?
Seronegativity
Sacroiliac and spinal involvement
Synovitis, enthesitis, dactylitis
Eye involvement
What is psoriatic arthritis?
Psoriasis associated inflammatory arthritis
Who does psoriatic arthritis affect?
10-20% of psoriasis patients get this
It can occur before visible skin changes
What are the 5 patterns of PsA
Asymmetrical oligoarthritis- affects 1-4 joints, often only unilaterally
Symmetrical polyarthritis- similar to RA
Distal interphalangeal predominant patternprimarily affects DIP joints. (However DIP joints can be affected across all types)
Spondylitispresents with back stiffness and pain. involvesaxial skeleton(spine and sacroiliac joints)
Arthritis mutilans-most severe, affectsphalanges. There isosteolysis around joints, leading to progressive digit shortening. Skin folds as digit shortens, resulting intelescoping digit
How does PsA present?
Visible psoriasis
Nail pitting
Onycholysis- nail nail bed separation PENCIL IN CUP
Dactylitis and enthesitis
X-ray signs of PsA
‘Pencil in cup’ in fingers
What is dactylitis?
Sausage fingers
How is PsA diagnosed?
PEST- psoriasis epidemiological screening tool
Screens psoriasis patients for PA, high scores get referred
Treatment for PsA
MDT involvement (dermatology, rheumatology)
NSAIDs
Steroids
DMARDs
AntiTNFs
Ustekinumab last resort (IL12 IL23 antagonist)
What is ankylosing Spondylitis?
Inflammation of spine and SI joints
Most common presentation of AS
Slow onset lower back pain and stiffness
Worse at rest, better with movement
Other associated symptoms of AS
Costochondritis
Enthesitis- inf of tendon/ligament insertions
Dactylitis
Vertebral fractures
SOB due to restricted chest wall movement
Plantar fasciitis
What conditions are associated with AS?
Anterior uveitis- treated with topical cyclopentolate
Aortic regurg
Atrioventricular block
Apical lung fibrosis
Anaemia of chronic disease
How is AS diagnosed?
Schobers test
CRP and ESR
HLA B27 testing
X-ray findings-
bamboo spine (SI joint fusion)
Vertebral body squaring
Areas of bone growth where ligaments insert into bone
Ligament ossification
MRI findings-
Bone marrow oedema
Management for AS
Non medical- physio, exercise, smoking cessation
Medical- NSAIDs, antiTNFs, IL17s and JAK inhibitors
Possible steroid injections
What is enteropathic arthritis?
Arthritis associated with inflammatory bowel disease
What are the clinical features of EA?
Large joint peripheral arthritis and axial arthritis
Enthesitis
May be active during flare of IBD
How is enteropathic arthritis treated?
Manage IBD
NO NSAIDs- may make IBD worse
Corticosteroids for short term flares
DMARDs, IL12/23 eg ustekinumab, and JAK inhibitors
What is reactive arthritis?
Any level of synovitis that has an infective trigger
What commonly triggers it?
Gastroenteritis
STIs
Dysentery
What is the common presentation of reactive arthritis?
Acute monoarthritis, commonly in the knee
Can’t pee, see, or climb a tree:
Urethritis, conjunctivitis, arthritis
Presentation can be confused with septic arthritis and gout
