Spondyloarthropathies

Question 1

What are spondyloarthropathies?

Answer 1

Inflammatory arthritides
Involves spine and other joints
In HLA B27 +ve individuals

Question 2

Name 4 main spondyloarthropathies

Answer 2

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

Question 3

Describe mechanical pain

Answer 3

Worsens with activity

Better with rest

Question 4

Describe inflammatory pain

Answer 4

Worse with rest
Better with activity
Marked early morning stiffness

Question 5

List 6 shared rheumatological features of spondyloarthropathies

Answer 5

Sacroiliac involvement
Enthesitis
Dactylitis
Oligoarticular
Asymmetric
Lower limb mainly

Question 6

List 4 extra-articular features of spondyloarthropathies

Answer 6

Ocular inflammation
Mucocutanous lesions (ulcers)
Aortic incompetence, heart block (RARE)
NO rheumatoid nodules

Question 7

What is ankylosing spondylitis (AS)?

Answer 7

Chronic inflammatory disorder
Systemic effects but
Primarily affects spine

Question 8

What is the hallmark feature of AS?

Answer 8

Sacroiliitis

Question 9

What is the second most common feature of AS?

Answer 9

Enthesopathy

- Achilles tendonitis

Question 10

Which demographic is mostly affected by AS?

Answer 10

Late adolescence-early adult

Mostly men

Question 11

What features are rarely seen with AS?

Answer 11

Peripheral arthritis

- hips, shoulders etc

Question 12

What are the 6 As associated with AS?

Answer 12

Axial Arthritis
Anterior Uveitis
Aortic Regurgitation
Apical fibrosis
Amyloidosis/IgA Nephropathy
Achilles tendinitis
PlAntar Fasciitis

Question 13

How does a person with AS look?

Answer 13

Increased thoracic kyphosis

Loss of lumbar lordosis

Question 14

What can be done in examination can measure the extent of vertebral flexion in patients with AS?

Answer 14

Tragus/occiput to wall measurement

Modified Schober’s test

Question 15

What are bloods checked for in AS?

Answer 15

ESR, CRP, PV

HLA B27

Question 16

What is typically seen on Xray of a person with AS?

Answer 16

“Bamboo spine”
Sacroiliitis
Syndesmophytes

Question 17

What is the drawback of using Xray to diagnose AS?

Answer 17

Changes can only be seen in very advanced disease

Question 18

Is bone density affected in AS?

Answer 18

No

- contrast with OA

Question 19

What is the main therapy of AS?

Answer 19

Home exercise
Physiotherapy
OT
NSAIDs for pain

Question 20

Which drugs are used for AS with peripheral involvement?

Answer 20

DMARDs
- methotrexate
Steroids

Question 21

What is psoriatic arthritis (PsA)?

Answer 21

Inflammatory
Associated w/psoriasis
Some cases occur without
NO rheumatoid nodules
Rheumatoid factor -ve

Question 22

List 5 clinical features of PsA

Answer 22

(Asymmetric) sacroiliitis
Nail pitting
Dactylitis
Enthesitis (plantar fasciitis, achilles tendinitis)
Ocular inflammation

Question 23

What are the findings in bloods of patients with PsA?

Answer 23

Raised inflammatory markers

-ve RF

Question 24

What are 3 findings in Xrays of patients with PsA?

Answer 24

Marginal erosions; whiskering
Osteolysis
Enthesitis

Question 25

List 4 drug classes used to treat PsA

Answer 25

NSAIDs Intra-articular steroids DMARDs Anti TNF (refractory)

Question 26

List 4 non-pharm treatments of PsA

Answer 26

Physiotherapy OT Chiropodist, ortotist

Question 27

What is Reiter's syndrome?

Answer 27

Systemic illness caused by infection Inflammatory synovitis but no culture possible HLA B27 +ve

Question 28

How long after infection does Reiters' come on?

Answer 28

1-4 weeks

Question 29

Which infections commonly trigger Reiters'?

Answer 29

Urogenital e.g. chlamydia | Enteropathic e.g. salmonella, shigella

Question 30

What is the Reactive Arthritis triad?

Answer 30

Urethritis Conjuntivitis/Uveitis/Iritis Arthritis

Question 31

What are the clinical features of Reactive Arthritis?

Answer 31

Constitutional symptoms Asymmetrical mono/oligoarthritis Enthesitis Mucocutaneous lesions

Question 32

Which investigations are needed to diagnose Reactive Arthritis?

Answer 32

Bloods (inflammatory markers) FBC, U+E Bacterial cultures (excrement and blood) Xray

Question 33

Should Reactive Arthritis always be treated?

Answer 33

No | 90% spontaneous resolution within 6/12

Question 34

What are the pharmacological treatments of Reactive Arthritis?

Answer 34

NSAIDs Corticosteroids Antibiotics DMARDs (refractory)

Question 35

What are the non-medical treatments of Reactive Arthritis?

Answer 35

Physiotherapy | OT

Question 36

What is Enteropathic Arthritis?

Answer 36

Associated with IBD Worse symptoms during flare of IBD Oligoarthritis - esp knees, ankles, elbows, wrist May involve spine, hips, shoulders

Question 37

What are the clinical features of Enteropathic Arthritis?

Answer 37

``` GI - obviously Weight loss, low fever Uveitis Pyoderma gangrenosum Enthesitis Apthous ulcers ```

Question 38

How does one investigate for Enteropathic Arthritis?

Answer 38

``` Upper and lower GI endoscopy Joint aspirate (should be sterile + no crystals) Raised inflammatory markers Xray - sacroiliitis USS - synovitis ```

Question 39

How is Enteropathic Arthritis treated?

Answer 39

``` Control IBD Analgesia NOT NSAIDs Steroids DMARDs Anti-TNF ```