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Flashcards in Spondyloarthropathies Deck (22):
1

Define spondyloarthropathy

Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed (HLA B27 positive) individuals

2

How is mechanical back pain defined?

Worsened by activity, typically worst at end of day, better with rest

3

How is inflammatory back pain defined?

Worse with rest, better with activity, early morning stiffness

4

What are some shared rheumatological features of the spondyloarthropathies?

Sacroiliac/spinal involvement. Enthesitis, inflammatory arthritis: oligoarticular, asymmetric, predominantly lower limb, dactylitis

5

What is enthesitis?

Inflammation at insertion of tendons into bones e.g. achilles tendinitis, plantar fasciitis

6

What is dactylitis?

Inflammation of entire digit

7

What are the seronegative inflammatory arthropathies?

AS, psoriatic arthritis, enteropathic arthritis, reactive arthritis

8

What antigen is often present in spondyloarthropathies?

HLA-B27

9

What is ankylosing spondylitis?

Chronic inflammatory disease of spine and SI joints which can lead to fusion of intervertebral and SI joints.

10

Who would likely present with AS?

Males 3M:1F, 20-40yo

11

What symptoms and signs may a patient with AS present with?

Spinal pain, stiffness, knee/hip arthritis, decreased spinal movement, development of question mark spine-loss of lumbar lordosis and increased thoracic kyphosis

12

What is used to test lumbar spine flexion?

Schobers test

13

What are the associated conditions of AS?

Anterior uveitis, aortitis, pulmonary fibrosis and amyloidosis

14

What may imaging show in AS?

XR-sclerosis and fusion of SI joints, bony spurs from vertebral bodies known as syndesmophytes, can be normal. MRI- bone marrow oedema, enthesitis of spinal ligaments

15

What is the treatment for AS?

Physio, exercise, NSAIDs and anti-TNF inhibitors. DMARDS no use on spinal disease, use if peripheral joint inflammation.

16

What is psoriatic arthritis?

Arthritis affecting up to 30% psoriasis patients. Usually asymmetrical oligoarthritis, can be similar in halds to RA.

17

What symptoms and signs occur in psoriatic arthritis?

Spondylitis, dactylitis, enthesitis commonly occur. Nail changes-pitting, oncholysis. Some patient have arthritis in DIP joints.

18

What is the treatment of psoriatic arthritis?

DMARDs, usually methotrexate. Anti-TNF therapy available. Joint replacement, DIP joint fusion considered

19

What is reactive arthritis?

An AI arthropathy which occurs in response to an infection in another part of the body. Usually self limiting (70-85%)

20

What infections usually cause an infective arthritis?

Commonly GU infections (chlamydia, neisseria, or GI (salmonella, campylobacter).

21

What symptons and signs occur in infective arthritis?

Large joints e.g knee become inflamed 1-3 wks post infection. Urethritis, uveitis/conjunctivitis and arthritis triad- Reiter's syndrome.

22

What is the treatment for infective arthritis?

Usually self limiting, 15-30% chronic or frequent relapses. Treat infectious cause, symptom relief- IA/IM steroid injections, occasionally DMARDs