Spondyloarthropathies Flashcards Preview

MSK > Spondyloarthropathies > Flashcards

Flashcards in Spondyloarthropathies Deck (42):
1

What is spondyloarthorpathy?

family of inflam arthritides characterized by invovlement of both the spone and joints principally in geneticall predisposed individuals

2

What is the main gene associated the spondylarthropathies?

HLA-B27

3

What diseases is HLA-B27 associated with?

ank. spon; reactive arthritis, Crohn's, uveitis

4

What diseases make p the spondyloarthropathies?

ankylosing spondylitis; psoriatic arthritis; reactive arthritis; enteropathic arthirits

5

What are hte differences betweeen mechanical and inflammatory back pain?

mechanical- worsened by actvity, typically worst at end of the day, better with rest
inflam-worse with rest, better with activity, signif early morning sitfness (>30 mins)

6

What are the shared rheumatological features of the spondyloarthropathies?

sacoriliac and spinal involvemtn; enthesitis; dactylitis

7

What is dactylitis?

"sausage digits"- inflam of entire digit

8

What are the extra-articular features seen in the spondyloarthropathies?

ocular inflammation (uveitis; conjunctivites; mucocutaneous lesions; aortic incompetence or heart blcok

9

What is ankylosing spondylitis

chronic systemic inflam disorder that primarly affects the spine

10

What is the hallmark features of ank spon?

sacroiliac joint involvemnt

11

Who is ank. spon seen in?

late adolescence or early adulthood; M:F- 3-5:1

12

What are the features of ank. spon in the classificitation?

inflam back pain for longer than 3 months
arthritis
enthesitis (heel)
uveitis
dactylitis
psoriasis
Crohn's
good response to NSAIDs
FHx
HLA-B27
inc. CRP

13

What are the CVS; resp and neurological involvement seen with ank. spon?

aortic valve/ root-aortic regurg
fibrosis of upper lung lobes
A-A subluxation

14

What are the 7 As for ank. spon??

axial arthritis
anterior uveitis
aortic regurg
apical fibrosis
amyloidosis/Ig A nephropathy
achilles tendinitis
plAntar fasciitis

15

What happens to the spine in pts with ank. spon?

syndesmophytes- fusion of vertebrae; question mark posture- straightening of the lordosis

16

What examinations can be done in pts with ank. spon?

tragus/occiput to wall- wont be able to
chest expansion- costovertebral joints can be affected
modified schober test- should be >5cm when bend over

17

What is seen on MRI in ank. spon?

bone density is normal in early disease but reuced in late disease
shiny corners
flowing syndesmophytes
fusion (bamboo spine)
bone marrow oedema
enthesitis

18

What is the treatment for ank. spon?

PT; OT; NSAIDs; DMARDS; anti-TNFs

19

What is the newest licensed drug for AS?

secukinumab- anti-IL17

20

What is psoriatic arthritis?

inflammatory arthritis assoc with psoriasis

21

How is psoriatic arthritis differentiated from RA?

no rheumatoid nodules; RF negative

22

What are the clinical features of psoriatic arthritis?

sacroilitis; nail involvement; dactylitis; enthesitis; extra-articular features eg eye disease

23

What is seen on x-ray in psoriatic arthritis?

marginal erosions and whiskering; pencil in cup deformity; osteolysis; enthesitis

24

Are inflam markers raised with psoriatic arthritis?

yes

25

What is the treatment for psoraitic arthritis?

PT;OT; NSAIDs; CS; DMARDs; anti-TNFs; anti-IL17

26

What is reactive arthritis?

infection induced systemic illness characterized primarly by an inflam synovitis from which viable microbes cannot be cultures

27

What infections tend to induce reactive arthritis?

GU- chlaymydia and GI- eg salmonella; shigella

28

Who gets reactive arthritis?

young adults (20-40); theres an equal sex distributiona

29

When do reactive arthritis symptoms start after an infeciton?

1-4 weeks post infection

30

What is reiters syndrome?

a form of reactive arthritis
triad of urethritis; eye inflam; arthritis

31

What are the clinical features of reactive arthritis?

general- fever fatigue; malaise
asymmetrical monoarthritis or oligoarthritis
enthesitis
mucocutanoues lesions
ocular lesions
mild renal disease
carditis

32

Why does joint fliud analysis need to be done in reactive arthritis?

to rule out infection

33

What is the prognosis for reactive arthritis?

spontaneously resolve within 6 months

34

What are the treaments for reactive arthritis?

NSAIDs; CS; antibiotics for underling infection; PT; OT

35

What treatment is given for resistant/chronic reactive arthritis?

DMARDs

36

What is enteropathic arthritis associated with?

inflammatory bowel disease

37

where do pts with enteropathic arthritis present with symptoms?

several joints, esp knees, ankles, elbows and wrists and sometimes in spine (20% of Crohns pts have sacroilitis) hip or shoulders

38

What are the clinical symptoms associated with enteropathic arthritis?

GI-loose, watery stool with mucous and blood
weight loos, low grade fever; eve involvemnet, skin involvement (pyoderma gangrenosum)
enthesitis
oral-apthous ulcers

39

What are the investigatsion done in enteropathic arthritis?

upper and lower GI endoscopy; joint aspirate- no organism or crystals; raised inflam markers

40

How does the IBD disease progression correlate with the arthrtisi?

arthritis worsens when IBD worsens

41

What is the treatmnet for enteropathic arthritis?

treat IBD controls the arthritis; normal analgesia eg paracetamol; steroids; DMARDs

42

Why are NSAIDs not a good idea in enteropathic arthritis?

may exacerbate inflam bowel disease