Spondyloarthropathies

Question 1

spondyloarthropathies = (4)

overlap and ass with HLA ___

Answer 1

ank spond
enteropathic
reactive 
psoriatic arthritis
HLA B27

Question 2

HLA B27 ass with (4)

inheritance =

Answer 2

Crohns
uveitis
ank spond
reactive arthritis
auto dom

Question 3

shared rheum features of spondyloarthropathies (6)

Answer 3

SI and spinal involvement
enthesitis
oligoarticular inflam arthritis
asymmetrical
predominantly lower limb
dactylitis

Question 4

sausage fingers =

Answer 4

dactylitis

Question 5

shared extra art features of spondyloarthropathies (4)

Answer 5

ant uveitis, conjunctivitis
mucocutaneous lesions
aortic incompetence and heart block (rare)
no rheum nodules

Question 6

ank spond is a ___ condition that primarily affects ___

Answer 6

chronic systemic inflammatory

spine

Question 7

hallmark of ank spond =

Answer 7

sacroiliitis

Question 8

ank spond
M:F
age

Answer 8

M3.5:1F

late adolescence/early adulthood

Question 9

diagnosis of ank spond

Answer 9

> =3months back pain and <45yo onset

HLA B27 +ve/sacroiliitis on imaging and >=2 features of ank spond

Question 10

Imaging used to detect early and late changes in ank spond

Answer 10

early = MRI
late = xray

Question 11

features of ank spond (10)

Answer 11

back pain
enthesitis
peripheral arthritis (rare)
ant uveitis
CV involvement
neuro
upper lung lobe fibrosis
asympt neteric mucosal inflam
amyloidosis
plantar fasciitis

Question 12

examination of ank spond = (3)

Answer 12

chest expansion (decreased)
Schobers test
tragus/occiput to wall (difficult if neck fusion)

Question 13

blood results in ank spond

Answer 13

inflam markers increased

HLA B27 +ve in 90%

Question 14

xray findings of late ank spond

Answer 14

bamboo spine
sacroiliitis
syndesmophytes
bone density becomes reduced

Question 15

MRI-STIR early findings in ank spond

Answer 15

bone marrow oedema

enthesitis

Question 16

treatment of ank spond

Answer 16

physio (most important)
OT
NSAIDs (niproxin in Tayside)
\+ DMARDs (if peripheral arthritis)
anti-TNF (if severe)
anti-IL17(secukinumab)

Question 17

psoriatic arthritis
10-15% have it ___
__ -ve and no ___

Answer 17

without psoriasis
RF -ve
no rheumatoid nodules

Question 18

features of psoriatic arthritis: (6)

Answer 18

inflammatory arthritis
sacroiliitis (usually asymmetrical)
nail pitting/onycholysis
dactylitis
achilles tendonitis/plantar fasciitis
eye disease

Question 19

5 subgroups of psoriatic arthritis

1) confined to __
2) symmetrical __
3) __ +/- peripheral joint involvement
4) asymmetrical __ with __
5) arthritis __

Answer 19

DIPJ
polyarthritis
spondylitis
oligoarthritis - dactylitis
mutilans

Question 20

blood results of psoriatic arthritis (2)

Answer 20

increased inflam markers

no RF

Question 21

xray findings in psoriatic arthritis (4)

Answer 21

“pencil in cup” of thumb
enthesitis
osteolysis
marginal erosions and “whiskering”

Question 22

drug treatment of psoriatic arthritis

Answer 22

NSAIDs, steroids

may add DMARDs => anti TNF if severe and unresponsive => secukinumab

Question 23

reactive arthritis occurs __ after ___

characterised primarily by ___ which has a -ve __

Answer 23

1-4wks ; infection induced systemic illness

inflammatory synovitis ; culture

Question 24

common infections that cause a reactive arthritis

Answer 24

urogential eg. chlamydia

enterogenic (salmonella, shigella, yersinia)

Question 25

reactive arthritis age: M:F +ve HLA ___

Answer 25

20-40yo M=F B27

Question 26

features of reactive arthritis

Answer 26

asymmetrical mono/oligoarthritis enthesitis keratoderma blenorrhagia, circinate balanitis, painless oral ulcers, hyperkeratinous nails conjunctivitis, iritis

Question 27

Reiter's syndrome = a form of __ | triad =

Answer 27

reactive arthritis urethritis arthritis conjunctivitis/uveitis/iritis

Question 28

Ix for reactive arthritis

Answer 28

``` inflam markers FBC U+E culture aspirate joint xray joints ophthalmology ```

Question 29

treatment of reactive arthritis

Answer 29

``` 90% resolve spontaneously in 6 months physio and OT NSAIDS - first line Steroids Abx if underlying infection if resistant = DMARDs - usually sulfasalizine ```

Question 30

enteropathic arthritis = 9-20% of __ patients | 20% of ___ = sacroiliitis

Answer 30

IBD | Crohns

Question 31

features of enteropathic arthritis =

Answer 31

``` arth esp knees ankle, elbow wrists IBD GI symptoms uveitis pyoderma gangrenosum enthesitis aphthous ulcers WORSE during IBD FLARE ```

Question 32

Ix of enteropathic arthritis:

Answer 32

``` upper and lower endoscopy and biopsy joint aspirate increased CRP and PV xray and MRI (sacroiliitis) US (synovitis/tenosynovitis) ```

Question 33

Rx of enteropathic arthritis

Answer 33

``` treat IBD paracetamol / co codamol steroids DMARDS anti TNF ```

Question 34

no __/___ in enteropathic arthritis as __

Answer 34

NSAIDs secukinumab exacerbate