Spondyloarthropathies

Question 1

what are spondyloarthropathies

Answer 1

family of inflammatory arthratides involving the spine and joints especially in genetically predisposed patients

Question 2

what is the gene that predisposes someone to spondyloarthropathy?

Answer 2

HLAB27 +ve

Question 3

what other conditions are HLA B27 +ve people at risk of?

Answer 3

crohns disease

uveitis

Question 4

4 types of spondyloarthritis

Answer 4

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

Question 5

what is an enthesis

Answer 5

site of insertion of a tendon/ligament/articular capsule into bone

Question 6

name rheumatological clinical features of spondyloarthropathies

Answer 6

sacroiliac and spinal involvement
enthesitis
inflammatory arthritis
digit inflammation

Question 7

can spondyloarthropathies cause:

1. ocular inflammation
2. rheumatoid nodules
3. heart block

Answer 7

T
F
T

Question 8

what is dactylitis

Answer 8

inflammation of tendons

Question 9

what is ankylosing spondylitis

Answer 9

chronic systemic inflammation of the spine, with the sacroiliac joint being involved

Question 10

who gets ankylosing spondylitis typically

Answer 10

young people

Question 11

why would an ankylosing spondylitis patient get impaired chest expansion

Answer 11

if thoracic spine is involved

Question 12

does back pain associated with AS improve with exercise?

Answer 12

yes

Question 13

name the 7 A’s of AS and why they are relevant

Answer 13

axial arthritis
anterior uveitis
aortic regurgitation
apical fibrosis
amyloidosis
achilles tendonitis
plAntar fasciitis

commonly present with AS

Question 14

what are the pathological effects of AS on the spine

Answer 14

causes vertebrae to fuse together forming a “bamboo spine”

Question 15

what happens to the spine’s shape and curvature?

Answer 15

straightening of lumbar lordosis and pronounced thoracic kyphosis

Question 16

typical examinations done in suspected AS patients?

Answer 16

schober test
chest expansion
x ray

Question 17

what is the schober test

Answer 17

measures the degree of lumbar forward flexion as the patient bends over as though touching their toes.

Question 18

is bone density affected in AS?

Answer 18

gets worse over time

Question 19

what are the shiny corners on x ray of AS?

Answer 19

thickening of desmophytes

Question 20

clearest imaging to use for AS and why

Answer 20

MRI

shows early radiological images

Question 21

treatment for AS

Answer 21

NSAIDs
DMARDS eg szp
anti TNF

Question 22

does inflammatory arthritis test positive for RF?

Answer 22

no

Question 23

clinical presentation of inflammatory arthritis?

Answer 23

asymmetric sacroiliitis
psoriatic nail involvement
dactylitis
enthesitis
eye disease

Question 24

which condition is inflammatory arthritis associated with?

Answer 24

psoriasis

Question 25

x ray presentation of inflammatory psoriasis

Answer 25

marginal erosions pencil in cup deformity osteolysis enthesitis

Question 26

treatment for inflammatory arthritis

Answer 26

NSAIDs corticosteroids DMARDs eg methotrexate anti-TNF only if unresponsive

Question 27

what is reactive arthritis

Answer 27

infection induced illness characterised by an inflammatory synovitis

Question 28

when do symptoms typically start in reactive arthritis

Answer 28

1-4 weeks

Question 29

name some typical infections that trigger reactive arthriis

Answer 29

STIs eg chlamydia | Enteric eg salmonella, shigella

Question 30

who tends to get reactive arthritis?

Answer 30

20-40 yr olds

Question 31

what is reiters syndrome and what makes up the triad of symptoms it presents with

Answer 31

a form of reactive arthritis that presents with: uveitis conjunctivitis arthritis

Question 32

does reactive arthritis present asymmetrically?

Answer 32

yes

Question 33

accompanying clinical features to reactive arthritis

Answer 33

``` oral ulcers hyperkeratotic nails fever enthesitis circinate balanitis renal disease ocular lesions ```

Question 34

investigations for reactive arthritis

Answer 34

stool culture for enterics fbc, u+es inflam markers joint aspirate

Question 35

treatment for reactive arthritis?

Answer 35

NSAIDs ABs if infection DMARDs (SZP) if unresponsive

Question 36

most common associated symptom of enteropathic arthritis?

Answer 36

IBD especially crohns

Question 37

most common areas of arthritis in enteropathic arthritis?

Answer 37

knees ankles elbows wrists

Question 38

symptoms of enteropathic arthritis?

Answer 38

IBD symptoms eg loose stool, weight loss, pyoderma gangrenosum etc enthesitis sacroiliitis synovitis

Question 39

investigations for enteropathic arthritis?

Answer 39

``` upper and lower GI endoscopy joint aspirate CRP/PV x ray/MRI USS ```

Question 40

which imaging would show synovitis

Answer 40

USS

Question 41

which imaging would show sacroiliitis

Answer 41

x ray/MRI

Question 42

treatment for enteropathic arthritis?

Answer 42

``` treat IBD first not NSAIDs analgesia steroids DMARDS (ask GI doctor) anti-TNF ```