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Spondyloarthropathies Flashcards

(51 cards)

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1
Q

what is spondyloarthropathy?

A

family of inflammatory arthritides

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2
Q

what characterizes spondyloarthropathy?

A

involvement of spine and joints

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3
Q

what can cause a predisposition to spondyloarthropathy?

A

HLA B27 gene

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4
Q

what is HLA B27 associated with?

A

doesn’t directly cause anything

assoc with ankylosing spondylitis, reactive arthritis, crohns, uveitis

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5
Q

is HLA B27 used as a screening tool?

A

not really

only if patients have symptoms

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6
Q

name 4 subgroups of spondyloarthropathy

A

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

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7
Q

mechanical vs inflammatory pain?

A 
mechanical = worse on activity and at end of the day, better with rest
inflammatory = worse with rest, better with activity, significant early morning stiffness (>30 mins)
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8
Q

list some shared features of spondyloarthropathy

A

sacroiliac and spinal involvement
enthesitis (inflammation at site of tendon insertion)
inflammatory arthritis
dactylitis (inflammation of digits)

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9
Q

example of enthesitis

A

plantar fascitis

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10
Q

name some shared extra articular features of spondyloarthropathy

A

ocular inflammation (uveitis, conjunctivitis)
mucocutaneous lesions
rare aortic incompetence or heart block
no rheumatoid nodules

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11
Q

what is ankylosing spondylitis (AS)?

A

chronic systemic inflammatory disorder that primarily affects the spine

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12
Q

what does AS cause?

A 
hallmark = sacroiliac joint involvement (sacroiliitis)
enthesopathy
sparing of peripheral arthritis
more common in men
onset in late adolescence
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13
Q

ASAS classification criteria for AS?

A

Sacroiliitis imaging + 1 or more SpA feature
OR
HLA B27 positive + 2 or more SpA features

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14
Q

what are the SpA features?

A 
inflammatory back pain
arthritis
enthesitis
uveitis
dactylitis
psoriasis
IBD
NSAIDs response
FH
HLA B27
raised CRP
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15
Q

sacroliliitis imaging?

A

active inflammation on MRI suggesting sacroiliitis associated with SpA
definite sacroiliitis according to modified new York criteria

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16
Q

what are the clinical features of AS?

A 
back pain
enthesitis
extra articular features
- anterior uveitis
- cardiovascular involvement
- pulmonary involvement
- asymptomatic enteric mucosal inflammation
- neurological involvement
- amyloidosis
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17
Q

“A Disease”?

A 
Axial arthritis
anterior uveitis
Aortic regurgitation
Apical fibrosis
Amyloidosis/IgA nephropathy
Achilles tendinitis
PlAnter fascitis
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18
Q

how does AS affect the spine over time?

A

can cause it to fuse

deforms posture

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19
Q

how is AS diagnosed?

A

history
examination
bloods
X rays

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20
Q

AS examination?

A

tragus/occiput to wall
chest expansion
modified Schober test

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21
Q

AS blood tests?

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A

raised inflammatory markers

HLA B27

22
Q

can AS be present without HLA B27?

23
Q

AS imaging?

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A

can be normal in early stages

later = SIJ fusion/sclerosis, sacroiliitis, syndesmophytes, bamboo spine, vertebral fusion, erosions

24
Q

AS spine features?

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A 
normal bone density
(reduced in late disease)
shiny corners
flowing syndesmophytes
fusion (bamboo spine)
25
OA spine features?
``` normal bone density reduced joint space subchondral cysts subchondral sclerosis osteophyte formation - assoc with neural foraminal narrowing ```
26
early sign of sacro iliac inflammation?
bone marrow oedema on MRI | white parts
27
AS treatment?
``` physio occupational therapy NSAIDs DMARDs Anti TNF if severe Secukinumab? ```
28
what is psoriatic arthritis?
inflammatory arthritis assoc with psoriasis | but can appear without psoriasis
29
what are the clinical features of psoriatic arthritis?
``` no rheumatoid nodules rheumatoid factor -ve inflammatory arthritis sacroiliitis nail involvement dactylitis extra articular features (eyes) ```
30
what are the 5 subgroups of psoriatic arthritis?
1. DIP joints of hands/feets 2. symmetrical polyarthritis 3. spondylitis (spinal) with or without peripheral involvement 4. asymmetrical olioarthritis with dactylitis 5. arthritis mutilans
31
psoriatic arthritis diagnosis?
history (FH of psoriasis etc) examination bloods X rays
32
psoriatic arthritis bloods?
raised inflammatory markers | negative RF
33
X rays of psoriatic arthritis?
marginal erosions and (whiskering) Pencil in cup osteolysis enthesitis
34
psoriatic arthritis treatment?
medical - NSAIDs - steroids - DMARDs - Anti TNF if severe - Secukinumab non-medical - physio - Occ therapy - Orthotics, chiropodist
35
what is reactive arthritis?
infection induced systemic illness - chlamydia - salmonella, shigella etc
36
what are the characteristics of reactive arthritis?
inflammatory synovitis from which organisms cant be cultured | arthritis symptoms 1-4 weeks after infection
37
who is reactive arthritis common in?
young adults both genders HLA B27 positive
38
what is Reiter's syndrome?
``` form of reactive arthritis triad: - urethritis - conjunctivitis etc - arthritis ```
39
reactive arthritis clinical features?
``` general - fever, fatigue, malaise asymmetrical monoarthritis or oligoarthritis enthesitis mucocutaneous lesions ocular lesions visceral manifestations (heart, kidney) ```
40
reactive arthritis diagnosis?
``` history examination bloods cultures joint fluid analysis X ray opthamology ```
41
septic joint vs reactive arthritis?
septic = there are organisms in joint fluid | joint fluid is sterile in reactive
42
reactive arthritis bloods?
raised inflammatory markers FBC U&Es HLA B27 if needed
43
reactive arthritis treatment?
``` most resolve within 6 months medical - NSAIDs - steroids - antibiotics for infection - DMARDs ``` non medical - physio - occ therapy
44
prognosis of reactive arthritis?
generally good | can recur and become chronic
45
what is enteropathic arthritis?
assoc with inflammatory bowel disease
46
how does enteropathic arthritis present?
arthritis in several joints | can be better and worse with IBD flares etc
47
clinical symptoms of enetropathic arthritis?
``` loose watery stool with mucous/blood weight loss low fever eye involvement skin involvement enthesitis oral apthous ulcers ```
48
how is enteropathic arthritis investigated?
``` upper and lower GI endoscopy with biopsy (for IBD) joint aspirate raised inflammatory markers X ray/MRI showing sacroiliitis US showing synovitis ```
49
how is enteropathic arthritis treated?
``` treat IBD don't use NSAIDs (can affect IBD) Normal analgesia steroids DMARDs Anti TNF ```
50
what non medical therapies can help spondyloarthropathies?
physiotherapy occ therapy orthotics chiropodist
51
most useful investigation?
MRI | shows earlier disease than X ray

MSK (66 decks)

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