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MSK > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

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?

A

raised inflammatory markers

HLA B27

22
Q

can AS be present without HLA B27?

A

yes

23
Q

AS imaging?

A

can be normal in early stages

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

24
Q

AS spine features?

A 
normal bone density
(reduced in late disease)
shiny corners
flowing syndesmophytes
fusion (bamboo spine)
25
Q

OA spine features?

A 
normal bone density
reduced joint space
subchondral cysts
subchondral sclerosis
osteophyte formation - assoc with neural foraminal narrowing
26
Q

early sign of sacro iliac inflammation?

A

bone marrow oedema on MRI

white parts

27
Q

AS treatment?

A 
physio
occupational therapy
NSAIDs
DMARDs
Anti TNF if severe
Secukinumab?
28
Q

what is psoriatic arthritis?

A

inflammatory arthritis assoc with psoriasis

but can appear without psoriasis

29
Q

what are the clinical features of psoriatic arthritis?

A 
no rheumatoid nodules
rheumatoid factor -ve
inflammatory arthritis
sacroiliitis
nail involvement
dactylitis
extra articular features (eyes)
30
Q

what are the 5 subgroups of psoriatic arthritis?

A
  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
Q

psoriatic arthritis diagnosis?

A

history (FH of psoriasis etc)
examination
bloods
X rays

32
Q

psoriatic arthritis bloods?

A

raised inflammatory markers

negative RF

33
Q

X rays of psoriatic arthritis?

A

marginal erosions and (whiskering)
Pencil in cup
osteolysis
enthesitis

34
Q

psoriatic arthritis treatment?

A

medical

  • NSAIDs
  • steroids
  • DMARDs
  • Anti TNF if severe
  • Secukinumab

non-medical

  • physio
  • Occ therapy
  • Orthotics, chiropodist
35
Q

what is reactive arthritis?

A

infection induced systemic illness

  • chlamydia
  • salmonella, shigella etc
36
Q

what are the characteristics of reactive arthritis?

A

inflammatory synovitis from which organisms cant be cultured

arthritis symptoms 1-4 weeks after infection

37
Q

who is reactive arthritis common in?

A

young adults
both genders
HLA B27 positive

38
Q

what is Reiter’s syndrome?

A 
form of reactive arthritis
triad:
- urethritis
- conjunctivitis etc
- arthritis
39
Q

reactive arthritis clinical features?

A 
general - fever, fatigue, malaise
asymmetrical monoarthritis or oligoarthritis
enthesitis
mucocutaneous lesions
ocular lesions
visceral manifestations (heart, kidney)
40
Q

reactive arthritis diagnosis?

A 
history
examination
bloods
cultures
joint fluid analysis
X ray
opthamology
41
Q

septic joint vs reactive arthritis?

A

septic = there are organisms in joint fluid

joint fluid is sterile in reactive

42
Q

reactive arthritis bloods?

A

raised inflammatory markers
FBC
U&Es
HLA B27 if needed

43
Q

reactive arthritis treatment?

A 
most resolve within 6 months
medical
- NSAIDs
- steroids
- antibiotics for infection
- DMARDs

non medical

  • physio
  • occ therapy
44
Q

prognosis of reactive arthritis?

A

generally good

can recur and become chronic

45
Q

what is enteropathic arthritis?

A

assoc with inflammatory bowel disease

46
Q

how does enteropathic arthritis present?

A

arthritis in several joints

can be better and worse with IBD flares etc

47
Q

clinical symptoms of enetropathic arthritis?

A 
loose watery stool with mucous/blood
weight loss
low fever
eye involvement
skin involvement
enthesitis
oral apthous ulcers
48
Q

how is enteropathic arthritis investigated?

A 
upper and lower GI endoscopy
with biopsy (for IBD)
joint aspirate
raised inflammatory markers
X ray/MRI showing sacroiliitis
US showing synovitis
49
Q

how is enteropathic arthritis treated?

A 
treat IBD
don't use NSAIDs (can affect IBD)
Normal analgesia
steroids
DMARDs
Anti TNF
50
Q

what non medical therapies can help spondyloarthropathies?

A

physiotherapy
occ therapy
orthotics
chiropodist

51
Q

most useful investigation?

A

MRI

shows earlier disease than X ray

MSK (66 decks)

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