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Spondyloarthropathies Flashcards

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1
Q

What HLA group is associated with spondyloarthropathies

A

HLA B27

Therefore genetically predisposed

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2
Q

What conditions is HLA B27 associated with

A

Ankylosing spondylitis
Reactive arthritis
Crohn’s disease
Uveitis

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3
Q

Why is HLA screening not always useful

A

Can be present without causing disease

Only screen if patient has symptoms

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4
Q

Describe mechanical back pain

A

Worsened by activity
Worse at end of the day
Better with rest
More common

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5
Q

Describe inflammatory back pain

A

Worse with rest
Better on activity
Significant morning stiffness (>1 hour)

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6
Q

List some features of inflammatory arthritis

A

Oligoarticular - affects a few joints, typically larger ones like knees, hips etc.
Asymmetric
However psoriatic can be symmetric and in small joints
Predominantly lower limb
Dactylitis - sausage fingers

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7
Q

List some shared rheumatological features of spondyloarthropathies

A 
Involvement of the sacroiliac joints and spine 
Enthesitis - where tendons attach
Tenosynovitis and synovitis
Inflammatory arthritis 
Dactylitis - sausage fingers
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8
Q

List some shared extra-articular features of spondyloarthropathies

A

Ocular inflammation - e.g. uveitis/iritis
Mucocutaneous lesions - mouth, genitals
Rarely aortic incompetence or heart block
IBS history

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9
Q

What is the hallmark of ankylosing spondylitis

A

Involvement of the sacro-iliac joint as well as the spine

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10
Q

When should you consider ankylosing spondylitis as a cause of back pain

A

In patients where pain has lasted more than 3 months

Age of onset less than 45 (typically between 20-40)

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11
Q

What criteria must be met in order to diagnose ankylosing spondylitis

A

Sacroiliitis on imaging and more than one clinical feature of SpA
OR
HLA-B27 positive and more than 2 clinical features

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12
Q

What are the main clinical features of ankylosing spondylitis

A 
Back pain 
Enthesitis 
Peripheral arthritis - rare 
Uveitis 
CV or pulmonary involvement 
Mucosal inflammation 
Amyloidosis 
Neurological symptoms
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13
Q

What forms in the spine in ankylosing spondylitis

A

Syndesmophytes

Fusion of the vertebrae that leads to decreased movement

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14
Q

What is the Schober test

A

Measure 10cm from dimples of iliac crest and 5cm below
Ask patient to bend over and touch toes
Distance should increase

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15
Q

What is the limitation of the Schober test

A

Can be limited by pain

Even if back does move its too sore to complete

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16
Q

What is used to diagnose ankylosing spondylitis

A

History
Exam - occipital to wall, Schober test and chest expansion - reduced
Bloods - HLA B27 and inflammatory markers
X-ray
MRI

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17
Q

How is chest expansion affected in ankylosing spondylitis

A

May be reduced

Due to fusion of costochondral joints

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18
Q

How might ankylosing spondylitis present on X ray

A

May be normal in early disease
Bone density reduced (late disease only)
Shiny corners or fuzzy margins- start of fusion
Syndesmophytes
Fusion - bamboo spine due to bridging of sydesmophytes

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19
Q

How can you treat ankylosing spondylitis

A

Spinal disease: Physio and occupational therapy
NSAIDs
Anti-TNF - e.g. infliximab
Or IL-17 blockers

Peripheral disease
DMARDs - e.g. MTX
IM or IA steroids
Short course of oral steroids

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20
Q

What is psoriatic arthritis

A

Inflammatory arthritis usually associated with psoriasis

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21
Q

All patients with psoriatic arthritis will have psoriasis - true or false

Study These Flashcards
A

False
10-15% of patients will present without the skin condition
Often have a family member with psoriasis

22
Q

What are the clinical features of psoriatic arthritis

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A 
Inflammatory arthritis 
Sacroiliitis - often asymmetrical 
Nail involvement - pitting or white patches
Dactylitis 
Enthesitis 
Eye disease - uveitis or iritis
23
Q

What are the 5 clinical subgroups of psoriatic arthritis

Study These Flashcards
A

1- confined to DIP joints (hands and feet)
2- symmetrical polyarthritis
3- spondylitis (spine involved)
4- asymmetric oligoarthritis with dactylitis
5- arthritis mutilans - severe damage to the hands and feet

24
Q

How do you diagnose psoriatic arthritis

Study These Flashcards
A

History - PMH and FH of psoriasis is key
Examination - nail signs etc
Bloods - raised inflammatory markers
X rays

25
What X ray signs suggest psoriatic arthritis
Marginal erosions Enthesitis Pencil in a cup deformity - bone looks sharpened
26
How can you treat psoriatic arthritis
``` NSAIDs Steroids (inc. joint injection) DMARDs Anti-TNF - severe disease Physio and occupational therapy Orthotics ```
27
What is reactive arthritis
Infection induced systemic illness Typically a infective illness which leads to an inflammatory synovitis Common after GI or GU infection in UK - campylobacter and chlamydia
28
Who does reactive arthritis usually affect
Young adults 20-40 Equal sex distribution
29
What are the clinical features of reactive arthritis
``` Fever, fatigue, malaise Asymmetrical mono/oligoarthritis Enthesitis Mucocutaneous lesions Ocular lesions Mild renal disease Carditis ```
30
Which joints are commonly affected by reactive arthritis
Knees | Can affect any joint
31
How do you diagnose reactive arthritis
``` History and Exam Bloods - inflammatory markers, FBC, U&E, HLA B27 Cultures - blood, urine Joint fluid analysis X ray (last 2 mainly to rule out other causes) ```
32
How do you treat reactive arthritis
Most resolve itself in 6 months Can give NSAIDs, corticosteroids, antibiotics for underlying infection DMARD is resistant/chronic Physio
33
What is enteropathic arthritis
Arthritis associated with IBD (Crohn's and UC) 9-20% of sufferers will get it Can affect many joints
34
When does enteropathic arthritis get worse
During flare up of the IBD
35
What are the clinical symptoms of enteropathic arthritis
``` GI - loose stool with mucous & blood Weight loss Fever Eye inflammation Skin involvement # Enthesitis Oral ulcers ```
36
What investigations might you do for enteropathic arthritis | and what would the findings be
``` Endoscopy - shows UC or Crohn's Joint aspirate - no organism or crystals (excludes other conditions) Raised inflammatory markers X-ray/MRI - shows sacroiliitis USS - synovitis or tenosynovitis ```
37
How do you treat enteropathic arthritis
``` Treat the underlying bowel disease Normal analgesia - paracetamol Steroids - oral, IA or IM DMARDs Anti-TNF ```
38
Why would you not give NSAIDs to treat enteropathic arthritis
May exacerbate the existing inflammatory bowel disease
39
Psoriatic and other seronegative | arthropathies generally affect the DIPs - true or false
True This is because of enthesitis at the insertion of the extensor tendon into the terminal phalanx Not affected in RA
40
Which age group and sex are most likely to be affected by seronegative spondyloarthropathies
Young men between 20 and 40 years old are more likely to be affected by seronegative spondyloarthropathies such as AS.
41
Family history increases risk of seronegative | spondyloarthropathies - true or false
True - A first degree relative with AS increases the risk having the disease by 5-20% - A 50-fold increase for first degree relatives with psoriatic arthritis and monozygotic twins have a 50% concordance rate.
42
Seronegative | spondyloarthropathies typically affect which joints
Affect sites where tendons insert to bone - DiP, spine etc
43
Pain radiating down the front or back of legs | usually indicates which type of pain
Mechanical
44
Neurological | symptoms usually indicate a non-inflammatory cause for back pain - true or false
True | Things such as paraesthesia, bowel or bladder symptoms
45
Which type of back pain responds to NSAIDs
Inflammatory
46
Sacro-iliac joint issues can cause pain in the buttock - true or false
True | unilaterally or bilaterally.
47
List diseases affecting the entheses
``` seronegative spondyloarthropathies Tennis elbow Golfers elbow Plantar fascitis Achilles tendonitis ```
48
What causes the back pain in seronegative spondyloarthropathies
It occurs secondary to enthesitis of costovertebral and costotransverse ligament attachments Can also get similar chest pain due to costocondritis
49
What is the gold standard diagnostic test for seronegative spndyloarthropathies
MRI scans Particularly of spine and sacroiliac joints Picks up early changes such as enthesitis
50
Which blood abnormalities may be seen in seronegative spndyloarthropathies
May have anaemia of chronic disease - FBC CRP/ESR/PV may be raised Often normal though so don't rule out based on low inflammatory markers

MSK (21 decks)

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