Spondyloarthropathies Flashcards
(37 cards)
What are spondyloarthropathies
Group of related inflammatory arthropathies
- inflamm of the spine - axial inflammation
- sacro iliac joint involvement
- enthesis
Association with spondyloarthropathy
What isn’t associated with spondyloarthropathy
HLA B27
No association with RhF
FHx - psoriasis, IBS, inflam spine condition
What is enthesopathy/enthesitis
Inflam of the enthesis which is the point of attachment of a ligament or tendon to bone - this is the feature that distinguishes this group from the conditions which mainly affect the synovium - RA
What are the principle spondyloarthropathies
Ank spondylitis Psoriasis Reactive arthritis Enteropathic spondyloarthropathy - IBD related arthritis Undifferentiated spondylarthrpathy
Common features of spondyloarthropathies
Sacroiliac and spinal involvement
Enthesis
Peripheral asymmetrical arthroscopic, oligoarthritis, mainly in the lower limb
Dactylitis - inflammation of the whole digit not just the joint
Ocular involvement- anterior uveitis
Skin lesions - psoriasis, balantis, keratoderma blenorrhagica.
Symptoms of sacroiliac and spinal involvement
Young <50 Chronic pain Morning stiffness >30 min Rest does not alleviate the pain Improved by movement Night pain Buttock pain - radiate to the legs
Enthesis symptoms
Common sites of involvement - achilles, plantar fascia, infrapatella poles,ASIS, lateral epicondyle
Need to ask about other sites of pain - heel pain, ankle pain, tennis elbow?
Peripheral asymmetric arthritis
Not always a feature, synovitis not always present
- assymetrical
Large joint
Lower limb
Could be a monoarthritis -need to rule out, septic, crystal
Dactylitis what is it
Whole digit pain swollen - inflamm, joint, tendon, periarticular all involved
Sausage digit common is psoriatic and reactive
Ocular inflamm
Ask about painful red eye +photophobia
- recurrent
Skin involvement
Search for psoriasis
Scaly plaque - pit, onycholysis, - reactive
Keratoderma blenorrhagica
Psoriaisis - DIP
Ank spond epidemiology and symptoms
Inflamm back pain and stiffness. - worse in morn, wake up at night with pain , lasts >30 min stiffness
Young adults average age 27 years
Systemic symptoms - fatigue and weight loss
Can get peripheral synovitis = hip and shoulder
Chest wall pain - costovertebal, costchondral pain can also get reduced chest expansion because of this
Uveitis, enthesitis, aortitis, plum fibrosis - hypoventilation due to defect in the chest wall
How to diagnose ank spond - criteria
Inflamm back pain >3 months +1 more - buttock pain -sacroilitis XR - enterosopathy - +ve FHx - IBD - urethritis, cervicitis, diarrhoea NEW YORK CRITERIA 1) limited lumbar motion 2) low back pain 3 months - improved by exercise not relieved by rest 3) dec chest expansion 4) bilateral 2-4 grade S1 x ray 5) unilateral 3-4 grade SI XR
What is the Schoenberg manoeuvre
Find the PSIS draw a line 10 cm above and 5 cm below
Flex the lumbar spine, knees and hips straight, if the distance inc by 5 cm or above this is normal if it doesn’t abnormal
Shows spine flexibility is impaired
SI grades on XR
0 - normal
1 - suspicious
2 -minimal change with small areas of erosion/ sclerosis with normal SI width
3-definite mod - advanced SI+erosion, sclerosis, and partial ankylosis
4- total ankylosis of SI
Signs of spondyloarthropathy on XR
Squaring of the vertebrae
Bamboo spine
- gradual interosseous bridging and joint ossification
- syndesmophytes = join 1 vertebra to the body of the next - bamboo spine
Can also get - ligament ossification
Ix ank spond
Inflamm marker CRP, ESR inc FBC normocytic anaemia - chronic disease Elevated IgA Inc ALK HLA B27 Plain x ray Isotope bone can MRI CT US - enthesitis
What imaging is used as early markers may not be picked up with the other imaging
MRI
XR
Mx ank spond
Con - physio,OT, hydrotherapy,, education,support groups - NASS
Med - Analgesia, NSAIDS
NO ROLE FOR DMARDS
BIOLIGICS
What is used to asses the severity of the ank spond
BASDAI
Bath ank spond disease activity index
0-10 score based on the answers provided by the patient
What is psoriatic arthritis
Chronic inflamm arthritis found in approx 5% of psoriasis patients
50% have spondyloarthropathy, enthesis, axial disease
What are the patterns of psoriatic arthritis
- predominant spondylitis
- predominant DIP
- oligoarthrits asymmetrical large joint
- predominant plyarticular symmetrical large and small - mimic RA
- Arthritis mutilans
Clinical characteristics of psoriatic arthritis
Inflam arth DIP Asymmetrical Dactylitis Nail - pitting, onycholysis No rhem factor, no nodules Erosive arthritis without osteopenia - rule out RA Sacroilitis - asymptomatic Syndesmophytes Paravertenral assification Enthesopathy
Classic XR findings - psoriatic arthritis
Erosion, - penicil in a cup
