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Flashcards in Spondyloarthropathies Deck (40)
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1
Q

define spondyloarthropathy

A

Family of inflammatory arthritides characterized by involvement of both the spine and joints, principally in genetically predisposed individuals

2
Q

what is the genetically predisposed individuals buzz word in spondyloarthropathy?

A

HLA B27

3
Q

name the spondyloarthritis disease subgroups

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

4
Q

what word defines inflammation of entire digit?

A

dactylics - sausage fingers

5
Q

where is the main area of involvement in spondyloarthropathies?

A

sacroiliac and spinal

6
Q

define Enthesitis

A

inflammation at insertion of tendons into bones eg Achilles tendinitis, plantar fasciitis

7
Q

what is the hallmark in ankylosing spondylitis?

A

sacroiliac joint involvement (sacroiliitis)

8
Q

what sex is ankylosing spondylitis more common in?

A

male

3-5:1

9
Q

worsened by activity, typically worst at end of day, better with rest

mechanical or inflammatory?

A

mechanical

10
Q

worse with rest, better with activity, significant early morning stiffness (>30 minutes)

mechanical or inflammatory?

A

inflammatory

11
Q

name the shared extra-articular features in spondyloarthritis

A

Ocular inflammation (Anterior uveitis, conjuntivitis)
Mucocutaneous lesions
Rare Aortic incompetence or heart block
No rheumatoid nodules

12
Q

what does anklosing spondylitis primarily affect?

A

spine

13
Q

when does ankylosing spondylitis usually present?

A

late adolescence or early adulthood

14
Q

name some points in the modified New York criteria for diagnosis of analysing spondylitis

A
  1. Limited lumbar motion
  2. Lower back pain for 3 months
    Improved with exercise
    Not relieved by rest
  3. Reduced chest expansion
  4. Bilateral, Grade 2 to 4, sacroiliitis on X ray
  5. Unilateral, Grade 3 to 4, sacroiliitis on X ray

Definite AS if Criterion 4 or 5, plus 1,2 or 3

15
Q

what are the clinical features seen in AS?

A
back pain
enthesitis
peripheral arthritis
uveitis
CVS involvement 
pulmonary involvement
16
Q

what letter is important in AS?

A

A!

Axial Arthritis
Anterior Uveitis
Aortic Regurgitation
Apical fibrosis
Amyloidosis/ IgA Nephropathy
Achilles tendinitis
PlAntar Fasciitis
17
Q

what are the 3 things you should cover in an examination in someone with suspected AS?

A

Tragus/occiput to wall

Chest expansion

Modified Schober test

18
Q

what 2 things are you looking for in the bloods of someone with suspected AS?

A
Inflammatory parameters (ESR, CRP, PV) 
HLA B27
19
Q

what is seen on x ray in someone with AS?

A

Sacroiliitis
Syndesmophytes
“Bamboo” spine
shiny corners

20
Q

what is the treatment in AS?

A
physiotherapy
occupational health
NSAID
MTX
anti TNF
Secukinumab
21
Q

define psoriatic arthritis

A

Inflammatory arthritis associated with psoriasis

No Rheumatoid nodules
Rheumatoid factor negative

22
Q

what are the clinical features seen in PA?

A
inflammatory arthritis
sacroiliitis
nail involvement
dactylitis
enthesitis
eye disease
23
Q

how many clinical subgroups of psoriatic arthritis are there?

A

5

24
Q

what 2 things are you looking for in the bloods of someone with suspected PA?

A

Inflammatory parameters (raised)

Negative RF

25
Q

what is seen n x ray of someone with suspected PA?

A

Marginal erosions and “whiskering”
“Pencil in cup” deformity
Osteolysis
Enthesitis

26
Q

what is the treatment in PA?

A
NSAIDs
Corticosteroids/joint injections
Disease Modifying Drugs 
Anti TNF in severe disease
Secukinumab (anti-IL17)
27
Q

what are the most common infections responsible for reactive arthritis?

A

chlamydia
salmonella
shigella
yersinia

28
Q

when do you get symptoms in reactive arthritis?

A

4 weeks post infection

29
Q

what is Reiter’s syndrome?

A

a form of reactive arthritis

30
Q

outline the triad in Reiter’s Syndrome

A

Urethritis
Conjuntivitis/Uveitis/Iritis
Arthritis

31
Q

what are the clinical features of reactive arthritis?

A
general
asymmetrical arthritis
enthesitis
mucocutaneous lesions
ocular lesions
visceral manifesations
32
Q

what is the treatment in reactive arthritis?

A

NSAIDS
antibiotics
DMARDs

33
Q

what is enteropathic arthiritis associated with?

A

Crohn’s
UC
IBD

34
Q

what are the clinical symptoms in enteropathic arthiritis?

A

GI problems
weight loss
eye and mouth involvement

35
Q

what are the investigations in enteropathic arthiritis?

A

endoscopy
joint aspirate
x ray showing sacroiliitis

36
Q

what do you want to avoid in the treatment of enteropathic arthritis?

A

NSAIDs - exacerbate IBD

37
Q

what is the treatment of enteropathic arthritis?

A

steroids
MTX
anti-TNF
secukinumab

38
Q

things to remember in spondyloarthropathies…

A

Associated with HLA B27

Affect Spine/Joints

Enthesitis

Extra articular features

39
Q

what is the main treatment in AS?

A

NSAID
MTX
Anti TNF
Secukinumab

40
Q

what is ben porters reply when you ask him to lend you £5?

A

sorry im a little short