Spondyloarthritis flashcards
17 high-yield MRCP Part 1 cards from the Intellect Medicos Rheumatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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The seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic, reactive and enteropathic arthritis) are associated with ______.
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HLA-B27
Why? They share sacroiliitis, asymmetric peripheral arthritis, enthesitis, uveitis and a negative rheumatoid factor.
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A 24-year-old man has 6 months of low back and buttock pain that is worst in the early morning and after rest, and improves with exercise. Which bedside test quantifies his reduced lumbar forward flexion?
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(Modified) Schober's test.
Why? Two marks on the lumbar spine fail to separate normally (less than about 5 cm) on forward flexion in ankylosing spondylitis.
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What is the most common extra-articular manifestation of ankylosing spondylitis?
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Anterior uveitis.
Why? It presents as an acute painful red eye with photophobia and needs same-day ophthalmology review.
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Which heart valve lesion is associated with ankylosing spondylitis?
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Aortic regurgitation (from aortitis and aortic root dilatation).
Why? AS can also cause AV conduction block, from first-degree to complete heart block.
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What is the first-line imaging for suspected axial spondyloarthritis (NICE)?
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Plain X-ray of the sacroiliac joints.
Why? Sacroiliitis is the earliest radiological change. If the X-ray is normal but suspicion stays high, request MRI (inflammatory back pain protocol) to detect early disease.
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Name two late spinal X-ray features of ankylosing spondylitis.
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Syndesmophytes and "bamboo spine" (vertebral fusion), with sclerosis and fusion of the sacroiliac joints.
Why? Ossification of the annulus fibrosus and ligaments bridges adjacent vertebrae.
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What is the first-line drug treatment for ankylosing spondylitis?
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NSAIDs (with a PPI for gastroprotection).
Why? Physiotherapy and regular exercise are the cornerstone; NSAIDs are the first drugs. NICE: if one NSAID at maximum tolerated dose for 2–4 weeks fails, switch to another; biologics follow if NSAIDs fail or are unsuitable.
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A 30-year-old man with ankylosing spondylitis still has active axial symptoms despite physiotherapy and adequate trials of two different NSAIDs. Which drug class is the next step?
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A biologic or targeted synthetic DMARD — usually a TNF inhibitor first (e.g. adalimumab, etanercept); IL-17 inhibitors (e.g. secukinumab) and JAK inhibitors are alternatives.
Why? NICE TA383 allows TNF inhibitors when NSAIDs have not controlled the disease or are unsuitable (BASDAI ≥4 and spinal pain VAS ≥4 cm). BSR 2025 recommends TNF, IL-17 or JAK inhibitors with no class clearly preferred, noting NICE expects a TNF inhibitor first unless unsuitable.
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Secukinumab is a monoclonal antibody against ______.
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IL-17A
Why? It is used in ankylosing spondylitis and psoriatic arthritis (and psoriasis).
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What is the classic X-ray deformity of psoriatic arthritis in the digits?
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"Pencil-in-cup" deformity.
Why? PsA combines erosion with new bone formation, often in the DIP joints.
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Name two nail changes associated with psoriatic arthritis.
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Any two: nail pitting, onycholysis, subungual hyperkeratosis.
Why? Nail disease is strongly linked to DIP joint involvement in PsA.
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What is the first-line conventional DMARD for peripheral psoriatic arthritis?
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Methotrexate.
Why? It treats both skin and joints. Sulfasalazine and leflunomide are alternatives; biologics follow if cDMARDs fail.
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Ustekinumab, used in psoriatic arthritis, blocks ______.
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IL-12 and IL-23
Why? It targets the p40 subunit shared by both cytokines.
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What is the most common infective trigger of reactive arthritis?
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Chlamydia trachomatis (genitourinary).
Why? Gastrointestinal triggers are Salmonella, Shigella and Campylobacter. Arthritis follows the infection by 1–4 weeks and the joint is sterile.
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In reactive arthritis, the scaly lesion on the soles is ______, and the painless penile lesion is circinate balanitis.
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keratoderma blennorrhagicum
Why? These mucocutaneous signs plus urethritis, conjunctivitis and arthritis complete the picture.
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In reactive arthritis, the scaly lesion on the soles is keratoderma blennorrhagicum, and the painless penile lesion is ______.
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circinate balanitis
Why? These mucocutaneous signs plus urethritis, conjunctivitis and arthritis complete the picture.
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What is the first-line treatment of reactive arthritis?
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NSAIDs (plus antibiotics such as doxycycline if Chlamydia is present).
Why? The arthritis is sterile, so treatment is anti-inflammatory; steroid injections are used for severe or persistent joints.