PART I

Question 1

major indication of ankylosing spondylitis?

Answer 1

low back pain, misdiagnosed as mechanical back pain

Question 2

is AS pain lasting greater or less than 30 minutes?

Answer 2

greater than, b/c its inflammatory

Question 3

AS can be peripheral or axial involvement?

Answer 3

both

Question 4

spine and SI joint can progress to loss of spinal mobility, T/F?

Answer 4

true

Question 5

what is the progression of axial AS?

Answer 5

from non radiographic axial SpA to ankylosing spondylitis

Question 6

what is invoice in the spondyloarthropathies?

Answer 6

spine
SI joint
oligoarticular peripheral arthritis

Question 7

what is the gene indicated?

sites of inflammation?

Answer 7

HLA-B27

synovium; enthuses can develop (achilles tendon, IIiotibial band, common extensor elbow)

Question 8

psoriatic arthritis

enteropathic arthrits

spondyloarthritides

reactive arthritis

ankylosing
spondylitis

undifferentiated SpA

Answer 8

spectrum of spondyloarthropathies

Question 9

common extra articular manifestations of AXSPA include?

Answer 9

uveitis, PSO, IBD

Question 10

reactive arthritis can present as?

Answer 10

conjunctivitis
circinate balanitis
enthesopathy
keratoderma blenorrhagicum
dactylitis

Question 11

average delay in diagnosis of AS?

Answer 11

8.8 years, worse clinical outcomes

Question 12

this is both a prognostic and pathogenic factor?

Answer 12

smoking

Question 13

how is AXSPA associated with reduced quality of life and high costs?

Answer 13

functional disability

pain

negative impact on employment and ability to work

high costs due to functional disability and disease management

Question 14

what are the peripheral manifestations?

Answer 14

enthesitis
peripheral arthritis
dactylitis

Question 15

how does AS present as an extra articular disease?

Answer 15

acute anterior uveitis

cardiovascular

• aortic regurgitation
• ascending aortitis
• conduction abnormalities
• pericarditis
• cardiomegaly
• increased CVA

pulmonary
-apical fibrosis

GI
-enteric mucosal lesions

renal
-IgA nephropathy

Question 16

tx options?

Answer 16

controlling pain, morning stiffness, fatigue, extra articular disease

preserving fxn

• spinal mobility
• ADL

minimizing structural damage
-osteoproliferative and ankylosis, osteodestruction

minimizing socioeconomic impact
-sick leave and disability

Question 17

best tx options for SPA and what for?

Answer 17

Anti TNF and IL-17, then NSAIDS

peripheral arthritis
axial disease
enthesitis
dactylitis
skin disease*

*NSAIDs do not

DMARDs only for peripheral arthritis and skin disease

Question 18

over time, how is AS treated?

Answer 18

patient education with NSAIDs

then, exercise for axial involvement (TNF and IL 17 antagonist) and peripheral joint involvement (sulfasalazine and corticosteroid injection)

Question 19

major summary of AS?

Answer 19

prolonged morning back stiffness

chronic enthesitis

appear bwt ages of 20-40