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NYCC Bone & Joint > (2,3) Ankylosing & Enteropathic Arthritis > Flashcards

(2,3) Ankylosing & Enteropathic Arthritis Flashcards

(52 cards)

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1
Q

What are the 4 inflammatory spondyloarthropathies?

A
  • ankylosing spondylitis
  • enteropathic arthritis
  • psoriatic arthritis
  • reactive arthritis
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2
Q

What is the most common inflammatory spondyloarthropathy?

A

ankylosing spondylitis

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3
Q

Which inflammatory spondyloarthropathy(ies) have a bilateral symmetric pattern of sacroiliitis?

A

ankylosing spondylitis
enteropathic spondylitis

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4
Q

Which inflammatory spondyloarthropathy(ies) can have a bilateral asymmetric OR unilateral pattern of sacroiliitis?

A

psoriatic arthritis
reactive arthritis

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5
Q

What is the only difference between ankylosing spondylitis and enteropathic arthritis?

A

presence of enterophathic disease
(identical in the spine)

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6
Q

Which seronegative spondyloarthropathy favours the upper extremity?

A

psoriatic arthritis

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7
Q

Which seronegative spondyloarthropathy favours the lower extremity?

A

reactive arthritis

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8
Q

What areas of the spine do the seronegative spondyloarthropathies prefer?

A
  • SI
  • thoracolumbar junction
  • may affect c/s
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9
Q

What is the defining characteristic of seronegative spondyloarthropathies?

A

sacroiliitis

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10
Q

What are the relevant lab findings for seronegative spondyloarthropathies?

A
  • RF negative
  • HLA-B27 positive
  • ^ESR & CRP
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11
Q

Inflammation of tendons and ligamentous attachments due to seronegative spondyloarthropathies causes _____ in the spine, and _____ outside of the spine/SI joints

A

syndesmophytes
enthesophytes

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12
Q

Ankylosing spondylitis and enteropathic arthritis cause ____ syndesmophytes

A

marginal

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13
Q

Psoriatic and reactive arthritis cause ____ syndesmophytes

A

non-marginal (AKA parasyndesmophytes)

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14
Q

Ossification due to inflammation where the IVD attaches to endplates is called ____

A

syndesmophytes

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15
Q

As opposed to RA, seronegative spondyloarthropathies like to result in ____ of joints

A

ankylosis (fusion)

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16
Q

Ossification outside of the spine where ligaments attach to bone is called _____

A

enthesophytes

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17
Q

Non-marginal syndesmophytes are also called ____

A

parasyndesmophytes

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18
Q

What are 2 other names for Ankylosing spondylitis (AS) that you should not use?

A
  • Rheumatoid spondylitis
  • Marie-Strumpell Disease
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19
Q

What is the age of onset for AS and Enteropathic arthritis (EA)?

A

15-35 yrs

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20
Q

Which gender is primarily affected by AS and EA?

A

Male > Female (10:1)

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21
Q

What is usually the first symptom of AS?

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A

Low back/SI pain

22
Q

What is a rhizomelic arthropathy?

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A

arthropathy affecting the root of a limb (proximal)

23
Q

AS and EA are considered _____ arthropathies, most commonly affecting the hips and shoulders

24
Q

What are the relevant lab findings of AS and EA?

Study These Flashcards
A
  • RF negative
  • mild anemia
  • ^ESR/CRP
  • HLA-B27 positive (90% AS, 10-12% EA)
25
What pattern of sacroiliitis is seen in AS and EA?
bilateral symmetric sacroiliitis to fusion
26
In AS and EA, an exacerbation-remission pattern is evidenced by alternating of what 2 radiographic signs of vertebral involvement?
Exacerbation = erosions (Romanus lesions) Remission = Shiny corner sign
27
What is the first radiographic sign of vertebral involvement in AS and EA?
Erosions (Romanus lesion): inflammatory change (loss of bone) at corners of vertebrae where annulus inserts via Sharpey fibers
28
What are the radiographic signs of AS and EA in the **spine**?
- Romanus lesions (erosions) - shiny corner sign (sclerosis) - squaring of bodies --> barrel shaped bodies - marginal syndesmophytes - bamboo spine (poker spine) - railroad/dagger/trolly track signs - carrot-stick Fx --> Anderson lesion - atlantoaxial instability (^ADI) - ankylosis
29
Inflammation at the corners of vertebral bodies creating erosive change is called ____
Romanus lesions
30
Sclerosis that occurs at the corners of vertebral bodies due to AS and EA is called ____
shiny corner sign
31
In AS and EA over time, repeated exacerbation/remission patterns cause the normal anterior and posterior concavity of vertebral bodies to become more vertical, which is called _____
squaring of vertebral bodies
32
In AS and EA over time, repeated exacerbation/remission patterns cause the normal anterior and posterior concavity of vertebral bodies to become more convex, which is called _____
barrel shaped bodies (later sign after squaring, less common)
33
Delicate egg shell ossifications from vertebral corner to corner along outer annular fibers are called ____
marginal syndesmophytes
34
Disc and vertebrae fusion create a radiographic sign on AP view called ____
bamboo spine
35
Facet joint involvement in AS and EA is seen radiographically as ____
railroad sign (inflammation resulting in fusion of facets)
36
Ossification of the interspinous ligament in the lumbar region is seen radiographically as one long piece of bone on AP view called ____
dagger sign (never call dagger sign on T-spine or Ferguson views)
37
What is trolley track sign?
rail road sign + dagger sign (radiographic characteristic of AS & EA)
38
What is a carrot-stick fracture?
Fx through ankylosed spine
39
What is the stability of a carrot-stick fracture?
unstable
40
What is an Anderson lesion?
ankylosed spine can lose pain sensation, causing pt to be unaware of **Fx which then heals non-union**
41
What are the common clinical features of AS and EA?
- stiff, achy spine (synovial inflammation) - exacerbation/remission pattern - decreased spinal & rhizomelic jt ROM - hyperkyphosis & fusion (later stage) - bilateral
42
What are the radiographic characteristics of AS and EA in the **SI joints** (sacroilitis)?
- bilateral symmetric - erosion & sclerosis of SI margins (**rosary bead appearance**) - loss of cortical definition - ghost joints (complete ankylosis, jt not visible)
43
What radiographic view should be used in a patient with LBP and suspected seronegative spondyloarthropathy?
Ferguson view (25 deg tilt up at L/S junction)
44
Your patient has elevated ESR & CRP, mild anemia, negative Rheumatoid factor, and positive HLA-B27, but SI joints on appear normal radiographically. What follow-up imaging would you order?
MRI
45
What are the radiographic characteristics of AS and EA in the appendicular skeleton?
- enthesophytes (plantarcalcaneal, achilles) - ankylosis
46
How do marginal syndesmophytes compare to non-marginal syndesmophytes?
Marginal = corner-to-corner, egg-shell thin Non-marginal = past corners (not in mid-portion), thicker
47
What are the most common pre-existing enteropathic conditions of EA?
- Ulcerative colitis - Crohn disease - Whipple disease (gluten intol.) (often misdiagnosed as IBS first)
48
What should your next step be if your patient presents with back pain and a history of inflammatory bowel disease?
radiographs (EA until proven otherwise)
49
What are the less common pre-existing enteropathic conditions of EA?
GI infections: - salmonella (chicken) - shigella (fecal) - yersinia
50
How does the timing of enteropathic symptoms correlate with arthritic symptoms of EA?
- diarrhea precedes arthritic outbreak - ^gut Sx before & during arthritis attack
51
What are the clinical manifestations specific to EA?
same SSx as AS, plus enteropathic Sx (diarrhea, gut Sx)
52
If you discover your patient has irritable bowel symptoms, where would you refer them to?
gastroenterology

NYCC Bone & Joint (71 decks)

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