21. Seronegative spondyloarthritides Flashcards Preview

Internal medicine III > 21. Seronegative spondyloarthritides > Flashcards

Flashcards in 21. Seronegative spondyloarthritides Deck (13)
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1
Q

What diseases belong to seronegative spondyloarthropathies?

A
  • Ankylosing spondylitis
  • Reactive arthritis
  • Psoriatic arthritis
  • Arthropathy of IBD
  • Undifferentiated spondyloarthropathies
2
Q

What do seronegative spondyloarthropathies have in common?

A
  • Negative RF
  • Strong association with HLA-B27 antigen
  • Oligoarthritis (asymmetrical)
  • Enthesitis (inflammation at sites of insertion of fascia, ligament, or tendon to bone)
  • Inflammatory arthritis (axial and sacroiliac joints)
  • Extra-articular features (eyes, skin, genitourinary tract)
  • Familial predispositions
3
Q

What are the general features of anykolsing spondylitis?

A
  • Strong association with HLA-B27 (90%)
  • 3x more common in males
  • Usually presents with family history of it, IBD or psoriasis
  • Bilateral sacroiliitis is a prerequisite for making a diagnosis
  • Characterized by fusion of the spine in an ascending manner (from lumbar to cervical)
  • Slow progressive disease
  • Exacerbation is common
4
Q

What are the clinical features of ankylosing spondylitis?

A
  • Lower back pain and stiffness
    • Secondary to sacroiliitis
    • Limited motion of lumbar spine
  • Neck pain and limited motion
  • Enthesitis
    • Inflammation at tendinous insertion into the bon (Achilles tendon and supraspinatus)
  • Weak spine and prone to fractures
    • Severe spinal cord injury may occure
  • Chest pain
    • Due to thoracic spine involvement
  • Constitutional symptoms
  • Extra-articular manifestations:
    • Acute anterior uveitis (most common)
    • Cardiac, renal, pulmonary and CNS
5
Q

How do we diagnose ankylosing spondylitis?

A
  • Imaging:
    • Lumbar spine and pelvis (MRI, CT) reveal sacroiliitis (“bamboo spine”)
  • Elevated ESR
6
Q

What is the treatment of ankylosing spondylitis?

A
  • NSAIDs
  • Anti-TNF medication
  • Surgery sometimes
7
Q

What is reactive arthritis?

A
  • It is an asymmetrical inflammatory oligoarthritis of lower extremities
  • Reiter’s syndrome is an example of it
    • But most patients don’t have the classical findings with it so now it’s called reactive arthritis
8
Q

What is the etiology of reactive arthritis?

A
  • Previous infectious process that is remote to the site of arthiritis
  • HLA-B27 positive (usually)
9
Q

What is undifferentiated spondyloarthropathy?

A

Features of reactive arthritis, but there is no evidence of previous infections

10
Q

What are the clinical features of reactive arthritis?

A
  • Look for evidence of a previous infection 1-4 weeks prior to symptoms
  • Aymmetric arthritis
    • New joints may be involved sequentially over days
11
Q

How do we diagnose for reactive arthritis?

A

Send synovial fluid for analysis to rule out infection or crystals

12
Q

How do we treat reactive arthritis?

A
  • NSAIDs are the 1st line therapy
    • If no response, use sulfasalazine
13
Q

What is psoriatic arthritis?

A
  • Develops in < 10% of patients with psoriasis
  • Gradual onset
  • Usually asymmetric and polyarticular
  • Upper extremities most often are involves
  • Small joints are more commonly affected than large joints

Treatment:

  • NSAIDs