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ICM Exam 2- Rheumatology > Seronegative Spondyloarthropathies > Flashcards

Seronegative Spondyloarthropathies Flashcards

1
Q

HLA associated with SNSA

A

HLA B27 (on chromosome 6)

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2
Q

__% of AS patients have B27

A

90%

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3
Q

Reactive arthritis =

A

bacterial triggered arthritis

(following enteric or venereal infection)

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4
Q

Primary site of SNSA is ___

A

Enthesis

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5
Q

Enthesopathic change is characterized by

A

fibrosis and ossification (and formation of bone spurs)

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6
Q

SNSA has prediliction for ____

A

Spine

(sacroiliitis, spondylitis)

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7
Q

SNSA are usually __-articular

A

oligo

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8
Q

______ are usually affected by SNSA

A

young men

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9
Q

Epidemiology of AS (gender and race)

A

male to female = 3 to 1

white more common

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10
Q

Criteria for AS

A

4/5 on ASAS

  1. Onset before 40
  2. Insidious
  3. Improved with excercise
  4. Not improved with rest
  5. Pain at night (improved by moving)
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11
Q

Systemic featires of AS

A

Fever, weight loss, fatigue

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12
Q

Characteristic features of AS

A

Sacroilic edema, obliteration

Bamboo spine

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13
Q

Exam for AS includes _____

Specifically?

A

measurement of spine

Schober test = midpoint between Posterior iliac spines, measure distance changed upon bending over

Chest expansion + Occiput-to-wall distance

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14
Q

Main extraarticular manifestation of AS?

Others?

A

Prostatitis

Others =

  1. Iritis/Conjunctivitis
  2. Upper lobe pulmonary fibrosis (late manifestation)
  3. Amyloidosis
  4. Cauda equina
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15
Q

Ddx for AS

A

OA, RS, PA

Mechanical pain

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16
Q

Most helpful modality for SI joint exam

Other special studies?

A

Pelvic Xray

  • MRI possibly
  • HLA-B27 is NOT favored but may assist diagnosis
17
Q

Treatment for AS

A
  1. Flexibility and stretching
  2. NSAIDs
  3. Sulfasalazine (more effective for peripheral arthritis)
  4. TNF blockers
18
Q

Reiters presentation

A

Prostatitis/cervicitis

Conjunctivitis, pain and erythema

Arthritis occurs LAST

19
Q

RS affects what joints

A

Large joint, LE

(Pauciarticular)

May have digit swelling - dactylitis

20
Q

RS similar to AS in that it may result in…

A
  • bone spurs, enthesopathy
  • low back pain, sacroiliitis
21
Q

Epidemic vs Endemic RS

A

Epidemic = enteric

Endemic = postvenereal

22
Q

B27 association rate for RS

A

80%

23
Q

Late manifestations of RS

A

Progressive iridocyclitis

Cardiac palp

CNS stuff

24
Q

Diagnosis of RS includes….

A

arthritis with one non-articular feature

25
Q

Diagnosis for RS Criteria for _____

A

Peripheral Spondylitis

  • Arthritis or Enthesitis or Dactylitis with…*
  • one of the classical non-articular features of RS, Reactive Arthritis, or enteric arthritis

OR

  • with 2 other arthritis/spondylitis findings without the extraarticular stuff
26
Q

Special studies - RS

A
  1. Joint aspiration
  2. Genital/oral cultures for STD
  3. AP pelvis film
  4. HLA typing helpful

*ANA and RF should be Negative!

27
Q

RS treatment

A

NSAIDs are mainstay

local injections might help

Immunosuppressives can be used

28
Q

RS remittive drugs

A

sulfasalazine

MTX, gold, AZT

29
Q

Psoriatic arthritis (PA) definition

A

seronegative inflammatory arthropathy with cutaneous psoriasis

30
Q

5 types of arthritis associated with PA

A
  1. DIP
  2. Peripheral asymm. oligarthritis
  3. RA-like symm. polyarthritis
  4. Arthritis mutilans
  5. Sacroiliitis
31
Q

PA gender ratio

A

equal

32
Q

HLA B27 associatio of:

Peripheral Arthritis

Spinal Arthritis

A

PA = 14-24%

SA = 35-100%

33
Q

Cmmon skin change locations in PA

A

Periumbilical area, elbow

Pitting of nails

Intragluteal area

34
Q

Radiological findings in PA

A
  • DIP involvement
  • Phalangeal osteolysis (hallux)
  • Arthritis mutilans
  • Oligarthritis
  • Sacroiliitis
35
Q

PA treatments

A
  1. Occ therapy for hand, physical therapy for large joint/back
  2. NSAID
  3. Remittive agents (MTX, gold, SSZ, AZT, Hydroxychloroquine, TNFa-blockers)
36
Q

Enteropathic Arthritis(es)

A
  1. IBD (Crohns + UC)
  2. Reactive arthritis
  3. Bowel Bypass disease
  4. Whipple’s Disease
37
Q

Whipples disease primarily affects

A

lamina propria of the small bowel

ICM Exam 2- Rheumatology (13 decks)

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