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chronic arthritis > Ch. 21 - Arthropathies of IBD > Flashcards

Ch. 21 - Arthropathies of IBD Flashcards

1
Q

2 patterns of joint inflammation of IBD

A

1) Peripheral polyarthritis

2) Involvement of SI joints and axial skeleton

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2
Q

T/F: In IBD, arthralgia is more common than arthritis

A

T

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3
Q

Ratio of boys to girls in those with and without peripheral arthritis in IBD

A

Almost identical

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4
Q

T/F There is a pronounced tendency for familial clustering in UC and CD

A

T

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5
Q

T/F SI arthritis is more common in patients with IBD compared to the general population

A

T, >30x

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6
Q

Peripheral polyarthritis vs SI arthritis: Associated with HLA-B27

A

SI arthritis

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7
Q

Most frequently affected joint in IBD arthritis

A

Lower extremity joints, esp ankles and knees

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8
Q

Usual duration of peripheral arthritis in IBD

A

1-2 weeks, and tend to recur

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9
Q

Arthritis of IBD may last for months especially if

A

GI disease is active

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10
Q

T/F If joint inflammation in IBD lasts for months, permanent functional loss or joint damage ensues

A

F, permanent functional loss or joint damage is unusual

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11
Q

SI arthritis vs peripheral arthritis: May reflect activity and course of GI inflammation

A

Peripheral arthritis

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12
Q

SI arthritis vs peripheral arthritis: More common in IBD arthritis

A

Peripheral arthritis

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13
Q

T/F IBD arthritis may be accompanied by enthesitis

A

T, SI arthritis in particular

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14
Q

Very painful MSK complication of IBD that occurs symmetrically in the limbs, rather than the joints, and may be accompanied by increased sweating and purplish discoloration of the affected limbs

A

Hypertrophic osteoarthropathy

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15
Q

T/F Osteoporosis can take place in patients with IBD arthritis even without steroid use

A

T

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16
Q

Severe form of IBD that appears to be an autoinflammatory, and is associated with treatment-resistant colitis, perianal fistula formation, folliculitis, and arthritis

A

Infantile-onset IBD

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17
Q

Infantile onset IBD results from

A

Mutations in IL-10 or its receptor

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18
Q

Treatment for infantile-onset IBD that may be curative

A

Hematopoietic stem cell transplantation early in the course of disease

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19
Q

UC vs CD: Bloody diarrhea

A

UC

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20
Q

Perianal skin tags and fistulae

A

CD

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21
Q

T/F In IBD arthritis, GI symptoms usually precede joint disease by months or years

A

T

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22
Q

T/F: In IBD arthritis, joint symptoms may precede GI symptoms or intestinal disease

A

T

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23
Q

When arthritis precedes GI symptoms in IBD, arthritis resembles what chronic arthritides

A

JIA, JAS, or seronegative enthesopathy and arthropathy syndrome

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24
Q

T/F: Mucocutaneous manifestations of IBD are less common in patients who have arthritis compared to those without arthritis

A

F, more common especially in those with peripheral arthritis

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25
Q

T/F: There is a higher frequency of arthritis in children with extensive, compared to segmental, bowel disease

A

T

26
Q

T/F: Patients with IBD arthritis usually have active gut disease

A

T

27
Q

Erythema nodosum (nodular panniculitis) in IBD occur most commonly in what area

A

Subcutaneous fat of the pretibial region

28
Q

Lesions of IBD that are erythematous, painful, slightly elevated, 1-2 cm in diameter, appear in groups and reappear sequentially in new areas after several days

A

Erythema nodosum

29
Q

T/F: IBD erythema nodosum is more likely associated with SI joint involvement

A

F, Peripheral arthritis of short duration and involving a few joints

30
Q

IBD skin lesion that begins as a pustule that breaks down and rapidly enlarges to forma chronic, painful, deep undermined ulcer with a red, raised border

A

Pyoderma gangrenosum

31
Q

Lesions of IBD that if recurrent and precedes intestinal symptoms, may lead to a misdiagnosis of Behcet’s

A

Painful oral ulcerations seen particularly in CD

32
Q

T/F: IBD vasculitis can affect both small and large vessels

A

T

33
Q

Uveitis in IBD vs Spondyloarthritis: More frequent HLA-B27 positivity

A

Spondyloarthritis

34
Q

Uveitis in IBD vs Spondyloarthritis: More common episcleritis, scleritis, and glaucoma

A

IBD

35
Q

Usual characteristics of uveitis in IBD: Location, onset, duration, symptom

A

Bilateral, posterior, insidious onset, chronic duration, asymptomatic

36
Q

RF in IBD arthritis

A

Negative

37
Q

ANA in IBD arthritis

A

Negative

38
Q

Antibodies that are frequently present in the sera of children with IBD

A

pANCA and ASCA

39
Q

UC vs CD: ANCA is more common

A

UC

40
Q

T/F: Vasculitis is more common in IBD patients with positive ANCA

A

F

41
Q

WBC range in synovial fluid of adults

A

5000-15000/mm3 or 5-15x10^9/L

42
Q

Predominant cell type in the synovial fluid of patients with IBD arthritis

A

Neutrophils

43
Q

T/F: Protein, glucose, and complement levels in synovial fluid of patients with IBD arthritis are low

A

F, normal

44
Q

T/F: SI arthritis of IBD is distinguishable from that associated with juvenile AS on radiograph

A

F

45
Q

Successful management of peripheral arthritis in IBD generally depends on effective treatment of GI disease

A

T

46
Q

Successful management of HLA-B27-associated spondylitis in IBD generally depends on effective treatment of GI disease

A

F, this is more likely independent of the GI activity

47
Q

T/F: Colectomy in UC may be followed by a striking remission in peripheral joint symptoms

A

T

48
Q

Treatment for IBD peripheral arthritis that can exacerbate disease

A

NSAIDs

49
Q

NSAID alternative when NSAID exacerbates IBD

A

Selective COX-2 inhibitor

50
Q

Best management for arthropathy of IBD

A

Early sulfasalazine or glucocorticoids

51
Q

Why are sulfasalazine or glucocorticoids considered best management for IBD arthropathy

A

Beneficial effect on GI inflammation

52
Q

Treatment for persistent IBD arthritis in 1 or 2 joints

A

Intraarticular glucocorticoids

53
Q

Use of this predominantly topical steroid in CD may result in remission of joint symptoms

A

Oral budesonide

54
Q

Treatment for IBD arthropathy that can result in improvement of both GI symptoms and arthritis

A

Sulfasalazine, glucocorticoids, MTX, anti-TNF particularly infliximab

55
Q

Treatment for IBD arthropathy that may be used for patients who fail infliximab therapy

A

Adalimumab

56
Q

Patients with these chronic arthritides may have an increased risk for developing IBD

A

ERA, PsA, extended oligoarticular arthritis

57
Q

Initial drug of choice for HLA-B27 associated spondylitis of IBD

A

Sulfasalazine at 30-50mkday, max 2.5g/day

58
Q

Treatment options for patients with HLA-B27 associated spondylitis of IBD who fail initial treatment with sulfasalazine

A

MTX and anti-TNF agents

59
Q

Treatment for vasculitis associated with IBD

A

Systemic glucocorticoids

60
Q

Treatment options for IBD uveitis

A

Topical glucocorticoids, more immunosuppression with MTX and anti-TNF may be necessary

61
Q

Most important determinant of overall prognosis in the child with IBD and arthritis

A

Outcome of GI disease

62
Q

T/F: Permanent changes in the spine and hips of children with IBD arthritis with axial disease are frequent

A

T

chronic arthritis (3 decks)

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