Flashcards in Exam 1 -- Rheumatology #3 Deck (86):
Of the spondyloarthropathy conditions, which is most common?
All of the spondyloarthropathy conditions are RF ___________ (negative/positive).
True or false: the spondyloarthropathy condtions are associated with HLA B27, just like RA.
Trick question: they ARE associated with HLA B27, but RA is not.
The spondyloarthropathy conditions typically present _____________ (bilaterally/unilaterally).
The spondyloarthropathy conditions typically involve the _____________ (axial/peripheral) joints.
True or false: the spondyloarthropathy condtions involve inflammation of the synovial fluid
False; they involve inflammation of tendons and/or ligaments
How many patients with ankylosing spondylitis test HLA B27 (+)?
How many patients with spondyloarthropathy conditions other than ankylosing spondylitis test HLA B27 (+)?
How many patients without spondyloarthropathy conditions test HLA B27 (+)?
HLA B27 is present in what percentage of anterior uveitis cases?
True or false: about half of patients with recurrent uveitis have some spondyloarthropathy condition
HLA B27 is most common in what demographic?
HLA B27 is "best at fighting" what diseases?
HIV, hepatitis C, influenza
HLA B27 is "poor at fighting" what diseases?
Chlamydia, gonorrhea, salmonella
What part of the skeleton is most affected in ankylosing spondylitis?
Spine, especially lower back
Inflammation in ankylosing spondylitis generally occurs in which joints?
What parts of the body experience pain in ankylosing spondylitis?
Which gender has a higher prevalence of ankylosing spondylitis?
What is the typical age of onset for ankylosing spondylitis?
Late teens to early 30s
True or false: ankylosing spondylitis is more common among Caucasians
Fill in the blank: pain in ankylosing spondylitis improves with ________(movement/rest) and is worse with (movement/rest).
What is another term for the bending of the spine that occurs in ankylosing spondylitis?
True or false: kyphosis can lead to heart and lung problems
True; kyphosis is a bending of the spine due to ankylosing spondylitis, which compresses the heart and lungs
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the foot?
Achilles tendonitis; also, skin lesions (red papules on soles)
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the hand?
Dactylitis in 6% of AS patients; also, skin lesions (red papules on palms)
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the eyes?
Uveitis in 20-40% of AS patients
What percentage of ankylosing spondylitis patients have inflammatory bowel disease?
What tests can be performed to screen for ankylosing spondylitis?
ESR, CRP, HLA B 27
An x-ray of the spine of a patient with ankylosing spondylitis may show what?
Fused vertebrae (bamboo spine)
The first signs of ankylosing spondylitis (as seen in an x-ray) are seen in the _______ joint of 95% of AS patients.
Briefly describe the Schober test for ankylosing spondylitis
Draw a line 10 cm above the iliac crest and one 5 cm below; have patient bend over, and distance between these two lines should be greater than 21 cm in a normal person
Briefly describe the chest expansion test for ankylosing spondylitis
Measure the chest circumference of the patient when they breathe in and when they breathe out; abnormal measurement is less than 2.5 cm difference
Briefly describe the wall touch test for ankylosing spondylitis
Have patient stand with their back up against the wall and try to move their head back to touch the wall too
What class of medication is effective in treating most patients with AS? Which drug in this class is usually used? What other class of drug could be used?
NSAIDs (effective in 70%); indomethacin; TNF-alpha blockers
True or false: hip replacement surgery is an option for patients with AS
Psoriatic arthritis is characterized by what type of lesion?
White, scaley skin rashes
True or false: pain in psoriatic arthritis is alleviated with activity
Does psoriatic arthritis feature more or less joint pain than RA?
What percentage of patients with psoriasis will develop psoriatic arthritis?
What is the typical age of onset for psoriatic arthritis?
Which gender has a higher prevalence of psoriatic arthritis?
Neither; prevalence is equal between the genders
Does the arthritic portion of psoriatic arthritis present unilaterally or bilaterally?
What two symptoms are the most prevalent in psoriatic arthritis? What percentage of patients with PA experience these symptoms?
Nail dystrophy (pitting, separation of nail from bed; 80-90%); dactylitis (50-60%)
What percentage of patients with psoriatic arthritis also get uveitis?
Psoriatic arthritis typically affects which joints?
Distal interphalangeal joints in hand
What medications can be used to treat psoriatic arthritis?
Topical corticosteroids or tacrolimus (for skin lesions), NSAIDs, DMARDs (except methotrexate, hydroxychloroquine, and sulfasalazine), anti TNF agents, and biologics
How does UV phototherapy work for patients with psoriatic arthritis?
An enhancing agent (Psoralen) is ingested. Upon exposure to UV light, this agent helps the body to absorb the UV-A or UV-B light, which is supposed to decrease the inflammatory response
What class of medication should a patient with psoriatic arthritis NOT be prescribed?
Oral steroids (they decrease the response of the skin in healing itself; lesions last longer)
What is the name for a spondyloarthropathy following an infection?
What percentage of all spondyloarthropathies is reactive arthritis?
Which gender has a higher prevalence for reactive arthritis?
Patients with untreated chlamydia infection have what percentage chance of developing reactive arthritis?
Besides chlamydia, what other types of infections are common in patients who then develop reactive arthritis?
Salmonella, Yersinia, Shigella, campylobacter, E. coli
What percentage of patients with reactive arthritis experience complete recovery within 6 months?
True or false: reactive arthritis is most common over age 50
False; it is more common in younger patients
How long after infection can symptoms of reactive arthritis occur?
True or false: reactive arthritis is usually accompanied by acute, asymmetric lower limb arthritis
What mnemonic can help you remember some of the common symptoms of reactive arthritis?
Can't see, can't pee, can't dance with me. (Uveitis, urethritis, lower limb arthritis)
How many patients with reactive arthritis are HLA B 27 (+)? What other tests can be done to test for reactive arthritis?
40-75%; stool sample and testing for chlamydia
How would you treat the underlying infection in reactive arthritis?
Oral antibiotic (azithromycin or doxycycline)
How would you treat the non-infection-related symptoms of reactive arthritis?
Start with NSAIDs, move on to corticosteroids, then to sulfasalazine and methotrexate, then finish with the TNF inhibitors
10-40% of patients with ulcerative colitis or Crohn's disease develop what kind of arthritis?
Which gender has a higher prevalence of enteropathic arthritis?
Neither; prevalence is equal between the genders
What are common symptoms of enteropathic arthritis?
Spondylitis, sacroilitis, stomach pain
What percentage of IBD patients have Type 1 enteropathic arthritis?
How many joints are involved in Type 1 enteropathic arthritis?
6 or less
What percentage of cases of type 1 enteropathic arthritis are self-limiting?
What percentage of IBD patients have Type 2 enteropathic arthritis?
How many joints are involved in Type 2 enteropathic arthritis?
More than 6
True or false: Type 2 enteropathic arthritis is chronic.
Type 1 and Type 2 enteropathic arthritis can be distinguished based on which came first, the arthritis symptoms or the IBD symptoms. List the order for each type.
Type 1: arthritis then IBD; Type 2: IBD then arthritis
How would you treat enteropathic arthritis?
Treat the underlying disease; NSAIDs (though can worsen diarrhea); corticosteroids, sulfasalazine, methotrexate, infliximab is preferred
Whipple's disease is a bacterial infection that might be mistaken for enteropathic arthritis. What part of the GI tract does Whipple's effect?
Small intestine (enteropathic affects the large intestine)
Behcet's disease can cause oral and genital ulcers like what spondyloarthropathy?
What gender and demographic is common for patients with Behcet's disease?
Young men of Middle or Far East descent
What percentage of patients with Behcet's disease experience ocular symptoms?
Polymyositis and dermatomyositis affect which gender more?
What is the main difference between polymyositis and dermatomyositis?
Dermatomyositis involves the skin as well
What is the typical age of onset for polymyositis and dermatomyositis?
What percentage of patients with polymyositis or dermatomyositis are ANA (+)?
The muscle weakness of polymyositis and dermatomyositis is usually in which areas of the body?
Hips and shoulders
What are some symptoms of polymyositis and dermatomyositis?
Muscle weakness, dysphagia, polyarthritis, Raynaud's phenomenon, interstitial lung disease, myocarditis
Polymyositis and dermatomyositis are more common in what ethnicity?
What tests can be performed to screen for polymyositis and dermatomyositis?
Chest x-ray, muscle biopsy, MRI
How would you treat polymyositis or dermatomyositis?
Physical therapy, corticosteroids, DMARDs, biologics, methotrexate