Rad L5: SLE, SCLERODERMA, PA, RS, AS, EA, OCI Flashcards Preview

CHI303:clinical Science And Diagnosis > Rad L5: SLE, SCLERODERMA, PA, RS, AS, EA, OCI > Flashcards

Flashcards in Rad L5: SLE, SCLERODERMA, PA, RS, AS, EA, OCI Deck (13):
1

What is Systemic Lupus Erythematosus (SLE) and what are some clinical features?

  • Connective tissue disorder
  • Chronic disease, variable prognosis
  • May evade diagnosis for years
  • F>M, especially 2nd-4th decade 
  • Malar rash- wolf markings; neck, elbow, hand 
  • Malaise, fever, weight loss, skin rash, polyarthralgia
  • Serious feature is renal involvement –glomerulitis renal failure
  • 90% show articular symptoms –usually hands (reversible deformities) –spinal involvement is uncommon
  • Steroid use >>> osteoporosis, avascular necrosis AVN, spinal fractures, gastric/duodenal ulcers
  • ESR elevated, ANA, anaemia, LE cells

2

What are some clinical features of Scleroderma?

Define

What is affected

Age

M F prevelance

  • Systemic connective tissue disorder
  • Involves skin, lungs, GI, heart, renal, musculoskeletal
  • Radiographic signs after disease is well established
  • Usually affects appendicular skeleton
  • Onset 30-50 yrs F:M, 3:1
  • Skin change stages
    • oedema
    • induration (hardening)
    • atrophy
  • Induration & mouse-like features of face; “hidebound” fingers, hands, feet
  • GI-dysphagia, heartburn
  • CREST: Calcinosis, Raynaud’s phenomenon, Esophageal involvement, Sclerodactyly, Telangiectasia

3

What are some clinical features of Psoriatic Arthritis?

What areas are affected

DDx

age/gender predilection

  • Peripheral joints, SIJs, spine
  • DDX: Reactive Arthritis 
  • 20-50 yrs, no sex predilection 
  • 15% of pts with a psoriatic skin condition develop this arthritide 
  • Arthritis within 5 yrs of skin condition
  • 80% with nail changes develop arthritis in DIPs
  • “Sausage digit”, from tenosynovitis
  • Low back pain, may radiate

4

What do Laboratory tests show for patient with suspected Psoriatic Arthritis?

what % with SI involvement +HLA-B27 

what % with peripheral changes +HLA-B27 









 

  • Labs: ESR up, RF negative
  • 75% with SI involvement have +HLA-B27
  • 30% w/peripheral changes have +HLA-B27

Note: 8%  of normal population have +HLA-B27

5

Describe the pathophysiology of Psoriatic Arthritis

  • Pannus formation, erosion, fibrosis
  • Enthesophyte formation - calcaneus, foot, hand
  • Lack of hypaeremia = normal bone mineralisation adjacent to involved joints 

6

What is the clinical triad presented clinically In Reactive Arthritis?

 

Clinical Triad: urethritis, conjunctivitis, polyarthritis

7

What is the Aetiology of Reactive Arthritis?


Aetiology unknown, but often post infection – STI or dysentery 
 

8

What age/sex is Reactive Arthritis most prevelent in?

  • Almost exclusively in males
  • 18-40 yrs M:F / 50:1 

9

Where does Reactive Arthritis usually occur?

Disease duration

Clinical presentation

Complications

Lab tests

WhereKnee, ankle, foot, shoulder, wrist, L/S 



 

Disease duration: Usually peripheral, self limiting 2-3 months



 

Clinical presentation: “Lovers heel” = pain at achilles

30% have distinctive skin lesions   

Multiple reoccurrences result in joint damage 







 

Complications: Urinary tract obstruction, iritis, corneal ulceration, aortitis 

Lab tests: ESR elevated, 75% +HLA-B27, anemia, RF negative 

10

Define Ankylosing Spondylitis (AS)

M F predelection

  • Chronic inflammatory cond. affecting males, axial skeleton
  • Articular ankylosis, ligament ossification, enthesopathy

11

What are some clinical presentations and what Joints/viscera can be affected in AS?

Secondary diseases

Labs

  • Regional pain,
  • 50% large joints involved (hips, shoulders) 
  • 30% small joints involved 
  • Extraskeletal, eyes, heart, vessels, chest, GI/GU –25% will develop iritis
  • Ulcerative colitis, Crohn’s disease secondary to AS (18% will develop AS (20X normal)
  • Labs: ESR when active, 90% HLA-B27, RF negative

12

Define Enteropathic Arthropathy

Labs

  • Term grouping diseases of GI & articular pathology
  • Ulcerative colitis, Crohn’s disease
  • Axial skeleton identical to AS
  • 10% full clinical picture of AS
  • Labs: 10% HLA-B27, RF negative

13

Osteitis Condensans Ilii

Define

Age/gender prevelance

Labs

DDx

 

  • Isolated SI “arthropathy” with controversial origin
  • Positive ortho with pain, adjust will hurt then quickly resolve 
  • multiparous women 20 - 40 years old, F:M, 9:1
  • Labs: normal,
  • DDX: seronegative arthropathy, DJD