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CT.MS > Seronegative spondyloarthritis > Flashcards

Seronegative spondyloarthritis Flashcards

1
Q

Define enthesis

A

Attachment of ligament, tendon, or joint capsule to bone

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2
Q

What is a key difference between RA and spondyloarthropathies?

A

Inflammation start in the enthesis in spondyloarthropathies

In RA, inflammation starts in the synovium

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3
Q

Ankylos means:

A

stiffening of joint

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4
Q

Spondylo means:

A

vertebrae

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5
Q

Arthro means:

A

joint

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6
Q

Sponyloarthritis:

A
  1. Asymmetric peripheral arthritis
  2. Sacroiliitis
  3. Enthesitis
  4. No RA dz (negative RF< ACPA, subQ nodules)
  5. HLA-B27 associated
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7
Q

Describe the pathophysiology of sponyloarthropathy

A

Genetics + environmental stimuli

  • ->Inflammation of enthesitis+osteoporosis
  • ->ankylosis (bone formation)
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8
Q

What are some presenting CCs of sponyloarthropathies?

A
  1. low back pain starting in the buttocks with insidious onset
  2. Worse in night and early morning
  3. Inflammatory signs (morning stiffness, relief with exercise, better with NSAIDs)
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9
Q

What are extraspinal Sx of spondyloarthropathies?

A
  1. Acute anterior uveitis (30-40%)
  2. Psoriasis
  3. Pulmonary fibrosis
  4. Aortitis/heart block
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10
Q

What physical exam tests would you want to perform?

A 
occiput to wall distance
chest expansion (>5cm)
Schober's
Pelvic compression
FABER
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11
Q

What is a positive schober’s?

A

Measure 10 cm from PSIS. If distance increases by less than 5cm, abnormal

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12
Q

What is a positive FABER test?

A

Pain in contralateral SI joint elicited

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13
Q

What is a syndesmophyte?

A

Bony growth inside a ligament

-Often seen in anterior vertebral margins=”shiny corners”

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14
Q

What radiographic sign is indicative to late sponyloarthritis?

A 
Bamboo spine (ossification of annulus in spine) 
-squaring of vertebrae
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15
Q

What is the age of onset for akylosing spondylitis?

A

16-40 yo

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16
Q

Describe the progression radiographic findings of Spondyloarthritis:

A
  1. Back pain with sacroiliitis seen on MRI
  2. Radiographic sacroiliitis
  3. Syndesmophytes
17
Q

What do patients with ankylosing spondylitis die from?

A

Cardiovascular disease

18
Q

How do you treat AS?

A

NSAIDs have some DMA properties

19
Q

What other drugs can help with the symptoms?

A

Sulfasalazine can help with stiffness
TNF antagonists: help with pain and ROM
Prednisone ONLY helpful for uveitis

20
Q

What is reactive arthritis?

A

STERILE synovitis

-Preceding infection, either GI/GU 2-4 weeks earlier

21
Q

What are the presenting features of reactive arthritis?

A

Can’t see (uveitis)
Can’t pee (urethritis)
Can’t climb a tree (Lower extremity arthritis, may see sacroiliitis)

Also mucocutaneous ulcers

22
Q

What are common infections associated with reactive arthritis?

A
  1. Chlamydia**
  2. Ureaplasma urealyticum
  3. Salmonella/shigella/e coli
23
Q

What are the main differences btw reactive arthritis and ankylosing spondylitis?

A
  1. Less correlated with HLA B27
  2. Asymmetric arthritis is common in RA
  3. SI is Asymmetric
  4. KB/CB lesions instead of psoriasis
  5. Syndesmophytes are bulky and not at margins
24
Q

What is keratoderma blenorrhagica?

A

hard, tender lumps and scaly patches on the soles of the feet

25
Q

What is Circinate Balinitis?

A

rash on the head of the penis

26
Q

How do you treat reactive arthritis?

A

If chlamydia, Abx

  • NSAIDS
  • Sulfasalazine
  • MTX
27
Q

Psoriatic arthritis-how does it present?

A

Preceding skin changes

mild and oligoarticular arthritis usually

28
Q

What is the age of onset for psoriatic arthritis?

A

30-55

29
Q

What is the prevalence of HLA B27 in psoriatic arthritis?

A

25-60%

30
Q

Is the sacroilitis in psoriatic arthritis bilateral or unilateral?

A

unilateral. Only anklylosing spondylitis has symmetric sacroiliitis

31
Q

How can you differentiate psoriatic arthritis from other types?

A

Psoriasis or nail pitting usually.

32
Q

What are the five patterns of inflammatory athritis in psoriatic arthritis?

A
  1. DIP arthritis (often dactylitis)
  2. Asymmetric oligoarthritis
  3. Symmetric polyarthritis
  4. Arthritis mutilans
  5. Spondyloarthrtitis (enthesitis peripherally)
33
Q

What are some radiographic characteristics of psoriatic arthritis?

A 
Erosive arthritis
Pencil-in-cup
arthritis mutilans
bony ankylosis
spurs
non-marginal asymmetric syndesmophytes
asymmetric sacroiliitis
34
Q

How do you treat Psoriatic arthritis?

A

The same: Nsaid/sulfa/methotrexate.

Only diff is that TNF alpha is shown to be more useful

35
Q

What type of arthritis is IBD arthritis?

A

Asymmetric oligo/poly

–However, sacroiliitis is symmetric

36
Q

What skin changes do you see in IBD arthritis?

A

Erythema nodosum

Pyoderma gangrenosum!!!

37
Q

What type of IBD is more common in IBD arthropathy?

A

Crohn’s more than ulcerative colitis

38
Q

How do you treat IBD arthritis?

A

Treat underlying disease

  • sulfasalazine
  • methotrexate
  • Azathioprine/6 mercaptopurine
  • Corticosteroids
  • TNF alpha antagonists
39
Q

Which spondyloarthropathies have the highest HLA B27 frequencies?

A
  1. Ankylosing spondylitis
  2. Enteropathic spondylitis
  3. Reactive arthritis
  4. Psoriatic spondylitis

CT.MS (13 decks)

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