Seronegative Spondyloarthritis Flashcards Preview

SBM IV CT/MS > Seronegative Spondyloarthritis > Flashcards

Flashcards in Seronegative Spondyloarthritis Deck (26):
1

general features of spondyloarthritis

  • spinal and/or peripheral oligoarthritis
  • xray evidence of sacroiliitis
  • enthesis
  • extra-articular features: systemic, ocular, cardiac disease
  • absence of other rheumatic disease
  • familial aggregation
  • assoc w/ HLA B27

2

HLA B27

closely linked w/ seronegative spondyloarthritis (but non-specific)

double edged sword: autoimmunity, but also protective against Hep C and HIV

 

3

pathogeneisis of seronegative spondyloarthritis

genetic predisposition + environmental stimulus --> inflammation (enthesis, bone destruction, new bone formation) --> ankylosis +/- extra-articular disease

4

ankylosing spondylitis: describe....

  • gender
  • age at onset
  • HLA B27
  • arthritis pattern
  • sacroiliitis
  • skin
  • eye
  • syndesmophytes

 

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5

how do you distinguish inflammatory back pain from mechanical back pain?

inflammatory back pain:

  • earlier age of onset
  • lasts more than 3 months
  • morning stiffness >1 hr
  • night pain
  • rest makes it worse, exercise helps
  • alternating buttock pain
  • NSAIDs help (only help 15% of the time for mechanical)

6

new criteria for axial spondylitis - ASAS criteria

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7

clinical features of ankylosing spondylarthritis

inflammatory back pain

extraspinal symptoms: 

  • acute anterior uveitis
  • enthesitis
  • peripheral arthritis (rare)
  • Others! (see picture)

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8

PE for AS

  • occiput to wall distance
  • chest expansion limited
  • Schober's
  • FABER: pain in contralateral SI joint is positive
  • Pelvic compression

9

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shiny corners - lumbar spine osteitis

10

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squaring off of vertebrae

AS

11

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advanced sacroiliitis in AS

12

tx for AS

things that help

  • NSAIDS
  • TNF-alpha: inflammation and progression, uveitis
  • PT!

things that help w/ specific syndrome

  • sulfasalazine - only helps w/ peripheral sx
  • prednisone - just for uveitis

things that don't help

  • DMARDs don't work for axial

13

reactive arthritis - what is it, what causes it?

sterile synovitis precipitated by extra-articular infection

occurs 2-4 weeks after extra-articular infection - infections usually GI or GU

synovial fluid culture neg, abx don't help

 

14

clinical features of reactive arthritis

"can't see, can't pee, can't climb a tree"

  • arthritis in LE, enthesitis, dactylitis
  • conjunctivitis/uveitis
  • mucocutaneous
  • urethritis

15

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keratoderma blennorhagica in reactive arthritis

16

reactive arthritis tx

  • antibiotics: only if caused by chlamydia
  • NSAIDs, prednisone, sulfasalazine, MTX, ?anti-TNF

17

typical presentation of psoriatic arthritis

skin changes first, then arthritis develops

arthritis usually mild and oligoarticular

18

5 patterns of inflammatory arthritis in psoriatic arthritis

  • DIP arthritis
  • asymmetric oligoarthritis
  • symmetric polyarthritis
  • arthritis mutilans
  • spondyloarthritis

19

dx criteria for psoriatic arthritis

  • inflammatory Joint/spine/entheseal disease

​AND

  • >3 of:
    • current or h/o psoriasis/ FH psoriasis
    • psoriatic nail pitting
    • RF neg
    • dactylitis ever
    • xray c/w psoriatic arthritis

20

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arthritis mutilans (telescoping digits) - psoriatic arthritis

21

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dactylitis in psoriatic arthritis

22

radiographic characteristics of psoriatic arthritis

  • erosive arthritis
  • pencil-in-cup deformity
  • arthritis mutilans
  • bony ankylosis
  • spurs/periosteal rxn
  • non-marginal asymmetric syndesmophytes
  • assymetric sacroiliitis

23

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pencil-in-cup deformity in psoriatic arthritis

24

tx for psoriatic arthritis

NSAIDs, DMARDs, TNF-alpha

prednisone tapering causes flare of skin disease - avoid

others in development

25

clinical features of IBD arthropathy

  • Crohns > UC
  • peripheral arthritis - oligoarticular or polyarticular
    • acute = type I; chronic = type II
  • assoc w/ skin disease: pyoderma gangrenosum, E. nodosum
  • spondylitis is not associated

26

tx for IBD arthritis

  • tx underlying disease!!!
  • usually avoid NSAIDs b/c IBD 
  • DMARDS: sulfasalazine, MTX, AZA/6MP, TNF-alpha
  • steroids