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seronegative spondyloarthropathies Flashcards

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1
Q

what are the seronegative spondyloarthropathies

A

group of -inflammatory joint diseases that share the HLA-B27 antigen and are negative RF and ACPA

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2
Q

5 seronegative spondyloarthropathies

A 
ank spond
axial spond
reactive arthritis
psoriatic arthritis
arthropathy assoc. to IBD
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3
Q

pathogenesis of seronegative spondyloarthropathies

A

inflammatory enthesitis

and synovitis

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4
Q

what type of arthritis are ss

A

asymmetrical

oligoarthritis

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5
Q

extra-articular features of SS 9

A
  • mucosal inflammation
  • conjunctivitis
  • urethritis
  • nail dystrophy
  • uveitis
  • erythema nodosum
  • psoriasis
  • IBD
  • aortic incompetence
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6
Q

what joint is predominantly affected by ank spond

A

sacroiliac joint progresses to bony fusion of spine

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7
Q

ank spond name for fusion of bony spine

A

bamboo spine

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8
Q

male to female ratio for ank spond and age of onset

A

3:1
Often young males in teens to early 20s
Rare after 50

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9
Q

clinical features of ank spond -bone

A 
lower back pain
early morning stiffness
worse on inactivity
relieved by movement
reduced lumbar motion
fatigue
kyphosis
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10
Q

extra-articular features of ank spond 8

A 
dactylitis
uveitis
conjunctivits
aortic incompetence
urethritis
amyloidosis 
tendonitis of achilles and plantar
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11
Q

how many ank spond % have peripheral arthritis and what joints

A

40%
large joints
asymmetrical
10% have peripheral before spinal

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12
Q

disease score for ank spond and components

A

BASDAI-bath

  • fatigue /`10
  • pain/10
  • pain and swelling of other joints /10
  • level of discomfort from tender areas /10
  • discomfort from wake up time /10
  • morning stiffness last 0-2 hrs
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13
Q

difference in diagnosis of axial and ank spond

A

axial=sacroilitis on mri only not on x-ray

ank spond= bilateral sarcroilitis on x-ray

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14
Q

diagnosis of ank spond and axial spond criteria

A 
back pain >3 months 
improved by exercise
not relieved by resr
insidious onset
night pain
(>45 for axial)
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15
Q

differences between axial and ank spond

A
  • axial responds to nsaid not ank

- no fhx for ank spond

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16
Q

biomarkers for ank spond

A

esr and crp raised
negative antibodies
hla b 27

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17
Q

x-ray signs of ank spond in sc joint 3

A

loss of cortical margins
widening of joint space
sclerosis
joint space narrowing and fusion

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18
Q

x-ray of ank spond thoracolumbars spine 3 signs

A
  • ant. squarring of veretbrae due to erosion
  • bridging syndesmophytes-calcification bony growth into intervetebral joint space into the ligament
  • ossification of ant. longitudinal ligament= bamboo spine
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19
Q

management of ank spond

Study These Flashcards
A
  • nsaid
  • analgesia
  • exercise
  • DMARDS only for peripheral (no effect on spine)
  • anti-tnf (other biologics don’t work)
  • steroids for enteropathies
20
Q

basdai score for anti-TNF

21
Q

male to female ratio for reactive arthritis

22
Q

what is the most common cause of inflammatory arthritis in males 16-35

Study These Flashcards
A

reactive arthritis

23
Q

what is a risk factor for reactive arthrtis

24
Q

classic triad of Reiter

Study These Flashcards
A

non specific urethritis
reactive arthritis
conjunctivitis

25
extra-articular features of Reactive arthritis 12
``` circinate balantis (20-50%)-penis nail dystrophy keratoderma blennorhagica 15% buccal erosions 10% conjunctivitis uveitis pustular psoriasis aortic incompetence pericarditis neuropathy seizures ```
26
5 main pathogens in reactive arthritis
``` salmonella shigella campylobacter yersinia chlamydia (sexually active) ```
27
cause of reactive arthritis
after having food poisoning or sti- get arthralgia in joint
28
clinical features of reactive arthritis
``` oligoarthritis asymmetrical lower limbs can be single joint systemic: fever and weight loss achilles tenonditis/ plantar fasciitis ```
29
what should reactive arthritis always be assumed as initially
septic arthritis
30
risk of recurrence of reactive arthritis
>60%
31
investigation of reactive arthritis
- joint aspiration (leucocyte rich- multinucleated macrophages Reiter cells) - raised esr and crp - 2 glass test urethritis- mucoid on 1st, clears by second - high vaginal swabs - serum agglutinin test for phx dysentry - antibodies- - x-ray
32
x-ray signs of recurrent reactive arthritis
``` joint space narrowing eerosion perositis asymmetrical sacroiliits rather than bilateral in AS syndesmophytes ```
33
management reactive arthritis
- start for septic - nsaid and anlagesia - steroid - antibiotics targeted
34
what should be given for chlamydial urethritis
doxycycline or azithromycin
35
what should be given for severe keratoderma
DMARD or anti-tnf
36
criteria for psoriatic arthritis CASPAR
inflammatory articular disease (joint or enthesis) with >3 - current psoriasis - hx of psoriasis in 1st/2nd degree relative - psoriatic nail dystrophy - negative IgM Rheumatoid factor - current dactylitis - hx of dactylitis - juxta-articular new bone
37
genes assoc. to psoriatic arthritis
hla-b and hla c genes strongest
38
clinical features psoriatic arthritis
pain and stiffness | tendons, joints and entheses
39
5 types of psoriatic arthritis
``` 1=asymmetrical inflammatory oligoarthritis 2=symmetrical polyarthritis 3=DIP joint arthritis 4= psoriatic spondylitis 5=arthritis mutilans ```
40
what is arthritis mutilans
deforming erosive arthritis of fingers and toes - enthesitis predominant - pitting - oncholysis
41
where does psoriatic arthritis usually affect
dip and pip joints of hand, entheses and larger joints
42
management of psoriatic arthritis
- nsaid and analgesia - steroid injection - splint and rest - DMARD persistent synovitis - anti TNF - IL17
43
first choice dmard for psoriasis rash and other beneficial treatment
methotrexate as effective for psoriasis | uv and sunlight helps psoriasis
44
enteropathic spondyloarthropathies what are they and % involvement
IBD patients | 20%
45
what joints are typically targeted by enteropathic spondyloarthropathies
larger lower limb joints
46
what treatment to avoid for enteropathic spondyloarthropathies 2
``` nsaids= worsen IBD etanercept= no efficacy in IBD ```

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