Seronegative spondyloarthropathies (obj 20)

Question 1

Your patient is a young man of 20 years old who is complaining of low backache that is worst in the morning. The pain improves with activity.
You obtain radiographic images and see bilateral symmetric sacroiliitis.
Diagnosis? Treatment?

Answer 1

ankylosing spondylitis

NSAIDs

Question 2

6 years later your male patient with ankylosing spondylitis comes to see you again for more radiographs. Now what do you see?

Answer 2

“bamboo spine”

spinal column in which vertebral bodies are fused

Question 3

What lab test do you run on your ankylosing spondylitis patient and what are the results (he is a white guy)?

Answer 3

Serologic testing will be positive for HLA-B27 in 90% of white patients.

Question 4

If psoriasis precedes onset of arthritis, what is the diagnosis?

Answer 4

psoriatic arthritis

Question 5

What are 3 common findings that are unique to psoriatic arthritis (vs. other types of arthritis)?

Answer 5

1. arthritis of DIP joints accompanied by nail pitting
2. “sausage” swelling of one or more fingers/toes
3. “pencil-in-cup” appearance of phalanges on radiograph

Question 6

What precedes the arthritic symptoms in reactive arthritis?

Answer 6

GI infection (Shigella, Salmonella, Yersinia, Campylobacter) or STI, usually C. trachomatis

Question 7

HLA-B27-positive patients can develop ____ at any time.

Answer 7

anterior uveitis