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Flashcards in Seronegative Spondyloarthropathy Deck (52):
0

ankylos

stiffening

1

spondylo

vertebra

2

seronegative means

RF
ANA
ANCPA

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enthesis

site of attachment of tendon, ligament or joing capsule to bone; inflam here

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key difference between RA w/ synovial inflam and SA is

inflammation starts at enthesis

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enthesis is ___

metabolically active

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4 types of arthridities taht dont equal RA

ankylosing spondylitis
reactive arthritis
psoriatic arthritis
inflammatory bowel disease arthrits

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pattern of spondyloarthopathy

assymetric peripheral arthritis
radiographic sacrolitis
enthesitis
absence of RA
significant familial--HLAb27

8

Juvenile SA vs undifferentiated SA

juvenile- AS, ReA
undifferentiated- PsA, IBDA

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definite AS dx

1 radiographic finding + > 1 clinical feature

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pre-radiographic stage

undifferentiated axial spa
back pain
mri: active sacrollitis

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radiographic stage AS

real AS
back pain, radigraphic sacrolitis-->ack pain + syndesmophytes

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clinical features AS

back pain
low back pain with alternating buttock pain
slow onset, chronic
worse at 2-5 am, early morning
better with exercise nad nsaids, worse with exercise

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most common extraspinal symptoms

eye-acute anterior uveitis
aoritis-rare but very dangerous
subclinical colitis
pulmonary fiborsis
Iga nephropathy, amyloidosis

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why do you get pulmonary fibrosis

mechanical restriction-->decreased chest expansion

15

PE AS

occiput to wall distance >0
decrease spinal mobility, chest expansion
Shobers <15 cm
FABER-pain in contralateral SI joint is +
pelvic compression

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early radiographic signs

shiny corners; romanus lesions

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later radiographic signs

granulation inflammation
ossification of annulus-->syndesmophytes-->bridge and obliterate joint space-->bamboo spine

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what marks severe sponylosis

PIP involvement

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decreased surivial spond because

CVD

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HLAb27

95% of patients have it, but only 5% of them develop HLAB27
if you have AS and are HLAb27, kids risk of getting it 20%

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hlab27 negative associated with

later onset

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Tx AS

nsaids, sulfsalazine

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TNF alpha antag

effective for both axial disease and uveitis- aggressive

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predinose

not effective for axial, but helps with uveitis

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MTX and other DMARdS

DO NOT WORK

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reactive arthritis

get 2-4 weeks after GI or GU infection
synovial culture negative
antibiotics dont help change course except clymidia

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85% of reactive arthritis is

HLA b27

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RA mostly affects

Lower extremities

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extraarticular reactive arthritis

uveitis/conjunctivitis
circinate balmus
keratoderm blenurrgium
urtherits
inflamation on achiles tendon insertion and plantar fascia

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circinuate balintus

ulcers and plaque like lesions on flans of penis

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keratoderm blenurrhgium

skin lesions palms and soles

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M=F for

GI infections

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M>F for

GU infection

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all of these infections have

LPS-pts with HLAb27 may have conserved t cell reaction that respond to it

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TX Reactive arth

nsaids
sulfasalazine anad dmards
prednisone

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reiter's syndrome

subet of ReA with urethritis, chlamydia+ arthritis, ach tendo periositis, conjunctivitis

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psoriatic arthritis

patients will have skin change and nail pitting before getting a mild, oligoarticualr (mostly) arthritis

patients dont have to have psoriasis

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5 patterns PA

DIP
asym oligo
sym polyarth
arthritis mutilans
spondyloarthritis

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classification PA

inflammatory joint/spine/entheseal disease and >/= 3

current/hx/or fx of psoriasis
psoriatic nail dystrophy
rf negative
dactylitis at any point
xray

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xray should show

erosive, assymetric arthritis
pencil in cup deformity
non-marginal assym syndesmophytes taht are big bulky realtive to AS

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dactylitis

inflammation of tendons (not painful)-->sausage like fingers/toes

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treatments

nsads
sulfa
dmards
tnfa antag!!!

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prednisone with PA

may help arthritis but mays psoriasis worse

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hydroxychloroquine in PA

might exacerbate skin disease

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IBD arthropathy

peripheral arthritis--freq associated with skin disease (e nodosum, pyoderma grangrenosum)

can be oligoarticular or polyarticular
bad back does not equal bowel problem

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IBD more common in

crohn than UC

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colectomy

can induce remission in UC

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treatment IBD arth

underlying diease!
NSAIDS maybe for pain, but contraindicated
sulfa, mtx
tnfa!
azanthhioprine
mercaptupurine

49

TNF a antag

adelimumb- crohns
infliximab- crohns, uc

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HLAb27 freq

AS>IBD spondylitis> psoriatic spondyltis>ReA>psoriatic>IBDA

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why is HLAb27 a double edged sword

provides anti-viral immunity (hep c clearance), but also increases autoimmunity (bacterial mimicry-->arthritogenic peptides) AND decreases intracellula rbacterial killing-->REA