SpondyloArthropathies Flashcards
(57 cards)
1
Q
Characteristics of seronegative spondyloarthropathies
A
male - before 40 inflammatory arthritis of spine and SI jts HLA B27++ (also ankylosis spondylosis) RF - CCP - ANA -
2
Q
Non-vertebral symptoms of spondyloarthropathies
A
asymmetric peripheral arthritis arthritis of Toe IP joints sausage digits Enthesopathy - achilles, plantar fasciitis, costochondritis Uveitits mucocutaneous lesion
3
Q
What does HLA B27 interatct with
A
CD 8 cells
CD 4 t cells
4
Q
what bacteria in stool of AS patients produces HLA-B27
A
klebsiella
5
Q
What diseases is HLA-B27 associated with
A
ankylosis spondylitis
reactive arthritis
IBD w/ spondylitis
Whipples disease
6
Q
How to make diagnosis of spondyloarthropathy
A
chronic(>3 months) low back pain ( 30 mins
improvement by exercise
HLA-B27 positive + 2 features
sacroillitis on imaging + 1 feature
7
Q
what are the features of spndyloarthropathy
A
arthritis enthesitis* uveitis* dactylitis psoriasis CD/UC NSAID response FH HLA-B27 Elevated C-RP aortic insuffiency*
8
Q
Symptoms of AS
A
bamboo spine SI inflammation/pain increased kyphosis fatigue Ocular inflammation, uveitis reduced rib expansion weight loss atlantoaxial subluxation pulmonary fibrosis aortic insuffiency
9
Q
AS - essentials of diagnosis
A
chronic LBP in young adults limitation of chest expansion - upper lobe pulmonary fibrosis SI abnormalities Peripheral arthritis - knees esp Inflammatory eye disease aortic insuffiency ESR elevated, neg RF and CCP HLA-B27
10
Q
Shobers test
A
rheumatolgy test for low back flexion
5cm below L5 and 10 cm above - touch toes
< 5cm of elongation is bad
11
Q
Lab findings in AS
A
ESR increased
RF and antiCCP - negative
mild anemia
HLA-B27 +
12
Q
imaging findings in AS
A
X rays
CT-scans
MRI - whole body w/ gadolinium*
may show edema at enthesitis sites
13
Q
Andersson lesions are
A
inflammatory involvement of intervertebral discs
simulates diskitis
found in AS
14
Q
what is shiny corner sign
A
reactive sclerosis (small erosions) on corners of vertebral bodies - found in AS
15
Q
Syndesmophytes
A
bony growth inside of cartilage - bamboo spine
16
Q
how are DISH and AS different
A
in DISH no involvement of SI joints and syndesmophytes are anterior and thicker
17
Q
SI joints and AS
A
Sclerosis, bilaterally on iliac side
sclerosis appears triangular with base inferior
18
Q
Other complications of AS
A
uveitis upper lobe PF cauda equina fibrosis heart block aortic regurg
19
Q
Treatment of AS
A
Phys/Occ therapy exercise NSAIDS - watch for CHF sulfasalazine - for peripheral arthritis ANTI TNF-a agents exclusion criteria - active/recent infections
20
Q
psoriatic arthritis patterns
A
oligoarthritis - pencil in cup arthritis mutilans "opera glass hand" unilateral sacroilitits asymmetrical polyarthritis DIP
21
Q
psoriatic arthritis - labs
A
HLA-B27 + - 30-50% RF/CCP neg UA increased FE++ decreased Th17 w/ increased IL-17 HIV - associated**
22
Q
Psoriatic Arthritis - essentials
A
psoriasis precedes arthritis 80% - search for PsA
asymmetric sausage appearance of fingers/toes-dactylitis
X-ray: osteolysis, pencil in cup, lack of osteoporosis, bony ankylosis, atypical syndespophytes
may have uveitis, pleruitis, aortitis
23
Q
psoriatic arthritis - management
A
topicals PUVA NSAIDs Methotrexate Anti-TNF agents - good for nail and cutaneous lesions of psoriasis IL17/IL23 blockers IL23 triggers proinflamatory cascade apremilast(PDE4 inhibitor) surgery NOT STEROIDS
24
Q
reactive arthritis
A
has antecedent bacterial infection or HIV*
25
what are the bacteral for reactive arthritis
```
S3YC3
Shigella
Salmonella
Streptococcus
Yersinia (enterocolitica, pseudoTB)
Camplylobacter
Clostridium
Chlamydia
and Ureaplasm
```
26
Chlamydia induced arthritis
genital forms containing ocular forms carried by monocytes to jts and chronically stim Th1 rxn
producing - IL1, TNF a, IFN g
can come from pneumonic forms also
27
Chlamydiaceae forms
```
C. pneumoniae
psittaci
tracomatis
A-C - trachoma
D-K - NGU gential tract infections - PID/sterility
L1-L3 - Lymphogranuloma venereum
```
28
Reiters' Syndrome - reactive arthritis
AI condition in response to infxn in body
| - following urethritis/cervicits/infections diarrhea
29
Reactive arthritis associations
```
enthesopathy - Lovers heals
inflammatory eye disease
palmar pustulosis
circinate balanitis**
keratoderma blenorrhagicum***
oral ulcers - painless - unlike behcets
sacroilitis in 20%
```
30
reactive arthritis - diagnosis
```
50-80% HLA-B27 +
large joint oligoarthritis or sacroiliits
uveitis conjunctivitis**
urethritis**
mouth ulcers
follows dysentery or STI
self limited 15% relapse and 15% chronic
may have carditis and AR
```
31
management of reactive arthritis
```
antibiotics*** doxy+rifampicin or AZT+rifampicin
- effective in Chlamydia
NSAIDS***
opthalmic drugs
sulfasalazine
biologics - anti-TNF
```
32
IBD w/ arhtritis
especially chrons 15% HLAB27 +
1.) non deforming asymmetric oligoarhtritis athat parallels bowel disease
2.) bilateral and symmetrical sacroilitis 50% HLA B27+
acts independently of IBD
33
treatment of peripheral arthritis of IBD
```
corresponds to status of IBD so treat IBD
sulfasalazine
corticosteroids
AZA or 6-MP
TNF inhibitor
```
34
hemearthrosis is
```
recurrent hemorrhage in
knees/ankles/elbows
synovial hypertrophy
hemosiderin deposition
persistent boggy synovitis
cartilage erosion
fibrosis and ankylosis
```
35
diagnosis of hemarthrosis
mri better than xray for early damage
| xray can show hemosiderin
36
treatment of hemarthrosis
prophylactic clotting factors QOD non on demand
37
septic arthritis
monoarthritis is septic arthritis until proven otherwise
more jts == less likely except for
RA, group B strep, endocarditis
anti TNF therapy patients - 2x as likely
38
septic arthritis - risk factors
sudden onset of acute arthritis, usually monoarticular
- usually large weight bearing jts
previous jt damage or IV drug abuse
Infection w/ causative organisms commonly found elsewhere
joint effusions are large with WBC > 50,000
39
diagnostic approach to septic arthritis
blood culture + in 50% - check for AFB in anti-TNF therapy or HIV
synovial fluid
gram stain + in 50-75%, culture + in 80%
WBC > 50,000 often > 100,000
glucose, crystals, serologic studies
MRI good to find early changes of osteomyelitis
arthrocentesis - watch for allery to anesthetic, bleeding, or anti coag
40
serologic fluid
string sign - high viscosity?????
41
septic arthritis - organisms
Gram + 90%
staph aureus (50%) MRSA, GBS, pneumococcal
Gram - 10%
e coli, pseudomonas, DGI, Salmonela
42
prosthetic jt infections
have a biofilm that stops staph(coag+ and -) and pseudomonas
infxns > 24 months seeded from blood
tx depends on prosthetic loosening
43
treatment of septic arthritis
3rd gen cephalosporin - ceftriaxone/cefotaxime
vancomycin
4-6 weeks and drain
44
Gonococcal arthritis
most common septic arthritis in young adults
| asymptomatic pharyngitis and proctitis in gay men
45
Risk factors of Gonococcal arthritis
menstruation, pregnancy
| C5-C9 deficiencies
46
Gonococcal arthritis labs
synovial fluid + in 25%
culture + in 50%
need urethral, throat, cervical and rectal cultures
47
Gonococcal arthritis treatment
3rd gen cephalosporins IV x 2 days then cefixime
48
Disseminated gonococcal infrection(DGI)
```
Arthritis/Dermatitis syndrom
olioarthritis form - preceded by migratory polyarthritis
tenosynovitis
rash - pustules (palms/sole
fever
may also get osteomyelitis
```
49
spinal septic arthritis (discitis)
chronic unrelenting back pain, fever, local tenderness
thoracolumbar region
Infection usually crosses disc space(not in malignancy)
TB(potts disease): T10-L2 region
gibbus deformity, paraspinal cold abcess
50
viral arthritis - common agents
```
parvo B19
HIV
hep b/c
EBV
adeno/coxsackie
rubella
mumps
```
51
Viral arthritis presentation
megratory arthralgia/itis or polyarthritis
wrists, hands, knees
frequently symmetric
rash may be present
Hep C may look like RA (anti-CCP)
Hep B similar to serum sickness w/ urticaria and decreased complement
52
HIV and Diffuse Infiltrative Lymphocytosis Syndrome (DILS)
```
CD 8 cells infiltrate the organs
Sjogrens and bells palsy
myositis
reactive arthritis
peripheral neuropathy - sensory motor
hepatitis
interstitisal nephritis
Pneumonia
psoriasis esp palmo-pustular
responds to steroids and HAART
```
53
immune reconstitiution inflammatory syndrome
| iris
```
Conditions driven by CD 4 lymphocytes
RA
SLE
sarcoid
Sjogrens
immune system begins to recover but then responds to previously acquired opportunistic infection w/ overwelming inflammatory response that make worse
TB and cryptococcal meningitis
```
54
Erythema Nodosum w/ Arthritis
```
BUMPS
Boeck's sarcoid
bechets disease
ulcerative colitis/crohns
mycoses - blasto, histo, TB, mycoplasma
Pills (
BCP
Streptococcus
```
55
what is lofgren's syndrome
sarcoidosis w/ perihilar lympheadenopath and erythema nodosum
56
Lyme disease
stage I - flu syndrome w/ rash(ECM)
Stage II - dissemination heart, joints nerves
heart block, bells palsy, miratory arthralgias
Stage III - joints oligoarthritis, encephalitis, paresthesias
HLA-DR4 risk factor
57
how to confirm lyme disease
Western blot
| treat w doxy, amoxicillin, ceftriaxone
