The Spondyloarthropathies Flashcards
(123 cards)
1
Q
Four examples of spondyloarthropathies:
A
ankylosing spondylitis, reactive arthritis, psoriatic arthritis, enteropathic arthritis
2
Q
spondyloarthropathies CM
A
spine/SI joint pain; chronic inflammation = new bone formation; peripheral arthritis (asymmetrical and lower extremities); inflammation at tendon insertion = enthesitis; ocular inflammation = acute anterior uveitis
3
Q
spondyloarthropathies are associated with which gene marker
A
HLA-B27
4
Q
spondyloarthropathies diagnostic criteria
A
sacroiliitis on imaging plus 1+ SpA feature OR HLA-B27 plus 2+ other SpA features
5
Q
SpA features
A
inflammatory back pain, arthritis, enthesitis (heel), dactylitis, psoriasis, Crohn’s/colitis, good response to NSAIDs, FH, HLA-B27, elevated CRP
6
Q
Radiographic sacroiliitis criteria for SpA
A
grade 2+ bilaterally or grade 3-4 unilaterally
7
Q
Treatment of spondyloarthropathies
A
patient education, exercise, medicine (NSAID, corticosteroids, sulfasalazine, methotrexate, maybe abx, anti-TNF therapy)
8
Q
HLA association for RA
A
DR4
9
Q
HLA association for ankylosing spondylitis
A
B27
10
Q
HLA association for for enteropathic arthritis
A
B27 (axial)
11
Q
HLA association for psoriatic arthritis
A
B27 (axial)
12
Q
HLA association for reactive arthritis
A
B27
13
Q
joint pattern for RA
A
symmetrical, peripheral
14
Q
joint pattern for ankylosing spondylitis
A
axial
15
Q
joint pattern for enteropathic arthritis
A
axial and peripheral
16
Q
joint pattern for psoriatic arthritis
A
axial and asymmetrical, peripheral
17
Q
joint pattern for reactive arthritis
A
axial and asymetrical, peripheral
18
Q
Sacroiliac for RA
A
NA
19
Q
Sacroiliac for ankylosing spondylitis
A
symmetrical
20
Q
Sacroiliac for enteropathic arthritis
A
symmetrical
21
Q
Sacroiliac for psoriatic arthritis
A
asymmetrical
22
Q
Sacroiliac for reactive arthritis
A
asymmetrical
23
Q
syndesmophyte for RA
A
NA
24
Q
syndesmophyte for ankylosing spondylitis
A
smooth, marginal
25
syndesmophyte for enteropathic arthritis
smooth, marginal
26
syndesmophyte for psoriatic arthirits
coarse, non-marginal
27
syndesmophyte for reactive arthirits
coarse, non-marginal
28
eye manifestations for RA
scleritis
29
eye manifestations for ankylosing spondylitis
iritis
30
eye manifestations for enteropathic arthritis
+/-
31
eye manifestations for psoriatic arthritis
none
32
eye manifestations for reactive arthritis
iritis and conjunctiviits
33
skin manifestations for RA
vasculitis
34
skin manifestations for ankylosing spondylitis
none
35
skin manifestations for enteropathic arthritis
none
36
skin manifestations for psoriatic arthritis
psoriasis
37
skin manifestations for reactive arthritis
keratoderma
38
What's the most common axial skeleton inflammatory disorder?
ankylosing spondylitis
39
Are men or women more affected by ankylosing spondylitis?
men
40
who does ankylosing spondylitis most commonly affect?
white males 15-40
41
onset of ankylosing spondylitis
young adulthood; sometimes juvenile
42
S/S of ankylosing spondylitis
persistent LBP >3 months; SI joint; possible radiation to buttock; early morning stiffness; pain that wakes patient up from sleep; fatigue; asymmetrical polyarthritis (most common in LE); enthesitis (achilles tendinitis and/or heel pain); extra-articular features
43
PE ankylosing spondylitis
TTP; spinal decreased ROM; stooped posture; Schober test; possible FABER test; chest expansion; peripheral joints
44
What test do you use to test for ankylosing spondylitis
Schober Test, FABER test
45
Labs for ankylosing spondylitis
RF (negative), ANA (negative), SED, CRP, HLA-B27
46
Imaging for ankylosing spondylitis
plain films (lumbar spine and SI joint) , MRI
47
What will you see on plain films of ankylosing spondylitis
bamboo spine
48
Tx for ankylosing spondylitis
patient education, exercise (PT, OT, AT), meds (NSAIDs, corticosteroids, sulfasalazine, MTX, DMARDs, anti-TNF therapy)
49
What's reactive arthritis?
aseptic arthritis-synovitis
50
when does reactive arthritis develop?
after systemic infection; 1-3 weeks
51
offending agents of reactive arthritis?
salmonella typhimurium, erisinia enterocolitica, shigella flexneri, chlamydia trachomatis
52
reactive arthritis is associated with what genetic marker
HLA-B27
53
are males or females more impacted by reactive arthritis?
men
54
S/S of reactive arthritis
LE asymmetrical polyarthritis; sacroiliitis; malaise, fatigue, fever; enthesitis (achilles tendon or plantar fasciitis), dactylitis (sausage fingers); Reiter's Syndrome
55
Reiter's Syndrome
urethritis/cervicitis; arthritis; conjunctivitis "can't see, can't pee, can't climb a tree"
56
PE of reactive arthritis:
dactylitis, asymmetric arthritis (LE), mucocutaneous lesions, papulosquamous eruptions on palms and soles; conjunctivitis; cervicitis/urethritis/ diarrhea
57
Imaging for reactive arthritis
plain films; MRI
58
labs for reactive arthritis
CBC with diff, ESR, CRP, HLA-B27, synovial fluid analysis
59
Course for reactive arthritis
initial onset 2-3 months with synovitis lasting up to a year
60
Treatment of reactive arthritis
treat symptoms, NSAIDs, possible intra-articular injection, systemic infections, extra articular manifestations
61
What's psoriatic arthrits?
papulosquamous disease with keratinocyte proliferation
62
onset of psoriatic arthritis?
30-35
63
Are men or women more impacted by psoriatic arthritis?
M=F
64
Genetic markers associated with psoriatic arthritis?
HLA-Cw6 (dominant); HLA-B39 and HLA-B27 (sacroiliitis and axial involvement)
65
What does psoriatic arthritis not produce?
immunoglobulin or RF
66
In regards to psoriatic arthritis, what additional condition can cause higher prevalence for joint destruction?
HIV
67
S/S of psoriatic arthritis
insidious onset of pain and stiffness; possible skin lesions
68
PE of psoriatic arthritis
asymmetrical polyarthritis in large and small joints and dactylitis; DIP joints with nail dystrophy (onycholysis, subungual keratosis, pitting, oil drop staining), symmetrical polyarthritis (no nodules), spondylitis
69
Imaging for psoriatic arthritis
plain films
70
treatment for psoriatic arthritis
pain control; anti-TNF
71
What's enteropathic arthritis?
Arthritis associated with Crohn’s disease/Ulcerative Colitis; more commonly Crohn's
72
Presentation of enteropathic arthritis?
non-erosive, asymmetric polyarthritis of large joints; lower extremities--peripheral arthritis not associated with HLA-B27, spondylitis/sacroiliitis associated with HLA-B27; inflammation of joint follows inflammation of GI
73
What's systemic sclerosis?
chronic autoimmune connective tissue disease; thickening of skin with internal organ involvement
74
3 cardinal processes of scleroderma
1) autoimmunity and inflammation; 2) vascular injury and obliteration 3) fibrosis and matrix deposition
75
Patho of scleroderma
capillary loss; obliterative vasculopathy (intimal proliferation in small and medium vessels); acellular fibrosis (deposition of connective tissue matrix); findings based on tissue biopsied
76
What skin findings can you find on biopsied tissue of scleroderma?
collage deposits in hair follicles; atrophic epidermis
77
Lung findings in biopsy of scleroderma
thickened alveolar septae
78
x-ray finding of lungs in scleroderma
honeycombing
79
GI biopsy findings in scleroderma
fibrosis of lamina propria and submucosa; muscle atrophy
80
Classification of scleroderma
systemic sclerosis (diffuse cutaneous vs. limited cutaneous); mixed connective tissue disorder; localized scleroderma
81
Describe limited cutaneous systemic sclerosis
fingers, toes, distal extremities and face; associated with Raynaud, CREST syndrome. Impacts periphery.
82
Describe diffuse cutaneous systemic slcerosis
involves skin proximal to elbows and knees, trunk and distal extremities; rapid progression; early pulmonary fibrosis and acute renal failure
83
What is CREST syndrome associated with?
limited cutaneous systemic sclerosis
84
CREST syndrome:
calcinosis cutis; Raynaud's phenomenon; esophageal dysmotility; sclerodactyly; telangiectasia
85
What's Raynaud's phenomenon?
episodic vasoconstriction
86
Describe a Raynaud's attack
vasoconstriction (pallor), ischemia (cyanosis), reperfusion (erythema)
87
Raynaud's triggers
cold, emotional stress
88
What's primary Raynaud's phenomenon?
benign condition, exposure to cold, more frequent in women
89
What's secondary Raynaud's phenomenon?
result of other diseases (scleroderma, other CT diseases, hematologic and endocrine); medications (beta blockers, chemotherapy, cisplatin, bleomycin)
90
Mixed Connective Tissue Disorder
overlap of symptoms of SLE, systemic sclerosis, myositis
91
CM of mixed connective tissue disorder
Raynaud with hand edema, other findings of CT disease, late stage: renal crisis
92
What genetic marker is associated with mixed connective tissue disorder?
autoantibody against U1-ribonuclear protein (U1-RNP_
93
Who does localized scleroderma primary effect?
kids
94
CM of localized scleroderma
morphea (reddish/purple lesions of the skin); skin induration (asymmetrical distribution; spares the digits; common on lower extremities); no Raynaud; no systemic involvement
95
Scleroderma etiology
unknown; attributed to: infectious agents (CMV, parvovirus B19), silica, epoxy resins, dietary, drugs (bleomycin, HRT, cocaine, appetite suppressants), lifestyle exposures, genetic susceptibility
96
Which gender is impacted more by scleroderma?
females
97
what age group is impacted most by scleroderma?
females in childbearing years and decreases after menopause
98
age for systemic sclerosis
30-50
99
Diffuse cutaneous scleroderma CM
soft tissue swelling, erythema, pruritus, fatigue, stiffness, malaise, Raynaud
100
Limited cutaneous scleroderma CM
history of raynaud's, possible ischemic ulcerations, indolent and delayed onset of other signs (CREST), more prevalent vascular manifestations (digital ischemia; telangiectasia; pulmonary HTN)
101
Skin involvement of scleroderma
thickening, symmetrical and bilateral, starts and fingers and works proximal, hyperpigmentation, vitiligo, decrease sweating and dry skin, masklike facies, calcium deposits (finger pads, extensor surfaces, forearms, bursae)
102
GI tract scleroderma manifestations
periodontal disease, GERD (possible Barrett's esophagus), gastroparesis, impaired small intestinal motility (chronic diarrhea), malabsorption of fat and protein; vitamin B12 and D deficiency, constipation, rectal prolapse
103
lung involvement of scleroderma
interstitial lung disease (exertional dyspnea, fatigue and decreased exercise tolerance); pulmonary hypertension
104
RF for interstitial lung disease from scleroderma
male, AA, diffuse skin involvement, severe GERD, presence of topoisomerase-I autoantibodies
105
What's pulmonary hypertension?
mean pulmonary arterial pressure >25 mmHg and pulmonary cap pressure <15 mmHg
106
RF for pulmonary hypertension from scleroderma?
limited cutaneous disease, late disease onset, large number of cutaneous telangiectasias, presence of anticentromere autoantibodies
107
Kidney manifestations of scleroderma
scleroderma renal crisis--uncommon but life threatening; chronic kidney disease
108
When does scleroderma renal crisis occur?
within 4 years of onset
109
What's scleroderma renal crisis?
obliterative vasculopathy and luminal narrowing = decreased blood flow; abrupt onset HTN and progressive renal insufficiency
110
RF of scleroderma renal crisis?
rapidly progressive sin involvement, tendon rubs, AA, male, autoantibodies to RNA polymerases I and III
111
cardiac manifestations of scleroderma
associated with diffuse cutaneous systemic sclerosis; tachycardia, conduction abnormalities, valvular regurgitation, diastolic heart failure, pericardial effusion; poor prognosis
112
MSK manifestations of scleroderma
carpal tunnel syndrome, decreased joint mobility, tendon friction rubs
113
Scleroderma "other" manifestations
dry eyes, dry mouth, hypothyroidism, CNS usually spared (trigeminal nerve fibrosis can occur)
114
Labs for scleroderma
cbc with diff (anemia), sed rate and CRP are usually normal, RF negative, ANA negative, vitamin deficiencies (folate, vitamin B12, vitamin D); nailfold capillaroscopy
115
Scleroderma treatment
corticosteroids (treats stiffness and aching), cyclophosphamide (decreased progression of symptomatic interstitial lung disease), methotrexate (skin manifestations), antifibrotic therapy--D-penicillamine (improves skin induration; prevents new internal organ involvement; improved survival); ACE inhibitors (sclerodermal renal crisis)
116
How to treat pulmonary arterial hypertension?
endothelin-1 receptor antagonist or 5-phosphodiesterase inhibitor
117
Which form of scleroderma has worst prognosis?
diffuse cutaneous systemic sclerosis
118
which symptom of scleroderma has the most rapid progression?
organ involvement
119
what happens 2-4 years after scleroderma onset?
inflammatory symptoms fatigue/edema/arthralgia subside, skin thickening plateau, organ involvement progresses
120
Ten-year survival rate for diffuse cutaneous systemic scleroderma
55%
121
ten-year survival rate for limited cutaneous systemic scleroderma
75%
122
leading cause of scleroderma death
pulmonary fibrosis, PAH, GI involvement, cardiac disease
123
poorer prognosis in scleroderma if
male, AA, older age of disease onset, low BMI, extensive skin thickening with truncal involvement, presence of antibodies topoisomerase-I or RNA polymerase III, absence of anticentromere antibodies
