1: Spondyloarthropathies

Question 0

Physical exam

Answer 0

• Height
• Chest expansion (less than 5cm)
• Occiput to wall distance
• Lumbar joint movements
• Schober test
• Sacroiliac and hip joint movements
• Loss of spinal mobility
• Lumbar lordosis is obliterated
• Thoracic kyphosis is accentuated
• Cervical spine causes forward stoop of neck
• Hip involvement cause flexion contracture
• “Question mark” posture develops

Question 1

Disorders include..

Answer 1

• Ankylosing spondylitis
• Reactive arthritis (Reiter’s syndrome)
• Psoriatic arthritis
• Enteropathic arthritis (with IBD)
• Undifferentiated spondylitis
• Juvenile spondyloarthritis

Question 2

Acute anterior iritis

Answer 2

Unilateral
Pain
Lacrimation
Photophobia
Blurred vision
Cataract, secondary glaucoma

Question 3

Aortitis

Answer 3

Aortic insufficiency

Collapsing pulse, early diastolic murmur, wide pulse pressure

Question 4

Ankylosing spondilitis- extra ariticular sx

Answer 4

Iritis
Aortitis
GI
Cauda equina syndrome
IgA nephropathy/ amyloidosis

Question 5

Ankylosing spondilitis- complications

Answer 5

• Spinal fractures (MC: Cervical spine)
• Cauda equina syndrome
• Fibrosis of chest wall
• Heart block
• Aortic regurgitation

Question 6

Lab

Answer 6

• No diagnostic test
• HLA B27 (+)
• Alk Phos increased (bone formation)
• ESR increased
• C reactive proteins increased
• IgA increased

Question 7

Radiographic findings

Answer 7

• Sacroilitis*
• Blurring of sacroiliac joints
• Pseudowidening of joint spaces due to erosion
• Calcaneal spur
• Lumbar spine
• -squaring of vertebrae due to erosion of corners
• -syndesmophytes (ossification of outer fibers of annulus fibrosus) formation at margins-> may join together to form “Bamboo spine”
• -Romanus sign: shining vertebral border

Question 8

Diagnosis criteria

Answer 8

1: history of inflammatory back pain
2: limitation of lumbar spine motion
3: limited chest expansion
4: define radiographic sacroilitis
5: radiographic sacroilitis plus any one other criteria makes a definite diagnosis

Question 9

Low back pain of AS is distinguished by..

Answer 9

1: insidious onset
2: duration >3 months
3: morning stiffness
4: improvement with exercise or activity
5: age of onset before 40yrs

Question 10

Tx- pharmacological

Answer 10

• NSAIDS
• Sulfasalazine
• Methotrexate
• TNF alpha inhibitors (Infliximab, Etanercept)

Question 11

Tx- surgery

Answer 11

• Total hip arthroplasty
• Pacemaker
• Aortic valve replacement
• Osteotomies

Question 12

Reiter’s syndrome- triad and sx

Answer 12

Triad

• Arthritis
• Urethritis
• Conjunctivitis

sx:

• Tendonitis and fascitis at Achilles insertion
• Prostatitis
• Circinate balanitis (small round red macules or vesicles taht rupture to form erosions)
• Salpingitis, Cervicitis
• Ulcers (mouth, lips, tongue, gums, soft palate)
• Keratoderma blenorrhagica (vesicles become hyperkeratotic forming a crust, typically found on soles and palms)

Question 13

R syndrome- triggers

Answer 13

Enteric
-Shigella
-Salmonella
-Yersinia enterocolitica
-Campylobactor
Urogenital
-Chlamydia trachomatis

Question 14

R syndrome- Arthritis

Answer 14

Asymmetric and additive
Usually affects large joints in lower limbs
Painful with tense joint effusion
Sausage digit- diffuse swelling of solitary finger or toe