Ankylosing Spondylitis & Enteropathic Arthritis Flashcards
What are 2 other names for Ankylosing spondylitis (AS) that you should not use?
- Rheumatoid spondylitis
- Marie-Strumpell Disease
What is the age of onset for AS and Enteropathic arthritis (EA)?
15-30 yrs
Which gender is primarily affected by AS and EA?
Male > Female (10:1)
What is usually the first symptom of AS?
Low back/SI pain
What is a rhizomelic arthropathy?
arthropathy affecting the root of a limb
AS and EA are considered _____ arthropathies, most commonly affecting the hips and shoulders
rhizomelic
What are the relevant lab findings of AS and EA?
- RF negative
- mild anemia
- ^ESR/CRP
- HLA-B27 positive (90%)
Systemic inflammation due to AS and EA is evidenced by ____
generalized osteoporosis
(also low grade fever, achiness)
What pattern of sacroiliitis is seen in AS and EA?
bilateral symmetric sacroiliitis to fusion
What are the radiographic signs of vertebral involvement in AS and EA?
- erosions (Romanus lesions)
- shiny corner sign (sclerosis)
- squaring of bodies (barrel shaped bodies)
- marginal syndesmophytes
- ossification of IVD
- bamboo spine
In AS and EA, an exacerbation-remission pattern is evidenced by alternating of what 2 radiographic signs of vertebral involvement?
Exacerbation = erosions (Romanus lesions)
Remission = Shiny corner sign
What is the first radiographic sign of vertebral involvement in AS and EA?
Erosions (Romanus lesion):
inflammatory change (loss of bone) at corners of vertebrae where annulus inserts via Sharpey fibers
Inflammation at the corners of vertebral bodies creating erosive change is called ____
Romanus lesions
Sclerosis that occurs at the corners of vertebral bodies due to AS and EA is called ____
shiny corner sign
In AS and EA over time, repeated exacerbation/remission patterns cause the normal anterior and posterior concavity of vertebral bodies to become more vertical, which is called _____
squaring of vertebral bodies
In AS and EA over time, repeated exacerbation/remission patterns cause the normal anterior and posterior concavity of vertebral bodies to become more convex, which is called _____
barrel shaped bodies
(later sign, less common)
Delicate egg shell ossifications from vertebral corner to corner along outer annular fibers are called ____
marginal syndesmophytes
Disc and vertebrae fusion create a radiographic sign called ____
bamboo spine
Facet joint involvement in AS and EA is seen radiographically as ____
railroad sign
(inflammation resulting in fusion of facets)
Ossification of the interspinous ligament in the lumbar region is seen radiographically as ____
dagger sign
What is trolley track sign?
rail road sign + dagger sign
(radiographic characteristic of AS & EA)
What are the common early clinical manifestations of AS and EA?
- initially transient Sx (1-2days), possibly only stiffness
- severe pain & stiffness of SI jts (focal, bilateral)
- relieved by movement (takes longer than DJD)
- worse in morning/evening/night (inactivity)
Describe the clinical course of AS as it relates to the time of diagnosis.
- Initially transient symptoms (stiff, achy back/SI), lasting 1-2 days, eventually recurring (exacerbation/remission pattern)
- 2-5 years latency of Dx since onset of symptoms
What are the common late clinical manifestations of AS and EA?
- kyphotic posture (shortening of inflamed spinal ligaments)
- less ROM (^rigid), proprio/pain sensation
- fusion of costotransverse/vertebral jts –> less chest expansion –> loss of normal breathing activity over few years w/ no Hx of smoking
- AA amyloidosis & uremia (rare)
- severe cardiac involvement (rare)
What radiographic view should be used in a patient with LBP and suspected seronegative spondyloarthropathy?
Ferguson view
(25 deg tilt up at L/S junction)
What are the radiographic characteristics of AS and EA in the SI joints?
- bilateral symmetric
- erosion of SI margins (rosary bead appearance)
- sclerosis of SI margins
- initial involvement = lower 2/3 of SI, iliac side
What are the radiographic characteristics of AS and EA in the spine?
- Marginal syndesmophytes (bamboo spine)
- Dagger sign
- Rail road sign
- Trolley track sign
- Osseous ankylosis
- ant. head carriage due to t/s kyphosis
- ^risk of patho Fx (less proprio/pain sensation)
How do marginal syndesmophytes compare to non-marginal syndesmophytes?
Marginal = corner-to-corner, egg-shell thin
Non-marginal = past corners (not in mid-portion), thicker
Enteropathic arthritis is also called ____
Enteric arthritis
What are the most common pre-existing enteropathic conditions of EA?
Ulcerative colitis & Crohn disease
(often misdiagnosed as IBS)
What should your next step be if your patient presents with back pain and a history of inflammatory bowel disease?
radiographs
What are the less common pre-existing enteropathic conditions of EA?
GI infections:
- salmonella
- shigella
- yersinia
How do enteropathic symptoms correlate with arthritic symptoms of EA?
- diarrhea precedes arthritic outbreak
- ^gut Sx before & during arthritis attack
What are the clinical manifestations specific to EA?
- mainly migratory & transient peripheral arthritis
- flare ups usually subside in 6 wks
- same SSx as AS, plus enteropathic Sx (diarrhea, gut Sx)
What are the possible treatments for EA?
- antibiotics (?)
- bowel resection in ulcerative colitis
- symptomatic management
