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In order Cuccurullo > Ch 3 - Rheumatology: Spondyloarthropathies > Flashcards

Ch 3 - Rheumatology: Spondyloarthropathies Flashcards

1
Q

What are types of Juvenile spondyloarthropathies?

A
  • Juvenile AS
  • Reiter’s syndrome
  • Psoriatic arthritis
  • Arthritis of Inflammatory bowel disease/Enteropathic arthropathy
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2
Q

How do seronegative enthesopathy and athropathy (SEA syndrome) present?

A

– RF (−)
– ANA (−)
– Enthesitis/arthritis/ arthralgia
– May have uveitis (painful and acute)

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3
Q

How does inflammatory arthritis present?

A
  • Inc WBC and ESR
  • Acute painful onset
  • Erythema, warmth, and tenderness
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4
Q

What are types of inflammatory arthritis?

A
  • CTD—SLE, polymyositis, dermatomyositis, PSS, RA
  • Crystal—gout and pseudogout
  • Infectious
  • Seronegative spondyloarthropathies
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5
Q

What are types of noninflammatory arthritis?

A
  • OA, AVN
  • Traumatic
  • Joint tumors
  • Hemophilia
  • Metabolic: hemochromatosis, alkaptonuria, rheumatic fever, Wilson’s disease
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6
Q

What diseases are HLA-B27 positive?

A
  • AS
  • Reactive arthritis (Reiter’s syndrome)
  • Psoriatic arthritis—HLA Cw6
  • Enteropathic arthropathy
  • Pauciarticular JRA
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7
Q

What is Ankylosing spondylitis?

A

Chronic, inflammatory rheumatic disorder of the axial skeleton affecting the sacroiliac joint and the spine

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8
Q

What is the hallmark finding of Ankylosing spondylitis?

A

Bilateral sacroiliitis

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9
Q

Who is affected by Ankylosing spondylitis?

A
  • Males&raquo_space; females

* More common in whites

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10
Q

What is the onset of Ankylosing spondylitis?

A

Late adolescent and early adulthood

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11
Q

What are the skeletal sites of involvement in Ankylosing spondylitis?

A
  1. SI joint
  2. Lumbar vertebrae
  3. Thoracic vertebrae
  4. Cervical vertebrae
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12
Q

What is the clinical presentation of Ankylosing spondylitis?

A

• Insidious onset, back pain, or tenderness in the bilateral SI joints
– Initially asymmetric then bilateral
• Sx for least 3 mo
• Lumbar morning stiffness that improves with exercise
• Dec lumbar lordosis and inc thoracic kyphosis

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13
Q

Which patients will develop cervical ankylosis?

A

Develops in 75% of the patients who have AS for 16 years or longer

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14
Q

What is the MC site of fracture in Ankylosing spondylitis?

A

Lumbar or lower cervical spine

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15
Q

What is enthesitis?

A

Inflammatory process occurring at the tendon insertion site onto bone

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16
Q

Where does enthesitis occur in AS?

A

Ischial tuberosity
Greater trochanter
ASIS
Iliac crests

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17
Q

Which joints are MC involved in juvenile AS?

A

Hip

Shoulder

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18
Q

What pulmonary condition can develop in AS?

A

Restrictive lung disease l/t dec chest expansion and diaphragmatic breathing

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19
Q

What is the MC extraskeletal manifestion of AS?

A

Acute iritis/iridocyclitis

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20
Q

What are extraskeletal manifestions of AS?

A 
Fever/fatigue/wt loss
Aortitis l/t fibrosis
Conduction defects
Apical plumonary fibrosis
Amyloidosis
Cauda equina syndrome
C1 to C2 subluxation
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21
Q

What are lab findings in AS?

A
  • HLA-B27 (+) in 90%
  • RF (–) and ANA (–)
  • Elevated ESR and CRP
  • Normochromic normocytic anemia
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22
Q

Describe SI joint narrowing on radiographs in AS.

A

Symmetric

Erosions and sclerosis may lead to fusion

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23
Q

Describe pseudo-widening of the joint space on radiographs in AS.

A

– Subchondral bone resorption (blurring of joint line)
– Erosion sclerosis
– Calcification leading to ankylosis

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24
Q

What causes bamboo spine?

A

Ossification of the spinal ligaments, syndesmophyte formation, and ankylosis of the facet joints lead to complete fusion

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25
Q

Describe the appearance of syndesmophyte formation

A

Squaring of lumbar vertebrae’s anterior concavity

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26
Q

What causes syndesmophyte formation?

A

Ossification of the outer annulus fibrosis at the dorsolumbar and lumbosacral area and reactive bone sclerosis

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27
Q

Describe bone density in AS.

A

Associated osteopenia/ osteoporosis (bone washout)

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28
Q

What is Schober’s test used to detect?

A

Limitation of forward flexion and hyperextension of the lumbar spine

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29
Q

Describe how to perform a Schober’s test.

A

While standing erect, place a landmark midline at a point 5 cm below the iliac crest line and 10 cm above the illiac crest on a spinous processes. On forward flexion, the line should increase by > 5 cm to a total of 20 cm or more (from 15 cm).

30
Q

What is considered a restriction on a Schobers test.

A

Inc <5 cm on forward spine flexion

31
Q

How should patients with AS sleep?

A

Firm mattress

Sleep in prone position to keep spine straight/prevent spine flexion deformity

32
Q

What type of PT should be used for AS patients?

A

– Spine extension-based exercises
– Swimming is ideal
– Joint protection

33
Q

Which DMARDs can be used for AS?

A

Sulfasalazine Methotrexate

TNF inhibitors

34
Q

What should be used to treat uveitis in AS?

A

Topical corticosteroid drops

35
Q

What is the triad of Reactive arthritis?

A
  1. Conjunctivitis
  2. Arthritis
  3. Nongonoccal urethritis
    (“Can’t see, can’t pee, can’t climb a tree”)
36
Q

Who is typically affected by Reactive arthritis?

A

Males&raquo_space; females

More common in Caucasian population

37
Q

Which organisms cause Reactive arthritis?

A

– STDs: Chlamydia
– GI: Campylobacter, Yersinia, Shigella, Salmonella
– Also assoc w/ HIV

38
Q

What can patients with reactive arthritis progress to?

A

3% to 10% of patients progress to AS

39
Q

What is the onset of arthritis in reactive arthritis?

A

2-4 weeks after infectious event

40
Q

Describe the feature of arthritis in Reactive arthritis.

A 
Asymmetric
Oligoarticular (<4 joints)
Dactylitis
Enthesopathies
Low back pain: sacroiliitis
41
Q

What are the MC joints involved in Reactive arthritis?

A

LE > UE joints
LE: knees, ankles, and small joints of the feet
UE: wrist, elbows, and small joints of the hand.

42
Q

What can Reactive arthritis be confused with?

A

Plantar fasciitis

43
Q

Describe the appearance of dactylitis.

A

Swollen, tender digits with a dusk-like blue discoloration

44
Q

Which tendon is MC involved with enthesopoathy in reactive arthritis?

A

Achilles tendon

45
Q

What are ocular disorders of reactive arthritis?

A 
Conjunctivitis
Iritis
Uveitis
Episcleritis
Corneal ulceration
46
Q

What is Balanitis circinata?

A

Small painless ulcers on the glans penis or urethritis in reactive arthritis

47
Q

What is Keratoderma blennorrhagica?

A

Hypertrophic skin lesions on palms and soles of feet in reactive arthritis

48
Q

What are Reiter’s nails?

A

Thickened and opacified, crumbling, nonpitting

49
Q

What is seen in synovial fluid of reactive arthritis?

A
  • Turbid
  • Poor viscosity
  • WBC 5,000 to 50,000 PMNs
  • Inc protein
  • Normal glucose
50
Q

What is seen on labwork in reactive arthritis?

A
  • Inc ESR
  • RF (–) and ANA (–)
  • normochromic normocytic anemia
  • HLA-B27 (+)
51
Q

What is seen on radiographs in reactive arthritis?

A
  • “Lover’s heel”
  • Ischial tuberosities and greater trochanter
  • Asymmetric SI joint involvement
  • Syndesmophytes
  • Pencil-in-cup deformities of the hands and feet
52
Q

What is a “Lover’s heel”?

A

Erosion and periosteal changes at the insertion of the plantar fascia and Achilles tendons

53
Q

What is the treatment of reactive arthritis?

A
  • NSAIDs (indomethacin)
  • Abx: tetracycline or erythromycin
  • Corticosteroids
  • DMARDs
54
Q

What % of patients with psoriasis develop psoriatic arthritis?

55
Q

Who is affected by psoriatic arthritis?

A
  • Male=female
  • 30 to 55 yo
  • MC in white
56
Q

What is associated with psoriatic arthritis?

57
Q

Which joints are involved in psoriatic arthritis associated with HIV?

A

Foot and ankle MC and severe

58
Q

What is the treatment of psoriatic arthritis associated with HIV?

A

– First-line NSAIDs
– No oral corticosteroids
– No methotrexate

59
Q

Describe the skin and nail findings of psoriatic arthritis.

A

Erythematous, silvery scales over extensor surfaces

Nail pitting

60
Q

What is Auspitz’s sign?

A

Gentle scraping of psoriatic lesions results in pinpoint bleeding

61
Q

Describe the arthritis of psoriatic arthritis.

A
  • Asymmetric monoarticular or oligoarticular
  • Enthesopathy
  • Spondylitis, sacroiliitis
62
Q

Which joints are MC involved in psoriatic arthritis?

A

– Large joints: knee

– DIP involvement

63
Q

What is Arthritis mutilans?

A

Osteolysis of the phalanges and metacarpals of the hand resulting in “telescoping of the finger”

64
Q

What are lab findings of psoriatic arthritis?

A

HLA-B27 (+)

65
Q

What is seen on radiographs in psoriatic arthritis?

A
  • “Pencil-in-cup” DIP
  • Asymmetric sacroiliitis l/t fusion
  • “Fluffy periostitis”—hands, feet, spine, and SI joint
  • Syndesmophytes
  • Bone erosion
66
Q

Describe rehab for psoriatic arthritis.

A
  • ROM to all joints

* Do not abuse an inflamed joint as can l/t exacerbation

67
Q

What is treatment for psoriatic arthritis?

A
  • PUVA (long wave ultraviolet light)
  • Steroids—oral steroids not proven, injection may help
  • Anti-TNF antibodies (adalimumab, infliximab)
68
Q

Which joints are affected in enteropathic arthropathy?

A

Large joints—knees, ankles, feet

69
Q

When will enteropathic arthropathy typically resolve?

A

With bowel disease remission

70
Q

What are extra-articular manifestations of enteropathic arthropathy?

A
  • Erythema nodosa—Crohn’s
  • Pyoderma gangrenosa—ulcerative colitis
  • Painful deep oral ulcers
  • Uveitis
  • Fever and weight loss during bowel episodes
71
Q

What is seen on lab work in enteropathic arthropathy?

A
  • Anemia
  • Inc ESR, CRP
  • RF (–), ANA (–)
  • HLA-B27 (+)
  • (+) antineutrophil cytoplasmic antibodies (ANCAs) ~60% (antimyeloperoxidase)

In order Cuccurullo (91 decks)

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