inflammatory joint diseases part 2 Flashcards
what is SLE?
generalzed connective tissue disorder involving multiple organs
what are positive signs of SLE?
seropositive (Rh+) female increased ESR presence of LE cells \+ANA marked subluxation although joint integrity is relatively normal butterfly rash
what are some symptoms of SLE?
fever malaise anorexia weight loss polyarthralgia skin rash with sunlight
What are some secondary signs and symptoms of SLE due to excessive immunoreactivity?
damage to joints, skin, kidneys, serosal membranes
who are more likely to get SLE?
females age 20-40
are severe radiographic changes seen in people with SLE? where are the complaints seen?
no, 90% have an articular complaint, though
most common areas of complaint are: hands, feet, wrists, knees
what is the most frequent and serious feature of SLE?
kidney involvement leading to nephropathy and renal failure
what phenomenon is associated with SLE?
raynaud
describe joints for SLE.
swelling, pain stiffness
easily reversed joint deformities
administration of steroids to SLE patients can lead to what?
osteoporosis
ANV
spinal fracture
gastric ulcerations
what lab results do you get for someone who has SLE?
normocytic normochromic anemia
elevated ESR
+ANA
+Rh
deposition of immune complexes and fibrinoid material in tissues results in what for SLE patients?
vasculitis, synovitis, pleuritis, pericarditis
what are radiographic changes for SLE?
bilateral, symmetric reversible deformities osteoporosis soft tissue atrophy minimal arthropathy soft tissue calcification increased incicence of AVN MC involvement in the hand
what are the signs of SLE in the hands?
MCP and PIP involvement
ligamentous laxity, which results in reversible nonserosive ulnar deviation of the digits
swan neck and boutonniere deformity
ulnar deviation is involved in what disease?
SLE, RA, Jaccoud’s
describe jaccoud’s arthropathy?
follows rheumatic fever and multiple connective tissue disorders
jaccoud’s arthropathy patients have had many diagnoses of what?
streptococcal pharyngitis, rheumatic fever
jaccoud’s arthropathy is marked by what?
non-erosive, reversible joint deformity
what is the demographic for scleroderma?
females 30-50 years old
what is scleroderma?
generalized inflammatory connective tissue disorder involving skin, lungs, GI tract, kidneys and musculoskeletal system
what does scleroderma cause?
small vessel disease and fibrosis in multiple organ systems. Scleroderma is the cutaneous manifestation of the disease
what is the most unique feature of scleroderma?
skin appearance: edema, induration (hardening), atrophy
what usually exacerbates scleroderma?
exposure to cold or emotional upset that precipitates Raynaud’s phenomenon
what is raynaud’s phenomenon?
sympathetic nervous system dysfunction characterized by cyclic vascular canges usually of the hands which is precipitated by the cold or emotional upset
an initial vasoconstriction followed by a vasodilation with severe pain and swelling
what are some non joint related symptoms of scleroderma?
dysphagia and heartburn from decreased motility and dilation of esophagus
bowel is sluggish, distention and constipation occurs
muscle weakness and atrophy
skin edema being replaced by thickening and becoming “hidebound”
what pneumonic is associated with scleroderma?
CREST syndrome
what does CREST stand for?
calcinosis raynaud phenomenon esophageal dysmotility sclerodactyly telangectasia
what are the clinical features of scleroderma?
females, 30-50 years old, raynaud phenomenon, joint pain and stiffness, dysphagia, elevated ESR, +ANA, RF+
what radiology can you see with scleroderma?
acral tapering of soft tissues
extensive subcutaneous soft tissue calcification
flexion contractures
what are the segonegative arthropathies?
AS
Psoriatic arthritis
Reiter’s disease
enteropathic arthritis
AS
chronic inflammatory disorder, predominately affecting young adult males primarily involves axial skeleton
what are some characteristics for AS?
sequela of articular ankylosis, ligamentous ossification and enthesopathic changes
chronic low back pain in young men
aching, stiffness typically originate in low back ESPECIALLY IN SI JOINTS
50% of AS patients will have a peripheral disease where?
in hips and shoulders
clinical features of AS
MC seronegative spondyloarthropathy 1:1 to 1:10 female to male ratio male predominance 90% positive for HLA-B27 unknown etiology pannus
skeletal distribution of AS
axial, SI and spine
appendicular: proximal large joints of extremities
enthesis
erosions, bondy proliferation, fusion, bilatreal symmetrical
clinical features of AS
male 15-35 years 3 months of physcian observed pain and stiffness limited spinal motion SACROILIITIS limited chest expansion presents as spinal pain and stiffness iritis, conjunctivitis \+HLA B27, +ESR, -RA, -ANA usually no disability, sometimes severe aortic insufficiency, pulmonary fibrosis
what is the management of AS?
long-term plan to prevent, decrease or delay joint and postural deformities
NSAIDS to prevent inflammation and pain
suggest rheumatological cosultation with any of the inflammatory joint diseases
what are the discovertebral signs of AS?
corner erosions (romanus lesion)
reactive sclerosis (shiny corner sign)
loss of anterior concavity (vertebral squaring)
thin syndesmophyytes (bamboo spine)
disc calcification
interspinous ligament ossification (dagger sign)
trolley track sign (z capsular ossification)
whiskering (ischial entheseopathy)
endplate destruction (anderson lesion)
spinal fracture (carrot stick fracture)
spondylitis rhizomelique
a type of AS that looks like RA, but also has sacroiliitis
enteropathic arthritis is radiographically similar to what?
AS
is enteropathic arthritis HLA B27 positive or negative?
positive
5-15% of ulcerative and granulomatous colitis patients progress to what?
enteropathic arthritis
what are some clinical features of enteropathic arthritis?
abdominal complaint with joint pain HLA B27 + conservative management for arthropathy malaise, anorexia, weight loss in younger adults no gender association
what can surgical bowel removal do for enteropathic arthritis?
can stop peripheral involvement of enteropathic arthritis, but not axial involvement
how is enteropathic arthritis similar to AS?
SI joints bilateral, symmetrical, erosions, sclerosis, bony ankylosis
discovertebral erosions, sclerosis, squaring, thin, bilateral, marginal syndesmophytes
peripheral joints tend to be nonspecific swelling and periarticular osteoporosis
what is the difference between an anderson lesion and a carrot stick fracture?
if the ankylosed spine is fractured only, then it is a carrot stick fracture
it the ankylosed spine is fracture and hypermobile, it is an Andersson lesion
