June1 M2-Inflammatory Back Pain

Question 1

inflam back pain is what

Answer 1

• back pain present in ank spond (a type of arthritis)
• 5% of chronic back pain (mech or inflam pain 3+ months) pts have this
• is an extension of the ERA JIA

Question 2

(EXAM) charact of inflammatory back pain

Answer 2

• uncommon
• starts <40
• morning stiffnes >30 min
• better with exercise
• rest doesn’t help
• pain at night
• insidious

Question 3

(EXAM) charact of mechanical back pain

Answer 3

• common
• any age, often >40
• morning stiffness <10 min
• worse with exercise
• better with rest
• may or may not have pain at night
• acute

Question 4

ank spond (the disease causing inflam back pain) definition

Answer 4

• chronic inlfma disease of axial skeleton: sx = back pain + progressive stiffness of spine
• not just a spinal disease (hips, shoulders, peripheral joints + also eyes, lungs, heart)

Question 5

what happens if ank spond untreated

Answer 5

spine fuses and you develop a bent, crooked spine

Question 6

ank spond is in which bigger group of diseases

Answer 6

spondyloarthritis

Question 7

spondyloarthritis (SpA) definition

Answer 7

• diseases characterized by enthesitis

- assoc with HLA-B27

Question 8

SpA diseases + most common

Answer 8

• ank spond (most common SpA)
• psoriatic arthritis
• ERA (juvenile SpA)
• undifferentiated SpA
• acute anterior uveitis
• reactive arthritis
• arthritis assoc with IBD

Question 9

(EXAM) clinical manifestations in SpA (ank spond)

Answer 9

• back pain (70% + of pts)
• inflammatiory back pain: >1 hour EMS (early morning sitffness), age onset <40, best with exercise, not better with rest, pain at night

Question 10

(EXAM) important investigation to do in SpA suspicion

Answer 10

genetic testing for HLA B27

the other testing usually done for autoimmune diseases is not useful, the RF, ANA, CRP, C3 C4, ESR, etc.

Question 11

(EXAM) recurrence of ank spond in families (inheritance)

Answer 11

• if you’re HLA-B27 negative, won’t recur in the family (in your kids), it’s rare that it recurs
• if HLA-B27 +, then may recur but other genes involved

Question 12

inheritance of ank spond

Answer 12

• many genes involved
• HLA-B27 is essential for inheritance
• HLA-B27 = 50% of the risk of getting the disease
• ONLY 5% OF HLA-B27+ PEOPLE DEVELOP ANK SPOND
• rarely recurs in families if HLA-B27 is negative in the parent, or if positive in parent and negative in children

Question 13

(IMPORTANT) how ank spond tx differs from RA tx

Answer 13

if NSAIDs don’t work, you have to jump to biologics immediately

Question 14

biologics that work in AS

Answer 14

• anti-TNFa
• anti-IL17 (secucinumab)
• anti-IL-12/23 (against the p40 chain) (ustekinumab) for psoriatic arthritis
• Jak3i (jakus kinase inhibitor) tofacitinib

Question 15

therapeutic dose of NSAIDs in ankspond

Answer 15

1800-2400 mg a day

Question 16

prognosis in SA

Answer 16

patients get much better when treated, easy to treat when recognized

Question 17

clinical assessment of SA (PE)

Answer 17

• full exam

- mechanical back exam to assess for flexibility, mobility, bending

Question 18

imaging in ank spond and SpA

Answer 18

XR to look for sacroilitis + grade it (end stage grade 4 = bilateral joint fusion)

Question 19

summary of diff things used to dx SpA

Answer 19

• inflam back pain
• arthritis
• enthesitis
• uveitis
• sacroilitis on XR, marrow edema on MRI
• elevated inflam markers (CRP, ESR)
• response to NSAIDs

Question 20

non pharmaco thing that helps a lot in AS

Answer 20

exercising (helps a lot and prevents fusing)

20 min a day