Juvenile Inflammatory Arthritis and Spondyloartritis Flashcards
What are the three types of juvenile inflammatory arthritis?
systemic
pauciarticular
polyarticular
Describe the clinical presentation and lab results of systemic JIA.
least common, presenting <17yo
presents with pain in any joint due to destructive arthritis, fever, rash, enlarged lymph
nodes but rarely uveitis
marked leukocytosis, anemia, elevated ESR
*absent ANA, rare rheumatoid factor
Describe the clinical presentation and lab results of pauciarticular JIA.
most common presentation, peaking at 2-3yo
affects large joints, rarely hips without systemic symptoms, uveitis is common
expect positive ANA and mild ESR elevation
Describe the clinical presentation and lab results of polyarticular JIA.
peak presentation 2-5 and 10-14yo
destructive arthritis in any joints, rarely the hip
no systemic symptoms, uvetitis is uncommon
mild leukocytosis or anemia, mildly elevated ESR +/- ANA, +/- RF
What is the typical presentation of ankylosing spondylitis?
more commonly males, 90% are HLA B27 positive (15% of US population), likely genetic component
principle symptom is symmetric sacroilitis (progresses to scaring fusion)
ascending fusion causing bridging syndesmophytes and ankylosis (shiny corner, bamboo spine)
associated symptoms: enthesitis, dactylitis (sausage fingers), restrictive lung disease
synovitis and enthesitis may be present on Xray early
What non-specific symptoms are associated with spndyloarthropathy? (ROS type items)
chronic low back pain inflammatory back pain heel pain peripheral arthritis acute anterior uveitis psoriasis positive FH good response to NSAID elevated CRP/ESR HLA-B27 MRI or radiographic evidence of SI joint scaring
How is ankylosing spondylitis diagnosed?
meeting criteria either:
imaging evidence and 1 other clinical feature or HLA-27 and 2 clinical features
Name 4 Spondyloarthropathies besides Ankylosing Spondylitis.
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Spondyloarthropathy
Juvenile Ankylosing Spondylitis
Define spondyloarthropathy.
Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself. However, many conditions involve both spondylopathy and spondyloarthropathy.
Which spondylarthroapthies are more common in men? Which are most associated with B27+?
AS and ReA affect men more frequently, equal effects in PsA and EA
90% AS are B27+, decreasing frequency with ReA, (80%) PsA (40%) and EA (30%) respectively
Are peripheral symptoms likely in AS, ReA, PsA and EA?
AS- rare
ReA common LE symptoms
PsA common UE and LE symptoms
EA common LE symptoms
Would you expect symmetric or asymmetric sacroiliac join involvement in AS, ReA, PsA and EA?
AS: always symmetric
ReA: 50% asymmetric
PsA: 40% asymmetric
EA: 20 symmetric
Describe the classic presentation of reactive arthritis.
low back pain/stiffness
posterior heal pain
uvetitis
history of travel or enteric disease
Describe the classic presentation of psoriatic arthritis.
fatigue few swollen digits **PIP predilection nail pits dactylitis scalp rash, also likely around umbilicus and glutes
arthritis mutilans (telescoping digits)
Describe the classic presentation of enteropathic arthritis.
lower extremity arthritis
history of diarrhea, GI upset, IBD
iron deficiency anemia (possible bleed)
