MS1: Seronegative Spondyloarthropaties Flashcards
what are spondyloarthropaties
group 2 inflammatory but non infectious - so negative sa RH factor
erosive din sha
what parts of the body do spondyloarthropaties usually affect
SI joint
sa IV disc
bony insertions ng mga tendon sa spine
classifications of spondyloarthropaties
inflammatory back pain
axial spondyloarthritis
mga disease under axial spondyloarthritis
ankylosing spondylitis
reiter’s
psoriatic arthritis
chronic inflammatory disease
general characteristics present in SS
negative RH
sacroilitis
axial involvement
peripheral arthrtis
enthesopathy
eye involvement
family clustering
LOM
HLA-B27
common symptoms SS
insidous onset of backpain at 30 yo for several months
pain more at rest - relieved by lakad
if may family history
discuss criteria of classification for axial spondyloarthritis
sacroilitis plus 2 other features
IBP
arhtritis peripheral
enthesitis
uveitis
dactylitis
psoriasis
crohns or UC
family history
HLA B27
elevated CRP
most common type of SS
ankylosing spondylitis
nag ffuse spine
discuss charactericts AS
chronic progressive inflammatory - SI pataas
undetermined cause
inflammation of insertion ng ligaments, tendons and capsules
may extraarticular involvement
primary joints affected AS
SI - hallmark
spine
large peripheral joints - hips and joints
hallmark joint of AS
SI
which popu is AS more common
males 35 yo.
genetic sa HLA-B27
classic presentation of AS
mid 20s sa male
middle or low back pain localized to pelvis, buttocks and hips
morning stiffness more than an hour - more than 3 mo.
paravertebral muscle spasm, aching stiffness
xray sacroilitis
PE of AS
dec mob = reduced lumbar flexion and lordosis
rarely tender and SI
spine becomes fused
+ schober’s test
lab findings of AS
+ HLA-B27
- RF and ANA
elevated ESR, serum IGA, bone alkanise phosphatase and CK
radiologic finding of ankylosing spondylitis
bamboo spine
complications of AS
fracture/SCI common sa cervical
osteoporosis
pseudoarthrosis sa thoracolumbar
discuss reactive arthritis
sterile infflamatory arthritis - reactive to infections away from joint
UTI ganun
discuss reiter’s syndrome
type of reactive arthritis
may triad - conjunctivitis, urethritis and arthritis
discuss DD of reactive from reiter
may triad yung reiter
discuss DD of reactive to septic arthritis
pag inaspirate no pus in joint sa reactive
how are reactive and reiters related
both positive for HLA-B27
features of reiters
triggered by infection - 1-4 wks after onset
fever, malaise, weight loss
assymetric affecting large joints
group 2 - sterile inflammatory
may extraarticular - eyes and mucocutaneous lesion
other name for reiters
oculo-urethro-synovial syndrome
hans reiter description of reiter’s
urethritis
conjunctivitis
arthritis following bloody diarrhea
what are the mucocutaneous lesion in reiters
oral ulcers
keratoderma blennorrhagica
circinata balatis
nail changes
4th criteria toh
common popu of reiters
3rd decade and less in children
men
discuss post venereal and dysenteric reiters syndrome
venereal - males
dysenteric - equal males and females
urogenital pathogens of reiters
chlamydia
enteric pathogens of reiters
shigella
salmonella
yersinia
campylobacter
vibrio
common joints affected of reiters
knees and ankles less sa SI
weight bearing joints of LE
discuss skin lesions reiters
resembles psoriasis
keratoderma blennorrhagica - soles, palms
circinata balatis - tite
onycholysis - nails
oral ulcers
other extraarticular manifestations in reiters
cardio-pulmo and nerve lesions
determine if AS or reiters
no urethritis and conjunctivitis
AS
determine if AS or reiters
urethritis and conjunctivitis is common
reiters
determine if AS or reiters
SI and spine is involved and symmetric involvement
AS
determine if AS or reiters
knee and ankle and assyemtric involvement
reiters
what is psoriatic arhtritis
chroninc and recuurent tas erosive
GROUP 2 - associated w psoriasis
combines features of RA and spondyloarthropathies
sex predilection of psoriatic
equal sex but women tend to develop symmertric and spinal involvement
common age for psoriatic
20-30 yo
discuss onset for psoriatic
acute or insidous preceded by skin disease
risk factors fro psoriatic
unknown cause but HLA B27 marker is common
common joints affected in psoriatic
DIP, spine and SI
precedes skin lesion after 1 yr
pattern of arthritis in psoriatic
DIP - MCP and MTP later
assymetric oligo but symmetric poly
axial - ankylosing
arthritis mutilans - erosive
SSx psoriasis
pain and stiffness in inflamed joint
morning stiffness more than 30 mins
pain on stressing joint, tenderness and effusion
aggravated by prolonged immob and reduced by rest
if PSA or AS
less SI involvement
PSA
if PSA or AS
back and neck pain LOM of lumbar and cervical
AS
if PSA or AS
ankylosing
both
if PSA or AS
20-30 yo
PSA
if PSA or AS
40 up
AS
if PSA or AS
SI changes in 10-30%
PSA
if PSA or AS
agad na grade 4 sacroilitis
AS
if PSA or AS
skin lesion
PSA
dicuss dactylis in PSA
sausage digits - inflammation of tendon sheat in fingers
nail lesion in PSAs
pitting
ridging
crackling
onycholysis
other manifestations in psoriatic
uveitis
conjunctivitis
aortic valve insuff
skin manifestations psoriatic
auspitz - pinpoint bleeding
koebners - new skin lesions on injured skin areas
lab findings in psoriatic
+ HL4
- Rh
radiologic findings in psoriatic
pencil cup deformity
discuss inflammatory bowel disease
chronic inflammatory dieases in GIT
causes of inflammatory bowel disease
genetic predispo
environment
autoimmune
2 major types of inflammatory bowel disease
crohns
ulcerative colitis
discuss occurence of inflammatory bowel disease
15-35 yo
UC - women
CD - men
UC or CD
bloddy diaarhea
UC
UC or CD
tender RLQ mass
CD
UC or CD
acute flares
Uc
UC or CD
indolent and chronic
CD
UC or CD
rectal pain
UC or CD
uveitis
CD
UC or CD
erythma nodosum
CD
UC or CD
aphtous ulcer
CD
UC or CD
colitic arthirtis
CD
UC or CD
ankylosing
UC
UC or CD
cholangitis
UC
UC or CD
amyloidosis leading to renal failure
CD
UC or CD
gangrene
UC
STD in reiter is commonly seen in
men
GI involvment in reiter is commonly seen in
female
what does post venereal reiters mean
disease is from sex - STD
what does post dysneteric reiters mean
assoc w GI infection
