PART I Flashcards
major indication of ankylosing spondylitis?
low back pain, misdiagnosed as mechanical back pain
is AS pain lasting greater or less than 30 minutes?
greater than, b/c its inflammatory
AS can be peripheral or axial involvement?
both
spine and SI joint can progress to loss of spinal mobility, T/F?
true
what is the progression of axial AS?
from non radiographic axial SpA to ankylosing spondylitis
what is invoice in the spondyloarthropathies?
spine
SI joint
oligoarticular peripheral arthritis
what is the gene indicated?
sites of inflammation?
HLA-B27
synovium; enthuses can develop (achilles tendon, IIiotibial band, common extensor elbow)
psoriatic arthritis
enteropathic arthrits
spondyloarthritides
reactive arthritis
ankylosing
spondylitis
undifferentiated SpA
spectrum of spondyloarthropathies
common extra articular manifestations of AXSPA include?
uveitis, PSO, IBD
reactive arthritis can present as?
conjunctivitis circinate balanitis enthesopathy keratoderma blenorrhagicum dactylitis
average delay in diagnosis of AS?
8.8 years, worse clinical outcomes
this is both a prognostic and pathogenic factor?
smoking
how is AXSPA associated with reduced quality of life and high costs?
functional disability
pain
negative impact on employment and ability to work
high costs due to functional disability and disease management
what are the peripheral manifestations?
enthesitis
peripheral arthritis
dactylitis
how does AS present as an extra articular disease?
acute anterior uveitis
cardiovascular
- aortic regurgitation
- ascending aortitis
- conduction abnormalities
- pericarditis
- cardiomegaly
- increased CVA
pulmonary
-apical fibrosis
GI
-enteric mucosal lesions
renal
-IgA nephropathy
tx options?
controlling pain, morning stiffness, fatigue, extra articular disease
preserving fxn
- spinal mobility
- ADL
minimizing structural damage
-osteoproliferative and ankylosis, osteodestruction
minimizing socioeconomic impact
-sick leave and disability
best tx options for SPA and what for?
Anti TNF and IL-17, then NSAIDS
peripheral arthritis axial disease enthesitis dactylitis skin disease*
*NSAIDs do not
DMARDs only for peripheral arthritis and skin disease
over time, how is AS treated?
patient education with NSAIDs
then, exercise for axial involvement (TNF and IL 17 antagonist) and peripheral joint involvement (sulfasalazine and corticosteroid injection)
major summary of AS?
prolonged morning back stiffness
chronic enthesitis
appear bwt ages of 20-40
