post midterm 4: spondylo Flashcards
What causes spondyloarthropathy?
Pathogenesis uncertain; genetic factors play a role
**HLA-B27 association
HLA-B27 is present in up to 88% of patients with uveitis
HLA-B27 is present in 80-90% of patients with ankylosing
spondyloarthropathy affects what pops?
male more than female and caucasian
Age < 45
spondyloarthropathy shows up as what on lab findings?
No typical serologic abnormalities “seronegative”
*CRP often elevated
what does spondyloarthropathy affect?
*Large axial joints (sacroiliac, vertebral) develop endochondral bone formation and joint fusion.
-similar to tendonitis
*Peripheral arthritis = Non-erosive
[Monoarthritis or oligoarthritis (few joints)]
*Associated inflammation
Ocular, aortic, lung, skin
Fatigue, fevers
what are some Criteria For Spondyloarthropathy ?
*Age < 45
*Inflammatory back pain
*Sacroiliitis on imaging
HLA-B27
*Enthesopathy=attachment of a tendon or ligament to a bone
Synovitis (predominantly lower extremity)
Dactylitis
Uveitis
Psoriasis
*Inflammatory bowel disease
Recent urethritis, cervicitis, or acute diarrhea
Positive family history
describe the back pain assoc with Ankylosing Spondylitis? how long does it last, what improves it?
Inflammatory back pain, insidious onset (months or longer), stiffness
*often improves with movement
Sacroiliitis, usually progressive
Vertebral disc/ligamentous involvement -> ankylosis
T/F: Ankylosing Spondylitis can involve heart and lungs
True:
Cardiac involvement (10%)
Aortic root dilatation, aortic insufficiency
Cardiomegaly, conducting system abnormalities
Pulmonary fibrosis (cough, dyspnea)
what kind of Enthesitis does Ankylosing Spondylitis
Enthesitis: Fasciitis (heel pain), costochondritis (chest pain), tendinitis
Features of inflammatory spinal pain vs mechanical back pain:
Insidious onset
Improved with exercise
Morning stiffness and pain at night: same as mechanical…
At least 3 months duration
How do you dx Ankylosing Spondylitis?
*Assess spinal mobility (Schober test) Diminished in AS *X-rays Sclerosis Joint-margin blurring Ankylosis
what is often the first indication of undiagnosed spondyloarthropathy?
ocular symptoms:
Spondyloarthropathy present ~ 50% pts with recurrent, unilateral anterior uveitis
describe the common ocular associations with Ankylosing Spondylitis?
Nongranulomatous anterior uveitis
- Acute onset (over several days)
- Initial episode unilateral, recurrences in either eye
- Recovery generally in 2 to 3 months
Other findings of ocular inflammation
- Conjunctivitis
- Scleritis
- Keratitis
Recovery is often complete with overall good prognosis
Recurrence is common; late complications can occur (cataracts, glaucoma)
what are some complications with progressive spinal akylosis?
1) Progressive spinal ankylosis
- Limited spinal mobility
- Postural deformities – neck flexion
- Impaired vision
- Impaired lung capacity
- Neurological syndromes / compression
2) Long term ocular complications (cataract, glaucoma)
3) Bone loss / osteoporosis
4) Cardiac
5) Aortic insufficiency
6) Coronary artery disease – increased risk
how do you tx Ankylosing Spondylitis?
- PT
- surgery
NSAID’s (high doses)
Often effective alone
Glucocorticoids
Systemic short term, local injection, uveitis
what is Reactive Spondyloarthropathy (Reiter’s Syndrome)? what causes it?
-Inflammatory disorder of unknown cause
-Symptoms follow within weeks after infection with enteric or urogenital pathogens
-Association seen with HIV infection
Sometimes no pathogen identified (though history of diarrhea)
what are some Clinical Features of Reactive Spondyloarthropathy?
Oligoarticular arthritis
Enthesitis
Ocular inflammation
Mucocutaneous lesions
Genital inflammation: Urethritis, balanitis, cervicitis, prostatitis, cystitis
Pericarditis
Constitutional symptoms: fever, weight loss
what kind of arthritis do you see in Reiter’s?
Oligoarticular arthritis
- Large joints of lower extremities most often
- Small joints of hand / dactylitis (sausage digits)
- Ascending spinal arthropathy (less commonly)
what kind of Ocular inflammation do you see with Reiter’s?
Most commonly conjunctivitis
Less often: anterior uveitis, episcleritis, corneal ulcers
what kind of Enthesitis do you see with Reiter’s
Often Achilles / heel
what kind of mucocutaneous lesions do you see with Reiter’s?
-Painless oral ulcers
-Keratoderma blenorrhagica
[Pustular lesions progress to hyperkeratotic, scaling lesions]
-Erythema nodosum
Painful erythematous lesions on legs
what is the prognosis for Reactive Spondyloarthropathy/Reiter’s?
Prognosis > 50% resolve within 6 months > 6 months “chronic” Majority resolve by 12 months Chronic arthritis and longer term residual pain can persist; arthritis can recur
what is Juvenile Chronic Spondyloarthropathy? when is the onset? what gender does it affect?
Group of inflammatory joint disorders in children
-Onset age range often 2nd decade / adolescence
-More common in boys
HLA-B27 association
-Arthritis and enthesitis - usually lower extremity joints
-May initially be diagnosed as isolated injury (tendinitis, etc)
-Sacroiliitis and spinal arthritis may develop later
-Uveitis may occur
-Systemic symptoms
-Fever, weight loss, weakness, anemia, leukocytosis
Symptoms/findings of colitis or psoriasis should be sought
what is psoriasis?
Dermatological disease with:
Hyperproliferation of epidermis
Plaque form most common
Red, inflamed lesions covered with silvery white scales
T/F: psoriasis is assoc with uveitis and arthritis
True.
Can be triggered by Infections (strep, HIV), stress, skin injury
