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Tri 5 - Arthridities > Psoriatic and Reactive Arthritis > Flashcards

Psoriatic and Reactive Arthritis Flashcards

1
Q

What is a type of seronegative spondyloarthopathy that presents as a combination of EROSIVE and PRODUCTIVE asymmetric oligoarthritis mainly in the DIPs and PIPs?

A

PsA (Psoriatic Arthritis)

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2
Q

On avg, what percentage of patients with psoriasis will develop PsA?

A

5%

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3
Q

T/F After 1960, PsA was thought to be a type of RA

A

True, before 1960 it was considered a type of RA

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4
Q

T/F Pts in their 60s are the most susceptible to PsA

A

False, 30-50

Note: Female = Male in incidence

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5
Q

How long after the development of psoriasis can it take for a pt to develop PsA?

A

10-20 years

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6
Q

1 out of __ people with PsA will have arthritis as a condition which will lead to psoriasis

A

7

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7
Q

5 distinct subtypes of PsA. What are they?

mnemonic maybe?: Ao, Pd, SSA

A 
Asymmetric Ologoarthritis 55-70%
Polyarthritis in DIPs
Symmetric (resembes RA)
Spondyloarthritis (30-50%)
Arthritis mutilans (3-5%)
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8
Q

What is the etiology of PsA?

A

Autoimmune

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9
Q

What lab test marker will be elevated in 60% of patients who have sacroiliitis?

A

HLA-B-27+

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10
Q

What are some factors that may trigger the onset of PsA or exacerbations of psoriasis?

A

Recent infection, likely, GABHS organism (Strep A)
Regional trauma
Smoking/Alcohol

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11
Q

Clinically, what would you see in a patient with PsA?

A

Psoriasis

Note: Guttate and Pustular psoriasis may manifest with more severe arthritis

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12
Q

80% of cases of PsA will have what physical condition?

A

Psoriatic nail disease

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13
Q

What is an important factor of PsA in the distal LE?

A

Enthesitis at the achilles and plantar fascia insertion

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14
Q

PsA with sacroiliitis and spondyloarthropathy shows greater association with what ocular manifestations?

A

Uveitis and Keratoconjunctivitis

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15
Q

T/F PsA may present with more severe pain and in more joints than RA?

A

FALSE, PsA may present with less severe pain and in fewer joints

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16
Q

What is a key Dx finding that may lead you to the dx of PsA?

A

Morning stiffness and joint tenderness in asymmetrical distribution - esp. DIP and PIP
Note: MCP and wrist not commonly involved

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17
Q

Soft tissue swelling especially in the ____ tendons may be seen

A

flexor

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18
Q

What can be observed involving the entire digit, also known as a ‘sausage digit’ in PsA.

A

Dactilytis

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19
Q

Pathology of PsA is seen as reactive ____ causing ___ and productive osseous changes…

A

Enthesitis, erosions

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20
Q

T/F: Proliferative processes of PsA may lead to periostitis, osseous sclerosis and thickening of tissues especially of the digits…

A

True

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21
Q

T/F: Much like RA bone erosions, these begin marginally but are followed by enthesitis with reactive periostitis, whiskering and fuzzy bone formation seen as “mouse ears” in the distal tufts…

A

True

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22
Q

What three presentations can periostitis take in PsA?

A

Thin periosteal layer of new bone
Thick irregular layer
Irregular thickening of cortex itself

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23
Q

Erosions may proress leading to more aggressive artilage and subchondral bone destruction leading to ______ with “________” deformity

A

arthritis mutilance, “pencil in cup”

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24
Q

T/F: overall mineral bone density is affected like it is in RA

A

False; overall mineral bone density is NOT affected like it is in RA, aka bone density is maintained in PsA

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25
Q

Severe cases of PsA, one can see a telescope formation of an “_-___”

A

“opera-glass”

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26
Q

Spinal involvement with PsA is seen as what?

A

Bilateral sacroiliitis - asymmetric involvement

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27
Q

What is the presentation in the thoraco-lumbar area of PsA?

A

Bulky paravertebral ossifications, aka. non-marginal syndesmophytes

28
Q

T/F: PsA and ReA spinal involvement is not distinctly different from AS

A

False, PsA and ReA spinal involvement IS distinctly different from AS

29
Q

At what vertebral level in the cervical spine should PsA and ReA be considered as a possible cause of instability and ligamentous laxity?

A

C1-C2

Note: not frequent but has been seen

30
Q

What are the hallmark changes seen in PsA?

A

Fluffy periostitis combined with severe erosive bone changes - can see an “ivory phalanx” - also pencil in cup deformity is common in the interphalangeal joints

31
Q

T/F: in PsA sometimes erosions of the entire phalanx can be seen in addition to other patterns of erosive and productive bone changes

A

True

32
Q

Ankylosing spondylitis will present with marginal syndesmophytes in the spine, what does PsA present with?

A

Non-marginal syndesmophytes, aka. paravertebral ossifications

33
Q

PsA is a type of arthritis that can lead to complete destruction of joints and adjacent bone which is known as?

A

Arthritis Mutilants

34
Q

Concertina (like an accordion) this describes the telescoping of the digits in what type of arthritis when the patient has arthritis mutilans?

A

PsA arthritis (concertina deformity is also opera glass deformity)

35
Q

Treatment for PsA is what 5 things?

A

NSAID, DMARD
Corticosteroid injections
Physiotherapy
MANIPULATION - HIGHLY CONTRAINDICATED!

36
Q

ReA (Reactive arthritis) is formerly known as what?

A

Reiter syndrome

37
Q

ReA can be defined as a triad of what?

A

Non-infections urethritis
Conjunctivitis
Arthritis (affecting heels and knees commonly)
Note: this is present in less that 35% of cases…

38
Q

How does ReA develop?

A

autoimmune response to an infections agent

salmonella, shigella, campylobacter, GU infection - chlamydia

39
Q

ReA develops _____ weeks following infectious illness

A

1-3 weeks

40
Q

There is a possible 4th component of development, what is this?

A

Mucosal and cutaneous features

41
Q

ReA is 3:1 ___ : ___ and generally develops in 3-5 cases per 100,000 people

A

M:F

Males in their 20-30’s

42
Q

What immune histocompatibility complex is present in over 80% of people with ReA?

A

HLA-B27

43
Q

What is the classic saying for ReA?

A

“Can’t see, can’t pee, can’t climb a tree”

44
Q

Is ReA asymmetrical or symmetrical?

A

Asymmetrical as distal oligoarthritis

45
Q

_____ may present with burning, erythema, photophobia and ocular pain with reduced vision?

A

Conjuctivitis

46
Q

_______ can be significant as keratoderma blennorhagicum and onychodystrophy, painful pustular eruptions on dorsum of extremities.

A

Skin involvement
Hands - Palms (dorsum)
Feet - Soles (not dorsum but yuri thinks so)

47
Q

Psoriaiform lesions can be seen along with circinate blanatis… What is this?

A

Inflammation about the glans of penis

48
Q

Are there any bacterial species identified in the synovial fluid of ReA patients?

A

NO

49
Q

What two markers will be elevated in labs that may help with Dx?

A

T2 helper cells increased

HLA-B27 increased

50
Q

____ at the tendons and ligaments insertion sometimes identical to ____ can be seen at the plantar fascia and achilles… (25-50%)

A

Enthetitis, PsA

51
Q

What are the most common target sites of ReA

A 
Small foot joints
Calcaneous
Knees
Ankles
Note: Hands affected rarely
52
Q

What are a few of the GENERAL radiographic features seen in ReA?

A
  • Linear fluffy periostitis/enthesitis
  • Soft tissue thickening at the insertions of tendons and ligaments
  • Pre-achilles or retrocalcaneal bursitis
53
Q

T/F: Overall bone density is not maintained

A

False, overall bones density is maintained

54
Q

What type of osteoporosis can be observed?

A

Hyperemia-related Juxta-articular osteoporosis

55
Q

T/F: Spinal changes in ReA are seen in 40-60% early onset and 5-10% chronic cases

A

False, 5-10% Early, 40-60% Chronic

56
Q

Is There sacroiliitis noted and if so, is it bilateral or asymmetrical?

A

Sacroiliitis is noted

There is bilateral sacroiliitis, but it is ASYMMETRICAL

57
Q

In the T/L spine, what type of syndesmophytes are seen?

A

Non-marginal aka paravertebral ossifications

58
Q

What imaging modality can be used for early diagnosis and what does it show?

A

MRI - T2 specifically & STIR

shows: tenosynovitis, enthesitis, soft tissue inflammation

59
Q

Are there oral lesions in ReA?

A

Yes

60
Q

What is the typical treatment for ReA?

A

Systemic steroid and NSAID

61
Q

Can one distinguish the difference between ReA and PsA on a radiograph of the T/L region?

A

No, the non-marginal osteophytes will look the same

Note: to distinguish you must look at specific deformities, joints involved, and initial cause

62
Q

What are the target sites of ReA?

A
  • LE
  • MTP’s and 1st Ips
  • Calcaneous
  • Ankles
  • Knees
63
Q

What is the prognosis for ReA?

A

Variable
Mostly it is thought to be self-limiting in 3-12 months
Note: cases with high HLA-B-27 tend to recurr in 15-50%, Therapy = inflammation control

64
Q

What disease is defined as immune mediated triad or oral aphthous ulcers, genial ulcers and uveitis?

A

Behcet Disease

65
Q

Why the hell is Behcet disease at all important to arthridities?

A

Most common articular involvement is usually with non-erosive inflammation induced synovitis presented as arthralgias (knee, ankle, foot) in 40-70% of cases

Sacroiliitis in BD may appear similar to other seronegative spondyloarthropathies

Tri 5 - Arthridities (3 decks)

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