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NYCC Bone & Joint > Psoriatic & Reactive Arthritis > Flashcards

Psoriatic & Reactive Arthritis Flashcards

1
Q

5-7% of patients with ____ develop psoriatic arthritis

A

psoriasis
(must have this Dx first)

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2
Q

A patient with more surfaces of rough skin and bad dandruff is at most risk of developing ____

A

joint symptoms (psoriatic arthritis)
(more severe psoriasis = ^risk)

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3
Q

Where is psoriasis usually located?

A
  • extensor surfaces around elbows
  • knees
  • back
  • scalp (dandruff)
  • pubic regions
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4
Q

In a patient with psoriatic arthritis, ____ symptoms precede ____ symptoms

A

skin; joint

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5
Q

At what age do joint symptoms tend to manifest in patients with psoriatic arthritis?

A

20-50yrs

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6
Q

What joints are commonly affected by psoriatic arthritis?

A

(prefers UE)
- hands (DIPs)
- foot
- SI
- T/L
- c/s

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7
Q

The earliest manifestation of psoriatic arthritis is in what joints?

A

DIP (hands)

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8
Q

What gene is implicated in psoriatic arthritis?

A

HLA-B27

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9
Q

What are the clinical manifestations of psoriatic arthritis?

A
  • psoriatic skin rash, bleed when scratched
  • dactylitis (spindle digits & sausage digits)
  • asymmetrical stiffness & pain (after inactivity)
  • pitting (deep grooves) of nails
  • arthritis mutilans (later stage)
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10
Q

Describe the appearance of a psoriatic skin rash

A

sharply demarcated, non-elevated, erythematous skin lesions covered by dry silvery lesions

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11
Q

Swelling around the joints of the fingers is called ____

A

spindle digits

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12
Q

Swelling of the entire length of the digits is called ____

A

cocktail sausage digits

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13
Q

In psoriatic arthritis, dactylitis initially presents as ____, and may progress to ____

A

spindle digits
sausage digits

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14
Q

What are the common radiographic characteristics of psoriatic and reactive arthritis in the spine and SI joints?

A
  • uniform narrowing of jt space
  • asymmetrical sacroiliitis (bilat. or unilat.)
  • para/non-marginal syndesmophytes
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15
Q

What are the radiographic characteristics specific to psoriatic arthritis in the extremities?

A
  • marginal erosions & fluffy periostitis –> deformities (mouse ear, pencil-in-cup/mortar-in-pestle)
  • spindle digits, cocktail digits
  • Ray pattern
  • Arthritis mutilans (opera glass hand / main en lorgnette)
  • hitchhiker thumb, swan neck, boutonniere deformities
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16
Q

What is pencil-in-cup deformity?

A

peripheral erosion of proximal bone + central erosions of distal bone
(*don’t confuse w/ Gull-wing)

17
Q

What joint’s in the hand commonly have mouse ear deformity in patients with psoriatic arthritis?

18
Q

What is another name for reactive arthritis that should ABSOLUTELY NEVER be used?

A

Reiter’s syndrome
(bad dude)

19
Q

What demographic is primarily affected by reactive arthritis?

A
  • almost exclusively men (men are sluts; 50:1)
  • onset in 18-40s
20
Q

What is the classic triad of symptoms seen in reactive arthritis?

A

“can’t see, can’t pee, can’t dance with me”
- conjunctivitis
- urethritis
- polyarthritis (SI jts & LE)

21
Q

What are the most common STIs that precede reactive arthritis?

A
  1. chlamydia
  2. gonorrhea
    (can affect HIV pts)
22
Q

What enteric disease may precede reactive arthritis?

A
  • Shigella
  • Yersinia enterocolitica
  • salmonella
23
Q

What genetic variant is commonly associated with reactive arthritis?

24
Q

What is generally the earliest symptom of reactive arthritis?

A

urethritis (burning & ^frequency)

25
Q

What are the clinical features of reactive arthritis?

A
  • urethritis
  • conjunctivitis
  • asymmetrical polyarthritis
  • keratoderma blennorrhagica
  • Balanitis circinata (penile lesion)
26
Q

What is keratoderma blennorrhagica?

A

red bumps or pustules on the palms, soles of the feet, and trunk, resembling psoriasis or meningitis, but caused by reactive arthritis

27
Q

What are the radiographic characteristics specific to reactive arthritis?

A
  • Favors LE
  • Lover’s heel
28
Q

What is Lover’s heel?

A
  • inflammatory erosion from the retrocalcaneal bursa adjacent to the achilles tendon insertion
  • inflammatory enthesophytes at plantar fascia origin
29
Q

What are the target sites of reactive arthritis?

A
  • SI jts (unilateral or BL asymmetric)
  • spine
  • calcaneus (lover’s heel)
  • ankle
  • knee
  • forefoor
  • shoulder
  • wrist
30
Q

What are the relevant laboratory findings of reactive arthritis?

A
  • HLA-B27 positive
  • RF negative
  • anemia, leukocytosis
  • ^ESR/CRP
  • often no organism isolated at culture of urethral specimen (occurs 6mo - 2yrs post STI)

NYCC Bone & Joint (52 decks)

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