Rheum #3 Flashcards
What are the 4 seronegative arthropathies
AS
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis
4 commonalities in seronegative rheumatic diseasd
1) negative RF test and ANA
2) predilection for spin
3) SI joint involvement
4) Association with HLA-B27
common S&S for ankylosing spondylitis
chronic inflammation, often associated with enthesitis
often young males (3:1 ratio for men under 40)
and 90-90% have HLA-B27
Rule of 2s for Ankylosing Spondylitis
0.2% of gen pop
2% of HLA-B27 positive individuals
20% of HLA-B27 positive indiivduals with affected family member
Ankylosing Spondylitis clinical presentation
mid and lower back stiffness, with morning stiffness lasting longer than 1 hour
night pain that is worse in the second half of the night.
Increasesd occiput to walld istance (because increased thoracic kyphosis and increased cervical flexion?)`
What ortho test for …AS?
FABER test for SI joint pain (commonly seen in AS patients I suppose?)
Modified Schober test (less than 5cm increase can be indicative of AS)
increased occiput to wall distance (>5cm)
Peripheral S&S for AS
asymmetrical large joint arthritis, and enthesitis.
extra-articular manigestations for AS
Opthalmic : acute anterior uveitis
Gastro: IBD (Ulcerative colitis)
Investigations for AS (special tests)
x-ray for SI (bony fusion(late) and symmetric sacroilitis)
x-ray for Bamboo spine
MRI (gold standard)
HLA-B27
big general 5 of psoriatic arthritis ***
asymmetric Olgioarthritis (<5 small and/or large joints)
- arhtritis of DIp w/ nail changes
- symmetric polyarthritis (like RA)
- Sarcoilitis
- Arthritis Mutilans (destructive and deforming small joint polyarthritis)
msk signs and symptoms of psoriatic arthritis (3)
morning stiffness >30 min
dactylitis (painful digits)
enthesopathy
Psoriatic Arthritis dermatology
- well-demarcated ertyhematous plaques with silvery scale
- nail involvement: pitting, transverse or longitudinal ridging, discoloration, subungual hyperketarosis, onycholysis, oil drops
Opthalmic cue in psoriatic arthritis
conjunctivity and iritis (anterior uveitis)
Classic imaging sign on psoriatic arthritis
pencil in a cup deformity of fingers
CASPAR classification of psoriatic arthritis (5, how many do u need to be pos)
evidence of psoriasis (current, past, family)
- psoriatic nail dystrophy
- negative Rheum Factor
- Dactylitis
- Radiological Evidence
patient must have at least 3
Psoriatic arthritis treatmetns (4)
treat skin lesions
NSAIDS initially
DMARDS
Anti TNF
Psoriatic arthritis treatmetns
treat skin lesions
NSAIDS initially
DMARDS
Anti TNF
Reactive arthritis/reiter’s syndrome def
seronegative, peripheral arthritis >1 month duration, after certain GI or GU tract infection
epidemiology of reactive arhtirits (what is it associated w + gender)
hla-b27 patients, more men than women
Etiology of Reactive Arthritis
GI: shigella, salmonella, campylobacter, yersinia, C. Diff
GU: Chlamydia! (16-44% of cases)
MSK S&S of reactive arthritis
ØAsymmetric peripheral arthritis
ØSpondylitis/sacroiliitis
ØEnthesitis (Achilles tendinitis, plantar fasciitis)
ØDactylitis
Opthalmic S&S of reactive arthritis
iritis (anterior uveitis) and conjunctivitis
Derm signs and symptoms of reactive arthritis (2)
Keratoderma blennorrhagicum (hyperkeratotic skin lesions on palms and soles)
Balanitis Circinata (small, shallow, painless ulcers of glans penis)
classic triad of reactive arthritis
arthritis
conunctivitis/uveitis
urethritis/cervicitis
Treatment for Reactive Arthritis (3)
NSAIDs + treat underyling cause
Sulfasalazine
Steroid Injections
Enteropathic Arthritis Definition
MSK manifestations in the setting of either ulcerative colitis or Crohn’s disease (with flares of inflammatory bowel disease) include peripheral arthritis (large joint, asymmetrical), spondylitis, and hypertrophic osteoarthropathy
