Rheumatology 2.0 Flashcards
what does HLA b27 predispose to? (4)
"seronegative inflamm arthropathy" ank spon psoriatic arthritis reactive arthritis enteropathic arthritis
describe the main features of ank spon
spinal inflammation + fusion
causing lack of movement particularly in lumbar region and poor chest expansion
lower back pain that resolves on exercise not rest
describe the main features of psoriatic arthritis
skin lesions + arthritis in various asymmetrical/ RA pattern
nail changes - pitting, onycholysis + dactylitis
severe = “mutilans”
“pencil in cup” on xray = ?
psoriatic arthritis
what is the pattern of enteropathic arthritis?
large joints
peripheral + spine - inc sacroiliitis
Sacroilitis particularly in Crohns (20%)
treatment for psoriatic arthritis?
DMARDS - methotrexate, mostly
Biologics antiTNF if unresponsive
Joint replacement / fusion is considered
main features of reactive arthritis?
includes Reiters = urethritis, uvieitis, arthritis
fever + fatigue
OCCULAR
VISERAL
SKIN LESIONS
- oral ulcers / Keratoderma blennhorrhagiaca
MAY BECOME CHRONIC OR RELAPSING
what is Keratoderma blennorrhagicum, a feature of reactive arthtritis?
keratinized skin mucousy discharge skin lesions
palms and soles
may spread to the scrotum, scalp and trunk.
may resemble psoriasis
management of reactive arthritis?
90% resolves itself in 6 months Antibiotics to treat infection Corticosteroids for symptom relief DMARDS if becomes chronic Physio + OT potentially
main features of enteropathic arthritis?
peripheral + spinal arthritis Sacroilitis particularly in Crohn's fluctuates with IBD flares IBD symptoms - poo, weight loss, oral ulcers rheum - uvieitis, achilles tendonitis
treatment of enteropathic?
IBD treatment
Avoid NSAIDs
Analgesia
Steroids
DMARDS
Anti TNF
