Seronegative Arthritis - Buskila Flashcards
What is the typical progression of ankylosing spondylitis?
What are the skeletal and extraskeletal manifestations?
Skeletal
• Sacroiliitis (always starts with erosions in the sacroliliac joints then moves to spine:)
• Spondylitis (attachments of ligaments, fusion of anterior ligament, and syndesmophytes-bamboo spine, then progresses peripherally)
• Peripheral arthritis
• Enthesitis (inflammation of tendon attachment to bone)
• Osteoporosis
• Vertebral fractures
• Spondylodiscitis
Extraskeletal: • Uveitis anterior • Pulmonary involvement • Cauda equina syndrome • Amyloidosis • Colitis (IBD) • Cardiac involveme
inflammatory- improves with exercise
What is the clinical presentation of psoriatic arthritis?
Swollen DIPs
Yellowish-white nails with ridges and pitting (>20/nail bed)
Dactylitis (pathognomonic of this or reactive arthritis)
Psoriatic rash with swan-neck deformaties
5 Presentations
Spondylitis (5%, different from AS, can affect isolated segments, but 1/3 sacroiliac involvement)
Oligoarthritis (40-50%)
Symmetric Polyarthritis
Arthritis Mutilans (5%)
DIP Involvement (5%)
Psoriasis present before the onset of joint disease (70%)
Psoriasis comes with the arthritis (15%)
Psoriasis comes after the arthritis (15%)
How is psoriatic arthritis distinguished from alkylosing spondylitis?
What treatments are used for ankylosing spondylitis and psiriatic arthritis?
Daily NSAID treatment (75% respond vs 15% of regular back pain)
TNF-alpha blockers
- Infliximab: chimeric McAb (Remicaid)
- Etanercept: Not McAb but an IgG receptor construct
- Adalimumab (Humera): fully human Ab, decreases reactions
Which bacteria are most common in causing reactive arthritis?
Yersinia
Campylobacter
Shigella
Salmonella
Chlamydia
Classified as a seronegative spondyloarthropathy
Occurs 2-4 weeks after inciting infection
Most responsible organisms have an affinity for mucous membranes
