Seronegative Polyarthritis Flashcards
poly vs oligo arthritis
polyarthritis= inflammation of >4 joints
oligoarthritis = 2-3 joint inflammation.
careful Qs to ask on history
joint swelling
morning stiffness
- pattern of joint involvemtn
extra-articular symptoms and signs
- family history
- XRAYS
4 key reasons why someone might have ACUTE polyarthritis
-
infection-related
- bacterial (gonnococcal, meningococcal, subacute bacterial endocarditis)
- viral (rubella, parvovirus)
- post-infectious reactive arthritis - immune (early AI disease)
-
metabolic: crystal-induced arthritis
- 4. neoplastic (leukemia)
4 key reasons why someone might have CHRONIC polyarthritis (>6 weeks)
- infection related: hepC
- immune: RA, seronegative sponduloarthropathies, connective tissue diseases like SLE or sjogrens, vasculitis, systemic sclerosis
- metabolic (crystal induced arthritis)
- degenerative :OA
4 broad catergories of seronegative spondyloarthropathies
- ankylosing spondylitis (adult and juvenile- onset AS)
- enteropathic arthritis (crohn’s disease, ulcerative colitis)
- psoriatic arthritis
- reactive arthritis
features of spondyloarthropathies– which joints does it affect more? age of onset? which lab values are affected? which genes are associated?
rf and ANA negative, maybe has an ESR OR CRP,ANEMIA
- axial arthritis (sacroilitis, spondylits)
- peripheral - large joints, uaully asymmetric, affects LOWER EXTREMITIes
- ENTHESITIS IS HALLMARK
- younger age of onset
what in enthesitis
hallmark of spondylarthropathies
- inflammation at fibrocartilage insertions of tendons, fascia or ligaments into bone.
- spine, elbows, shoulders, hip girdle, patellar tendon, achilles, plantar fascia, fingers and toes
features of ankylosing spondylitis- which sex is affected more, what genetic ocmponent, which joints, what would you see on PE?
– all patients have sacroiliitis (symmetrical)
– ascends from lumbar TO cervical spine
– progressive bony fusion of spine
- starts with alternating buttock pain and has INFLAMMATORY BACK PAIN with morning stiffness– worse with rest, pain disturbs sleep but better with exercise
- 1/3 has peripheral joint involvement.
affects males>females
- usually onsets in late teens or early 20s
- higher prevalence in native americans
- some association with HLA-b27
PE: - tender SI joines/spine/enthesis. decreased range of motion in all planes with abnormal schober’s test. there is an INCREASED DISTANCE occiput-to-wall distance, QUESTIONMARK POSTURE.
HOW does the question mark posture in AS manifest?
decreased lumbar lordosis, increased thoracic kyphoses and decreased cervical lordosis.
what is the shober test
for ankylosing spondylitis: find dimples of venous where iliac spine is (around L4-L5), should be around 15 cm when trying to touch toes. in AS, the spine doesn’t expand.
xray features of AS
- sacroilitis cuasing erosion and scleorsis of joint margins
- bondy fusion, loss of sclerosis
- symmetrical syndesmophytes (ossification of longitudinal spinal ligaments)
- osteopoosis
- BAMBOO SPINE
complete fusion of SI joint. you cant even see the joint
compare the vertebra
on the left is AS. there is calcificaiton of ligements contributing to spine fusion. normally, there is a clear separation on xray between vertebra
extraarticular features of ankylosing spondylitis
- enthesitis
- iritis
- cardiac involvement (aortic regurgitation, conduction defects),
- apical pulmonary fibrosis
this patient with AS has enthesitis– can see erosions where the tensons (plantar and achilles) are inserted
irits. extraarticular featurs of ankylsoing spondylitis. irregular pupil, loss of vision, redness in eye and blurriness. pt can get scarring and lose vision if you don’t get urgen opthomology assessment
etiology of ankylosing spondylitis
HLA-B27 allele codes for Class I MHC
– Class I molecules present Ag to T cells
- this allele predisposes to AS
T/F: HLA-b27 is a good screening test for AS
false. it is associated with reactive arthritis, enteropathic arthritis, psoriatic arthritis with spondylitis and other diseases. it’s not specific for AS
classic PA- pencil-in-cup joint damage-
note: epidemiology of reactive arthritis
extraarticular features of reactive arthritis
- oral ulcers
- circinate balanitis (painless penile rash)
- kertaoderma blenorrhagicum on palms/soles (looks like pustular psoriasis
- nail changes (onycholysis, yellow discoloration
- asymptomatic bowel inflammatino (often because of the bacteria that caused reactive arthritis in the first place like salmonella or klebsiella)
keratoderma blenorrhagicum– seen on palms and soles
- looks like pustular psoriasis
due to reactive arthritis
