Seronegative Spondylarthopathies Flashcards
SS are related inflammatory arthritis conditions characterized by
Axial skeletal arthritis (involving spine) is
Peripheral joint arthritis
Varied organ involvement
Subgroups of SS:
Ankylosing spondylitis Reactive arthritis Arthritis associated with psoriasis Arthritis associated with inflammatory bowel disease Undifferentiated spondylitis (children)
Characteristics of SS
Seronegative for Rheumatoid factor
Presence of HLA B27
Inflammation of sacroiliac joints and spine
Enthesitis- inflammation at the insertion of ligament or tendon into bone
Asymmetric inflammatory arthritis
Extra articular disease- eye, skin, mucosa, organs: systemic
Differentiation of lower back pain- 2 groups and their differences
Inflammatory back pain- less than 40, insidious onset, nocturnal pain, better with exercise, loss of flexibility in all planes, decreased chest expansion
Mechanic back pain- any age, acute onset, less than four weeks, usually absent at night, worse with exercise, abnormal flexion but normal other, normal chest expansion
Insidious onset of diffuse lumbar spine/sacroiliac pain and stiffness
Bilateral sacroilitis- pain to gluteal area
Progress to spinal fusion in ascending fashion
Decreased ROM/deformities
Ankylosing spondylitis
Test where a mark is made at PSIS and the examiner places one finger 5cm below and another 10 cm above this mark. Patient is instructed to touch his toes, and if increase in distance is between the two fingers on the patient’s spine is less than 5cm then this is indicative of limitation to lumbar flexion
Schober Test
Ankylosing spondylitis diagnostics
Lab anomalies- elevated inflammatory markers, anemia, HLA-b27
Radigraphic- bilateral sacroiliitis, spondylitis results in squaring of vertebral bodies and syndesmophytes
Ossification of spinal ligaments= bamboo spine
Peripheral arthritis presentations
Hips and shoulders more common
Lower extremities large joints come after axial
Small joint arthritis of hands and feet- 10%
Enthesopathy (inflammation at insertion of tendon in bone)- Achilles’ tendon, plantar fasciitis, dactylitis
Other Clinical manifestations of ankylosing spondylitis
Ankylosing of costovertebral joints can limit chest expansion
Extra articular manifestations- anterior uveitis, apical pulmonary fibrosis, ascending aortitis/aortic valve insufficiency
Aseptic arthritis that is triggered by an infectious agent located outside the joint, beings 1-4 weeks after a genitourinary or GI infection
Clinical triad:
Reactive arthritis- “Reiter’s syndrome” with nongonoccoal urethritis, conjunctivitis, arthritis
Manifestations of reactive arthritis
Asymmetric, inflammatory oligoarthritis/sacroiliitis
Achilles tendinitis
Keratoderma blennorrhagica
Circinate balanitis
Conjunctivitis
Palate erosions- painful (unlike in lupus)
Dactylitis and tendosynovitis
Non-marginal, ‘jug-handle’ syndesmophytes (AS are ‘kissing like’)
Hallmarks of psoriatic arthritis if psoriasis is not presented
Nail changes and distal arthritis
DIP can be involved, unlike in RA.
Dactylitis
Different Patterns of psoriatic arthritis
Distal
Asymmetric oligoarthritis
Symmetric polyarthritis- the RA-like type
Arthritis Mutilans- erosions completely destroying joint
Spondylarthropathy- jug handle syndesmophytes
HIV associated- ‘explosive’ psoriasis
Ulcerative colitis and chron’s disease manifestations
- Sacroiliitis and spondylarthropathy- prolonged stiffness in back and button area in morning after rest, back symptoms unrelated to GI disease, alone or with peripheral disease
- Peripheral arthritis type 1: acute, oligoarticular and associated with flares of intestinal disease, non deforming, self limited
Peripheral arthritis type 2: polyarticular more involvement of MCPs, knees, ankles, elbows, shoulders, wrists. 50% migratory. Persistent synovitis and exacerbations and remissions.
