seronegative spondylo-arthropathies Flashcards
what falls under the family of SpA ?
PsA ( psoriatic arthritis )
AS ( Ankylosing spondylitis)
Enteropathic ( IBD associated)
Reactive Arthiritis
what does sero negative mean ?
serology is negative for both RF and anti-CCP
what is the genetic association with SpA?
HLA-B27
what are the different types of psoriatic arthritis ?
1- DIP affection and small joints of the hand (dactylitits) 2- asymmetrical oligoarthiritis 3- symmetrical polyarthritis ( resembles RA ) 4- arthritis of sacroiliac joint and spine 5- arthiritis mutilans
how can i differentiate between psoriatic arthritis (symmetrical polyarthiritis) and RA?
skin changes found in psoriasis not in RA
affection of the tendons in PsA not in RA
DIP is not affected in RA
what are the poor prognosis factors for PsA?
a strong family history of psoriasis disease onset younger than 20 polyarticular disease erosive disease extensive skin involvement
what is the classic presentation of psoriatic arthiritis ?
1.nail involvement:
pitting and seperation from the nail bed ( Onchylosis)
yellow-pink discoloration ( oil-drop sign)
2. dactylitits : sausage digits
3. enthesopathy : inflammation of the tendon
4. DIPJ involvement
what characteristic sign do we see in X ray in psoriatic arth ?
pencil in cup appearance
what does the term axial spondylo-arthiritis include ?
ankylosing spondylitis
non-radiographic axial spondyloarthiritis
what is the differernce between AS and nr-axSpA ?
AS- inflammatory back pain but with radiological manifestations
nr-axSpA - inflammatory back pain with no radiological manifestations
how can we diagnose a patient with nr-axSpA ?
using MRI to show signs of inflammation : sacroillietis
shiny corner sign
what is the criteria to diagnose a patient with inflammatory back pain ?
back months of at least 3 months duration :
1- Age of onset at least 40 years
2- insidious onset
3- improvement with exercise
4- no improvement with rest
5- Pain at night ( with improvement on getting up)
what are the 4 As associated with ankylosing spondylitis ?
aortic valve/root disease
anterior uveitis
apical fibrosis
amyloidosis
what are the clinical signs of AS and what are the tests used for diagnosis ?
1- question mark position - thoracic kyphosis and loss of cervical lordosis
2- modified schober test - limited lumbar flexion less than 5 cm
3- SIJ stress test = FABERs test
4- cervical test - occiput to wall or tragus to wall
5- thoracic chest expansion
what radiological finding is associated with late stages of AS ?
bamboo sign
what is reactive arthritis preceded by ?
infection such as gonorrhea, salmonella, shigella, campylobacter
what is the triad of reactive arthritis ?
Reiters triad :
arthritis
urethritis
conjunctivitis
what investigations would be required ?
inflammatory markers :
ESR , CRP
CBC , renal, liver , bone , vitamin D
serology : RF, CCP, ANA, Ig PEP, Anti-TTG
what is the first line treatment for Axial spond ?
NSAIDS ( this also applies to mild form of psoriatic SpA)
law 2 NSAIDS ma7awa2sh
biological treatments
what are the biological treatments available for SpA?
Anti TNF blockers
IL-12,23 - ustekinumab
IL-17
what is the first line treatment for peripheral affection ?
DMARDS
law 2 DMARDS ma7awa2oosh then
Biological treatments
what is the CASPAR criteria for the diagnosis of psoriatic arthiritis ?
1- evidence off current psoriasis or family history of it
psoriatic nail dystrophy
2- negative RF
3- dactilyitis
4- radiological evidence of juxta-articular new bone formation
what does the schober test assess ?
lumbar flexion
what are thee MRI findings of thee SIJ associated with ankylosing spondylitis ?
romanus lesions
shiny corner sign
what are the pathognomonic features associated with reactive arthritis ?
keratoderma blenorrhagica ( sole of the foot)
pustular rash
tenosynovitis of small joints
conjunctivitis
what must be excluded when suspecting reactive arthritis ?
septic arthritis must be excluded
what diseases are associated with enteropathic arthritis ?
IBD
whipple disease
intestinal bypass
vitamin D deficiency and low bone mineral density
what is the treatment for peripheral SpA ?
NSAIDS
DMARDS
steroids
when should biologics be started in peripheral SpA?
if failed or intolerant of 2 DMARDs
what is the role of DMARDs and steroids in axial disease ?
no role for steroids or DMARDs
