Seronegative Spondylo's - Background + AS Flashcards
name the big 4 on the spectrum
All tend to affect the ? and ?large joints, with more limited joint involvement than ??.
Joint ? and ? are more common than in RA.
AS
Ps A
Reactive A
IBD related arthropathy
spine proximal RA ankylosis enthesitis
? (? finger) is also seen commonly in these conditions,
o Particularly common in ? arthritis.
The cause and pathogenesis of the diseases are largely unknown, although
they all have a common aetiological factor of ? presence.
o Often a ? of other spondyloarthritidies.
They are all ? negative (‘seronegative’), and generally anti-? negative
dactylitis sausage psor HLA B27 FH RF CCP
AS
Presents usually as ? inflammation of the ? joints in young adults (around 18-?), with a ? preponderance of 3:1.
Other joints involved may be ?/? joints asymmetrically, or more rarely other ? joints.
? joints can also be affected, giving ? chest pain.
episodic sacroiliac 30 male hip/shoulder peripheral costochondral anterior
AS
Presentation
o Episodes of pain and ? in the lower back/?, worse in
the ?, relieved by ?.
o Remain otherwise ? between episodes.
o The pain in the buttocks may ? between sides.
o It may cause disruption from ? in the second half of the ?.
stiffness buttocks morning exercise aSx alternate sleep night
AS
On examination;
o LOOK: ‘? ? posture’ due to retention of the ? ? during spinal flexion (early sign), ?muscle wasting (later sign).
o FEEL: pain on ? over the ??Js.
o MOVE: limited ? and forward ? of the ? spine.
q mark lumbar lordosis paraspinal pressure SIJs lateral forward lumbar
AS
o Special tests: ? test;
• A line is drawn along the ?, ?cm above and ?cm below
the level of L? (or L? AT the level of the iliac crest).
• The distance between the two lines should ? by more than ?cm when the patient bends ?.
shobers midline 10 5 5 4 increase 5 forward
Extra-articular manifestations; o ? ?: 20%. o Pulmonary (?) fibrosis .o ?? node ?. o ? (inflammation of the ? root, leading to fibrosis and aortic ?) o ?osis.
ant uveitis apical av node block aortitis aortic regurgitation amyloidosis
AS
Investigations;
o ?: normal in 50% of patients with aggressive disease.
o Pelvis XR: bilateral ?(indistinct, ? joint line eventually leading to total ?).
o Spinal XR: vertebral bodies become ?, and ossification of the ? ? and interspinous ? can give a classical ‘? spine’ in severe disease.
–> • ?= ossified ligament.
–> • This ossification of the ligaments is what leads to the ? and ? spine.
esr sacroiliitis narrow fusion squared annulosus fibrosus ligaments bamboo syndesmophytes inflexible rigid
AS
Management;
o Full dose ? for 6 ?.
o If there is no improvement on two different ? (as shown by a high ? score), then ? are started, e.g. ?.
• ? is not used in AS.
nsaids weeks nsaids DAS biologics etanercept infliximab
