1. Asymmetric peripheral arthritis 2. Sacroiliitis 3. Enthesitis 4. No RA dz (negative RF< ACPA, subQ nodules) 5. HLA-B27 associated

Seronegative spondyloarthritis Flashcards by Hoi Wan

Define enthesis

Attachment of ligament, tendon, or joint capsule to bone

How well did you know this?

Not at all

Perfectly

What is a key difference between RA and spondyloarthropathies?

Inflammation start in the enthesis in spondyloarthropathies

In RA, inflammation starts in the synovium

How well did you know this?

Not at all

Perfectly

Ankylos means:

stiffening of joint

How well did you know this?

Not at all

Perfectly

Spondylo means:

vertebrae

How well did you know this?

Not at all

Perfectly

Arthro means:

joint

How well did you know this?

Not at all

Perfectly

Sponyloarthritis:

Asymmetric peripheral arthritis
Sacroiliitis
Enthesitis
No RA dz (negative RF< ACPA, subQ nodules)
HLA-B27 associated

How well did you know this?

Not at all

Perfectly

Describe the pathophysiology of sponyloarthropathy

Genetics + environmental stimuli

->Inflammation of enthesitis+osteoporosis
->ankylosis (bone formation)

How well did you know this?

Not at all

Perfectly

What are some presenting CCs of sponyloarthropathies?

low back pain starting in the buttocks with insidious onset
Worse in night and early morning
Inflammatory signs (morning stiffness, relief with exercise, better with NSAIDs)

How well did you know this?

Not at all

Perfectly

What are extraspinal Sx of spondyloarthropathies?

Acute anterior uveitis (30-40%)
Psoriasis
Pulmonary fibrosis
Aortitis/heart block

How well did you know this?

Not at all

Perfectly

What physical exam tests would you want to perform?

occiput to wall distance
chest expansion (>5cm)
Schober's
Pelvic compression
FABER

How well did you know this?

Not at all

Perfectly

What is a positive schober’s?

Measure 10 cm from PSIS. If distance increases by less than 5cm, abnormal

How well did you know this?

Not at all

Perfectly

What is a positive FABER test?

Pain in contralateral SI joint elicited

How well did you know this?

Not at all

Perfectly

What is a syndesmophyte?

Bony growth inside a ligament

-Often seen in anterior vertebral margins=”shiny corners”

How well did you know this?

Not at all

Perfectly

What radiographic sign is indicative to late sponyloarthritis?

Bamboo spine (ossification of annulus in spine) 
-squaring of vertebrae

How well did you know this?

Not at all

Perfectly

What is the age of onset for akylosing spondylitis?

16-40 yo

How well did you know this?

Not at all

Perfectly

Describe the progression radiographic findings of Spondyloarthritis:

Back pain with sacroiliitis seen on MRI
Radiographic sacroiliitis
Syndesmophytes

What do patients with ankylosing spondylitis die from?

Cardiovascular disease

How do you treat AS?

NSAIDs have some DMA properties

What other drugs can help with the symptoms?

Sulfasalazine can help with stiffness
TNF antagonists: help with pain and ROM
Prednisone ONLY helpful for uveitis

What is reactive arthritis?

STERILE synovitis

-Preceding infection, either GI/GU 2-4 weeks earlier

What are the presenting features of reactive arthritis?

Can’t see (uveitis)
Can’t pee (urethritis)
Can’t climb a tree (Lower extremity arthritis, may see sacroiliitis)

Also mucocutaneous ulcers

What are common infections associated with reactive arthritis?

Chlamydia**
Ureaplasma urealyticum
Salmonella/shigella/e coli

What are the main differences btw reactive arthritis and ankylosing spondylitis?

Less correlated with HLA B27
Asymmetric arthritis is common in RA
SI is Asymmetric
KB/CB lesions instead of psoriasis
Syndesmophytes are bulky and not at margins

What is keratoderma blenorrhagica?

hard, tender lumps and scaly patches on the soles of the feet

What is Circinate Balinitis?

rash on the head of the penis

How do you treat reactive arthritis?

If chlamydia, Abx - NSAIDS - Sulfasalazine - MTX

Psoriatic arthritis-how does it present?

Preceding skin changes | mild and oligoarticular arthritis usually

What is the age of onset for psoriatic arthritis?

30-55

What is the prevalence of HLA B27 in psoriatic arthritis?

25-60%

Is the sacroilitis in psoriatic arthritis bilateral or unilateral?

unilateral. Only anklylosing spondylitis has symmetric sacroiliitis

How can you differentiate psoriatic arthritis from other types?

Psoriasis or nail pitting usually.

What are the five patterns of inflammatory athritis in psoriatic arthritis?

1. DIP arthritis (often dactylitis) 2. Asymmetric oligoarthritis 3. Symmetric polyarthritis 4. Arthritis mutilans 5. Spondyloarthrtitis (enthesitis peripherally)

What are some radiographic characteristics of psoriatic arthritis?

``` Erosive arthritis Pencil-in-cup arthritis mutilans bony ankylosis spurs non-marginal asymmetric syndesmophytes asymmetric sacroiliitis ```

How do you treat Psoriatic arthritis?

The same: Nsaid/sulfa/methotrexate. Only diff is that TNF alpha is shown to be more useful

What type of arthritis is IBD arthritis?

Asymmetric oligo/poly | --However, sacroiliitis is symmetric

What skin changes do you see in IBD arthritis?

Erythema nodosum | Pyoderma gangrenosum!!!

What type of IBD is more common in IBD arthropathy?

Crohn's more than ulcerative colitis

How do you treat IBD arthritis?

Treat underlying disease - sulfasalazine - methotrexate - Azathioprine/6 mercaptopurine - Corticosteroids - TNF alpha antagonists

Which spondyloarthropathies have the highest HLA B27 frequencies?

1. Ankylosing spondylitis 2. Enteropathic spondylitis 3. Reactive arthritis 4. Psoriatic spondylitis