Seronegative Spondyloarthritis Flashcards
general features of spondyloarthritis
- spinal and/or peripheral oligoarthritis
- xray evidence of sacroiliitis
- enthesis
- extra-articular features: systemic, ocular, cardiac disease
- absence of other rheumatic disease
- familial aggregation
- assoc w/ HLA B27
HLA B27
closely linked w/ seronegative spondyloarthritis (but non-specific)
double edged sword: autoimmunity, but also protective against Hep C and HIV
pathogeneisis of seronegative spondyloarthritis
genetic predisposition + environmental stimulus –> inflammation (enthesis, bone destruction, new bone formation) –> ankylosis +/- extra-articular disease
ankylosing spondylitis: describe….
- gender
- age at onset
- HLA B27
- arthritis pattern
- sacroiliitis
- skin
- eye
- syndesmophytes
how do you distinguish inflammatory back pain from mechanical back pain?
inflammatory back pain:
- earlier age of onset
- lasts more than 3 months
- morning stiffness >1 hr
- night pain
- rest makes it worse, exercise helps
- alternating buttock pain
- NSAIDs help (only help 15% of the time for mechanical)
new criteria for axial spondylitis - ASAS criteria
clinical features of ankylosing spondylarthritis
inflammatory back pain
extraspinal symptoms:
- acute anterior uveitis
- enthesitis
- peripheral arthritis (rare)
- Others! (see picture)
PE for AS
- occiput to wall distance
- chest expansion limited
- Schober’s
- FABER: pain in contralateral SI joint is positive
- Pelvic compression
shiny corners - lumbar spine osteitis
squaring off of vertebrae
AS
advanced sacroiliitis in AS
tx for AS
things that help
- NSAIDS
- TNF-alpha: inflammation and progression, uveitis
- PT!
things that help w/ specific syndrome
- sulfasalazine - only helps w/ peripheral sx
- prednisone - just for uveitis
things that don’t help
- DMARDs don’t work for axial
reactive arthritis - what is it, what causes it?
sterile synovitis precipitated by extra-articular infection
occurs 2-4 weeks after extra-articular infection - infections usually GI or GU
synovial fluid culture neg, abx don’t help
clinical features of reactive arthritis
“can’t see, can’t pee, can’t climb a tree”
- arthritis in LE, enthesitis, dactylitis
- conjunctivitis/uveitis
- mucocutaneous
- urethritis
keratoderma blennorhagica in reactive arthritis
arthritis mutilans (telescoping digits) - psoriatic arthritis
dactylitis in psoriatic arthritis
pencil-in-cup deformity in psoriatic arthritis
