SERONEGATIVE SPONDYLOARTHRITIS Flashcards
What does spondylo mean?
SPINE
Seronegative spondylarthritis is a family of which 4 main disorders? Why are they referred to as seronegative?
Seronegative due to negative rheumatoid factor
- Ankylosing spondylitis
- Psoriatic arthritis
- Inflammatory bowel disease
- Reactive arthritis
What immune cells are seronegative spondyloarthritis conditions modulated by?
T cells
Monoarthritis vs oligoarthritis vs polyarthritis definitions
- Mono: 1 joint
- Oligo: 2 to 4 joints
- Poly: >5 joints
Spondyloarthritis disorders present differently but there is a classic presentation which is useful when differentiating from rheumatoid arthritis.
What is this classic presentation in terms of joint involvement, number and location? Compare with RA
- Oligoarthritis (2 to 4 joints)
- Often asymmetrical and in lower extremities
- For example: left hip, left knee and left ankle
► Compare to rheumatoid arthritis: symmetrical, polyarthritis, often hands
Which antigen is strongly associated with spondyloarthritis disorders and seen in 90% of people with ankylosing spondylitis and 50% of people with psoriatic arthritis?
HLA B27
Describe the ankylosing component of ankylosing spondylitis
New bone formation in spine leading to fusion, stiffness and pain
How would you describe backpain seen in <40, is slow in onset, improves with exercise, does not improve with rest and is worse at night? This type of backpain is a classic presentation of which condition?
Inflammatory backpain: classic ankylosing spondylitis presentation
Which joint in the axial spine is often involved in ankylosing spondylitis?
Sacroiliac joint
What is going on with the spine? In which condition is this seen?
Bamboo spine: pathognomonic radiographic feature seen in ankylosing spondylitis, occurs as result of vertebral body fusion by marginal syndesmophytes. Often accompanied by fusion of posterior vertebral elements
Pain in which part of the foot is a common presentation of ankylosing spondylitis? Explain why
Heel pain
Enthesitis: Inflammation of tendon insertion is into bone. Classically, insertion of Achilles tendon to calcaneous
♦ IMPORTANT FIRST SYMPTOM ♦
What’s going on with the second and third digits? In which condition is this seen?
Dactylitis - caused by uncontrolled inflammation that results from spondyloarthropathies, and can be associated with flaring of the underlying joint disease
Ankylosing spondylitis
Sudden red eye, pain and blurred vision in someone with spondylitis is likely what condition?
Anterior uveitis
What type of lung disease are people with ankylosing spondylitis more likely to get?
Restrictive lung disease due to decreased chest wall and spinal mobility
What is this condition?
Psoriasis
90% of people with psoriatic arthritis (vs 46% with uncomplicated psoriasis) have what type of finding on their hands?
Nail findings
- Onycholysis: separation of nail from nailbad
- Nail pitting
- Hyperkeratosis
In someone with asymmetrical polyarthritis that is worse in the morning and improves with use and has involvement of distal interphalangeal joints as well as signs of sacroiliitis, which condition would you consider?
Psoriatic arthritis. Key points:
- Asymmetrical
- Polyarthritis
- Distal interphalangeal joints
Crohn’s disease and ulcerative colitis are frequently complicated by arthritis. What are the two pattern types?
- Type I: <5 joints, usually large (knees, hips, shoulders), symptoms flare with GI disease
- Type II: >5 joints, small joints of hand, independent of GI disease
What are the other two classic symptoms are often accompany reactive arthritis? How can you remember this?
- Conjunctivitis
- Urethritis
“Can’t see, can’t pee, can’t climb a tree”
