Seronegative Spondyloarthropathies Flashcards
What are the 4 major seronegative spindyloarthropathies
- Ankylosing spondylitis (mc)
- Enteropathic spondylitis
- Psoriatic arthritis
- Reactive arthritis
What are the common features of seronegatives
- strong association with HLA B27
- Sacroiliatis
- common site of entheses
What are the 3 major findings of sacroilitis
- Subchondral sclerosis (both side)
- Articular margins (blurry-iliac side first)
- Jt space (pseudowidening)
What portion of the joint does sacroilittis affect
lower 2/3 leading to eventual fusion
What will an MRI for sacroiliitis show
MRI will demonstate active inflammation before radiographic changes seen
Management of sacroilitis
- Rheumatologist referal
- comanage
- avoud HVLA to inflamed jts*
AS- age, gender
mc seronegative
- mid-late 20s
- 3:1 M:F
Starts in SI jts
When you see bilateral symmetrical sacroiliitis what conditions should you think
AS first
Enteropathic spindylitis second
What is the steps of the pathological process to a marginal syndesmophyte (5)
- romanus lesion
- Shiny corner sign
- Squaring of VB
- Marginal syndesmophte
- (Fusion)
What is a romanus lesion
Inflammatory process that causes an erossion in sup ant corner of vert body
What is the shiny corner sign
Reactive sclerosis secondary to romanus lesion
What is squaring of vertebral body
Remodeling of the bone from erosions and healing over and over
what are marginal syndesmophytes and what else are they called
- ossification of the annular fibers of the disc
- fuses one vertebral segment with its adjacent vert seg
“bamboo spine”
What are ghost joints and what is it seen in
fusion of the SI joints
AS
What is the star sign and what is it seen in
Ossification of the interosseous lig
As
What is the railroad sign and what is it seen in
fusion of the lumbar facet jts
AS
What is the dagger sign and what is it seen in
ossification of interpinous/supraspinous ligs
What is a carrot stick fx and what is it seen in
fx of fused spine in AS
What should u check in those with AS before HVLA
Check ADI
Signs of enteropathic arthritis and what causes it
- radiographically identical to AS
Association w inflammtory bowel disease (Chrons/ Ulcerative colitis)
What lab tests are seen in enteropathic arthritis
+HLA B27 in 60-75%
ESR+ CRP elevated
What % of pop have psoriatic arthritis and what % develop inflammatory arthritis
2-3% have psoriasis
-30-40% of psoriactic patients develop inflammatory arthritis
What is the target area of psoriatic arthritis
Hands (Dips) > feet
Spine/SI
side characteristic of psoriatic arthritis
Bilateral, asymetrical distribiton
What radiographic signs will you see in the hands in psoriatic arthritis
- MCPs, PIPs, DIPs
- Ray pattern (affects all of one digit)
- Erosions (mouse ears, pencil in cup)
- Periostitis (whiskering)
- Sausage digits
- Acro osteolysis
Signs of psoriatic arthritis in spine
sacroiliitis common
(asymetrical initially)
Non-marginal syndesmophytes
What 2 conditions will have non marginal syndesmopytes
Psoriatic arthritis
reactive arthritis
reative arthritis: clinical triad, age
Conjunctivitis, urethritis, arthritis
Secondary to STD/GI infection
Reative arthritis in spine imaging
Radiographically identical to psoriatic arthritis
- Sarcroiliitis (bilateral asymetric)
- non marginal syndesmophytes
What is enthesophyte (lovers heal) seen in
Reactive arthritis
Sacroilliitis pattern of AS, ES, REA, Psoriatic
Bilat sym- AS, ES
Bilat aSym- ReA, Psoriatic
What is osteitis condensans Illi due to/common in
Mechanical stress across the SI joint (during preg)
- m/c in females
- self limiting
Radiographic findings of OCI
- Triangular sclerosis along only the iliac side of SI
- NO EROSIONS
- bilateral symetricaal
What is osteitis pubis (/findings)
Erosions of pubic bone (both sides)
- subchondral sclerosis
- irregular jt space
