seronegative spondyloarthropathies Flashcards
7 shared features of these disorders
- seronegative; no rheumatoid nodules
- HLA-B27 association
- familial aggregation
- inflammatory axial arthritis (SI and spondylitis)
- oligoarthritis w/ asymmetric presentation
- enthesis
- extraarticular features
inflammation of place where tendons or ligaments insert into bone
enthesitis (plantar fasciitis, achilles tendonitis, costochondritis)
fine delicate calcifications/osteophytes
syndesmophytes
digital tendon inflammation (sausage digits)
dactylitis
- dull achy, insidious lower back/gluteal pain/discomfort before age 40 lasting over 3 months
- associated w/ morning stiffness & improves w/ exercise
- initial presentation in the SI joint first then other joints
- peripheral joint involvement usually asymmetric
- neck pain & stiffness as late manifestations
ankylosing spondylitis (AS)
inflammatory d/o of unknown cause; affects axial skeleton, peripheral joints & extra-articular structures
AS
- loss of lumbar lordosis on flexion
- chest expansion
- peripheral involvement: achilles tendinitis, plantar fasciitis, tibial tuberosity, superior & inferior poles of patella, iliac crests
- schoeber’s test/index to monitor treatment
AS
3 areas of extra-articular involvement with AS
- Uveitis is most common; acute, unilateral & non granulomatous
- CV– aortitis of ascending causing aortic valve insufficiency, MV insufficiency, AV block
- Pulm– restrictive lung disease, bilateral apical pulm fibrosis
if a patient w/ known AS falls and has backpain, what imaging must you get to evaluate for fractures?
MRI!
- radiograph shows straightening of spine + squaring & fusion of vertebrae (bamboo sign)
- shiny end of vertebral bodies from where tendons pull (shiny corner/romanus sign)
AS
erosions, sclerosis, joint space widening, narrowing & eventually bony anklyosis on radiograph
sacroilitis
tx of uveitis from AS
steroids & cycloplegics
immunosuppressants if recurrent
- asymmetric inflammatory oligoarthritis of hands (often DIP joint) w/ axial involvement
- dactylitis/sausage digits
- nail changes
- erythematous plaques w/ thick silvery-white scales on skin
psoriatic arthritis
for each feature, which one happens in PsA vs RA?
- peripheral involvement
- axial involvement
- symmetry
- DIP joint
- enthesitis, dactylitis, bony erosions or new bone
- skin?
- peripheral– all
- axial– mostly PsA; RA is C1-2 only
- symmetry– RA, sometimes OA
- DIP joint– PsA (& OA)
- Enthesis, dactylitis, erosions, skin– PsA only
very fast resorption of bone/digits causing telescoped/collapsed “opera glass hand”
PsA– arthritis mutilans
