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Medicine II: Rheumatology > Seronegative Spondyloarthropathies > Flashcards

Seronegative Spondyloarthropathies Flashcards

1
Q

Seronegative Spondyloarthropathies

A

Heterogeneous group of inflammatory diseases with predominant involvement of axial – peripheral joints – enthesitis (inflammation at the site of insertion of tendons and ligaments to bone).

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2
Q

Enthesitis

A

Inflammation of site of insertion of a tendon, ligament or joint capsule to bone. HALLMARK OF THE DISEASE.

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3
Q

Seronegative Spondyloarthropathies are associated with:

A

High incidence of HLA-B27. Negative rheumatoid factor (seronegative)

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4
Q

__________ plays a critical role in pathogenesis of Seronegative Spondyloarthropathies.

A

HLA-B27 (in 90% of cases)

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5
Q

Clinical Features of Ankylosing Spondylitis

A

Early as affects primarily the lumbar spine. Early syndesmophyte formation is also seen. In late Ankylosing Spondylitis the lumbosacral spine is affected and Syndesmophytes are formed. The spine has a ‘Bamboo’ appearance.

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6
Q

Management of Ankylosing Spondylitis

A

Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.

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7
Q

Labs/Tests for Ankylosing Spondylitis

A

RF (-), HLA-B27 in 90-95%

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8
Q

Reiter’s Syndrome (Reactive Arthritis)

A

Aseptic arthritis. Triggered by an infectious agent outside the joint. Tends to begin 1-4 weeks after a genitourinary or gastrointestinal tract infection. Usually affects lower extremities.

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9
Q

Eitology of Reiter’s Syndrome (Reactive Arthritis)

A

Classic causative organisms include Chlamydia, Ureaplasma, Shigella, Salmonella, Yersinia and Campylobacter. Although just about any organism may result in reactive arthritis.

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10
Q

Signs of Reiter’s Syndrome (Reactive Arthritis)

A

Clinical Triad: non-gonococcal urethritis, conjunctivitis and arthritis. Characteristic skin rash is keratoderma blenorrhagica. Histologically identical to psoriasis.

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11
Q

Clinical Features of Reiter’s Syndrome (Reactive Arthritis)

A

Arthritis tends to be oligoarticular (~2-4 joints) and tends to affect the joints of lower extremity. Has an acute onset where joints become painful and swollen, asymmetric distribution. Enthesitis common in the heel. Often self-limited, may become chronic.

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12
Q

Management of Reiter’s Syndrome (Reactive Arthritis)

A

Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.

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13
Q

Labs/Tests of Reiter’s Syndrome (Reactive Arthritis)

A

HLA-B27 (70-30%); RF (-)

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14
Q

Psoriatic Arthritis

A

Symmetrical Polyarthritis that effects the joints, spine and entheseal.

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15
Q

Psoriatic Arthritis most commonly affected:

A

Predominant DIP involvement

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16
Q

Dactylitis

A

inflammation of an entire digit. Joint and tenosynovial inflammation. “sausage digit”

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17
Q

Clinical Features/Dx of Psoriatic Arthritis

A

Needs 3 of the following:

  1. Evidence of psoriasis.
  2. Psoriatic nail changes.
  3. RF (-).
  4. Dactylitis.
  5. Radiographic changes.
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18
Q

Management of Psoriatic Arthritis

A

Early recognition can help to limit disability. Non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Methotrexate, Tumor necrosis factor inhibitors and PT/OT.

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19
Q

Labs/Tests for Psoriatic Arthritis

A

RF (-); Radiographs are sensitive and specific. Show destructive arthritis, pencil-in-cup (erosions).

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20
Q

Nail Changes of Psoriatic Arthritis

A

Psoriatic nail changes: onycholysis, pitting, ridging and hyperkeratosis. TX with topicals, PUVA/UVB, or Biologics

21
Q

Enteropathic Arthritis (a/w IBD)

A

Gut wall is a leaky barrier, potential pathogenic microorganisms cross over.

22
Q

Etiology of Enteropathic Arthritis (a/w IBD)

A

Associated with inflammatory bowel disease: CD and UC.
Spine (axial) involvement occurs in 10-20%. Spine involvement may be silent or may precede the onset of IBD or occur later. Spine does not correlate with intestinal symptoms.

23
Q

Progression of Enteropathic Arthritis (a/w IBD)

A

CD patients with large bowel disease and intestinal complications (fistulas, abscesses) more likely to develop peripheral arthritis than those limited to ileum disease. IBD arthritis tends to be nondestructive and reversible (erosive changes may occur).

24
Q

Clinical Features of Enteropathic Arthritis (a/w IBD)

A

Clubbing, uveitis, skin manifestations and CD > UC. Uveitis tends to be bilateral and tends to be chronic. Erythema nodosum > UC. Pyoderma gangrenosum more frequently associated with systemic disease.

25
Q

Management of Enteropathic Arthritis (a/w IBD)

A

TNF alpha antagonists

26
Q

Labs/Tests for Enteropathic Arthritis (a/w IBD)

A

HLA-B27 in 7%. Affects the lower limbs symmetrically.

27
Q

Hallmark of Spondyloarthropathies

A

Enthesitis: Universal hallmark of spondyloarthropathies

28
Q

Enthesis =

A

site of insertion of a tendon, ligament, or joint capsule into bone

29
Q

T/F: Peripheral enthesitis observed in all spondyloarthropathies

A

True

30
Q

Sites of Enthesis

A

Large tendons and ligaments adjacent to joints. Superficial spinal insertions. Lower limb > upper limb

31
Q

Most Common Sites of Enthesis

A

Plantar fasciitis & Achilles enthesitis

32
Q

Clinical features of enthesitis: symptoms and signs

A 
Pain and stiffness, 
Most prominent in the morning, 
Improves gradually with movement, 
May have soft tissue swelling, 
May have pain on palpation,
33
Q

Comparison spondyloarthropathies: Gender (M:F)

A

AS: 3:1;
Psoriatic A: 1:1;
Reactive A: 8:1;
Enteropathic A: 1:1.

34
Q

Comparison spondyloarthropathies: Age of Onset

A

AS: <40;
Psoriatic A: 35-45;
Reactive A: 20-29;
Enteropathic A: Young adult

35
Q

Comparison spondyloarthropathies: Sacroiliitis or spondylitis

A

AS: 100%;
Psoriatic A: -20%;
Reactive A: -40%;
Enteropathic A: <20%.

36
Q

Comparison spondyloarthropathies: Symmetry of sacroiliitis

A

AS: Symmetrical;
Psoriatic A: Asymmetrical;
Reactive A: Asymmetrical;
Enteropathic A: Symmetrical.

37
Q

Comparison spondyloarthropathies: Peripheral arthritis

A

AS: -25%;
Psoriatic A: 95%;
Reactive A: 90%;
Enteropathic A: 15-20%

38
Q

Comparison spondyloarthropathies: Distribution

A

AS: Axial and lower limbs;
Psoriatic A: Any joint;
Reactive A: Lower limbs;
Enteropathic A: lower limbs.

39
Q

Comparison spondyloarthropathies: HLA-B27

A

AS: 90-95%;
Psoriatic A: 24%;
Reactive A: 70-30%;
Enteropathic A: 7%.

40
Q

Comparison spondyloarthropathies: Uveitis

A

AS: 20-55%;
Psoriatic A: -20%;
Reactive A: -50%;
Enteropathic A: <15%.

41
Q

Progression of AS

A

Leads to hunched over posture. Affects lumbar spine early and lumbosacral as it progresses.

42
Q

Eye in AS

A

Most common is acute anterior uveitis. Occurs in 25-30% of patients at some during the course of disease. No clear relationship between the articular disease and eye involvement. Usually acute onset and unilateral.

43
Q

Acute anterior uveitis: symptoms

A

Red eye, especially around the edge of iris, Pain in eye, Blurred vision, Increased tear production, Sensitivity to light, Floaters in field of vision and Smaller than normal pupil size.

44
Q

Cardiovascular in AS

A

Aortic incompetence (aortic insufficiency or aortic regurgitation)

45
Q

Pulmonary in AS

A

Lung involvement is rare. Slowly progressive fibrosis of the upper lobes of the lung. Typically occurs 20 years after the onset of AS. Cough, dyspnea, sometimes hemoptysis.

46
Q

Spinal involvement in AS

A

C5-6 or C6-7 most commonly involved

47
Q

Renal in AS

A

IgA nephropathy. Immunofluorescence mesangial deposition of IgA. Elevated serum IgA. Microscopic hematuria with proteinuria.

48
Q

Psoriatic arthritis: predominant joint involvment

A

DIP joint

49
Q

T/F: Sacroiliitis is present in all patients with ankylosing spondylitis.

A

True

Medicine II: Rheumatology (9 decks)

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