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Musculoskeletal/Rheum > Seronegative Spondyloarthropathies > Flashcards

Seronegative Spondyloarthropathies Flashcards

1
Q

Is rheumatoid factor positive in spondyloarthropathies?

A

NO

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2
Q

What gene are spondyloarthropathies assoicated with?

A

HLA-B27

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3
Q

What are characteristic musculoskeletal features of spondyloarthropathies?

A

axial skeleton involvement with sacroilitis and spondylitis

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4
Q

What are enthesitis?

A

inflammation at the sites where tendons and ligaments attach to bone

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5
Q

What is HLA-B27?

A

MHC class I molecule that binds antigenic peptides and presents them to CD8+ T cells

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6
Q

What does the presence of HLA-B27 lead to?

A

increased disease susceptibility and severity.

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7
Q

What cytokine is highly increased in Ankylosing Spondylitis?

A

TNF-alpha excess

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8
Q

When are symptoms bad in AS?

A

in the morning and they improve with exercise

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9
Q

How common is peripheral joint involvement in AS?

A

1/3 of patients (usually in lower limbs)

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10
Q

Why can a person with AS not touch their toes?

A

bony fusion of spine (leads to decrease of spinal flexibility)

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11
Q

What are hints that your patient has aortic insufficiency? (complication of AS)

A

low diastolic

increased systolic

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12
Q

What are some physical findings of AK?

A

Abnormal Schober’s test
Reduced chest expansion
Increased occiput to wall distance

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13
Q

What is codfishing of the spine?

A

inflammation at the margin of the vertebral bodies will eat away at the bones and “square them”

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14
Q

What are some extra-articular features of AK (eye)?

A

-Anterior Uveitis

ribs)

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15
Q

What are some extra-articular features of AK (heart)?

A
  • Aortic regurgitation (heart block)

- MI

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16
Q

What are some extra-articular features of AK (lungs)?

A

-Pulmonary (apical lung fibrosis, thoracic cage restriction due to ankylosis of costovertebral joints of

17
Q

What drugs are used to treat AK axial disease?

A

NSAIDs

TNF blockers

18
Q

What drugs are used to treat AK peripheral disease?

A

NSAIDs
sulfasalazine
local corticosteroids
TNF blockers

19
Q

What is Reiter’s Syndrome (reactive arthritis)?

A

Arthritis due to inflammation that arises after an infectious process

20
Q

What is the classic triad of reactive arthritis?

A
  • Arthritis
  • Urethritis (burning with urination with either GI or GU pathogen!)
  • Conjunctivitis
21
Q

What disease is Reiter’s syndrome VERY COMMONLY associated with?

A

HIV/AIDS

22
Q

What is keratoderma glennorrhagia?

A

psoriasis-like rash located on palms and soles of feet

23
Q

Waht are lab tests used to diagnose Reiter’s syndrome?

A
  • elevated ESR, CRP
  • Unusual to have positive culture
  • Get serology for potential pathogens
  • Consider HIV
  • Measure B27
24
Q

How long do symptoms of Reiter’s syndrome last?

A

2-3 months

or 20-50% demonstrate a chronic course

25
Q

What are some clinical patterns of psoriatic arthritis?

A
  • DIP involvement
  • Assymetric oligoarthritis (less than 5 small/large joints affected asymmetricly)
  • Symmetric polyarthritis (mimics RA)
  • Arthritis mutilans (very deforming)
  • Spondyloarthropathy
26
Q

What is a hand-finding in psoriatic arthritis?

A
  • *NAIL PITTING IN PsA!

- LOOK OUT FOR this picture on exam along with DIP involvement

27
Q

Telescopic digits are characteristic of what type of psoriatic arthritis?

A

arthritis mutilans

28
Q

What is the characteristic x-ray finding in arthritis mutilans?

A

“pencil-in-a-cup” DIP involvement

29
Q

What is enteropathic arthritis?

A

Inflammatory arthritis associated with Crohn’s disease, Ulcerative colitis, and Whipple’s disease

30
Q

How does enteropathic arthritis occur?

A

gut wall is a leaky barrier to commensal and pathogenic microorganisms–there is a balance between inflammatory events and tolerance that, if altered, could lead to problems

31
Q

What genetic predisposition do some enteropathic arthritis patients have?

A

HLA-B27

32
Q

What are the two patterns of enteropathic arthritis?

A
  • peripheral (parallels GI disease)

- axial (does not parallel GI disease)

33
Q

What is Celiac Disease?

A

Immune reaction to partly digested wheat gluten by T lymphocytes in the gut of genetically HLA-DQ2 positive or HLA-DQ8 postiive individuals

34
Q

How many Celiac Disease patients get joint symptoms?

A

25%

35
Q

How does celiac disease alter bone?

A

osteomalacia due to vitamin D deficiency (from malabsorption due to vilous atrophy)

Musculoskeletal/Rheum (12 decks)

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