Seronegative Spondyloarthropathies Flashcards
HLA associated with SNSA
HLA B27 (on chromosome 6)
__% of AS patients have B27
90%
Reactive arthritis =
bacterial triggered arthritis
(following enteric or venereal infection)
Primary site of SNSA is ___
Enthesis
Enthesopathic change is characterized by
fibrosis and ossification (and formation of bone spurs)
SNSA has prediliction for ____
Spine
(sacroiliitis, spondylitis)
SNSA are usually __-articular
oligo
______ are usually affected by SNSA
young men
Epidemiology of AS (gender and race)
male to female = 3 to 1
white more common
Criteria for AS
4/5 on ASAS
- Onset before 40
- Insidious
- Improved with excercise
- Not improved with rest
- Pain at night (improved by moving)
Systemic featires of AS
Fever, weight loss, fatigue
Characteristic features of AS
Sacroilic edema, obliteration
Bamboo spine
Exam for AS includes _____
Specifically?
measurement of spine
Schober test = midpoint between Posterior iliac spines, measure distance changed upon bending over
Chest expansion + Occiput-to-wall distance
Main extraarticular manifestation of AS?
Others?
Prostatitis
Others =
- Iritis/Conjunctivitis
- Upper lobe pulmonary fibrosis (late manifestation)
- Amyloidosis
- Cauda equina
Ddx for AS
OA, RS, PA
Mechanical pain
Most helpful modality for SI joint exam
Other special studies?
Pelvic Xray
- MRI possibly
- HLA-B27 is NOT favored but may assist diagnosis
Treatment for AS
- Flexibility and stretching
- NSAIDs
- Sulfasalazine (more effective for peripheral arthritis)
- TNF blockers
Reiters presentation
Prostatitis/cervicitis
Conjunctivitis, pain and erythema
Arthritis occurs LAST
RS affects what joints
Large joint, LE
(Pauciarticular)
May have digit swelling - dactylitis
RS similar to AS in that it may result in…
- bone spurs, enthesopathy
- low back pain, sacroiliitis
Epidemic vs Endemic RS
Epidemic = enteric
Endemic = postvenereal
B27 association rate for RS
80%
Late manifestations of RS
Progressive iridocyclitis
Cardiac palp
CNS stuff
Diagnosis of RS includes….
arthritis with one non-articular feature
Diagnosis for RS Criteria for _____
Peripheral Spondylitis
- Arthritis or Enthesitis or Dactylitis with…*
- one of the classical non-articular features of RS, Reactive Arthritis, or enteric arthritis
OR
- with 2 other arthritis/spondylitis findings without the extraarticular stuff
Special studies - RS
- Joint aspiration
- Genital/oral cultures for STD
- AP pelvis film
- HLA typing helpful
*ANA and RF should be Negative!
RS treatment
NSAIDs are mainstay
local injections might help
Immunosuppressives can be used
RS remittive drugs
sulfasalazine
MTX, gold, AZT
Psoriatic arthritis (PA) definition
seronegative inflammatory arthropathy with cutaneous psoriasis
5 types of arthritis associated with PA
- DIP
- Peripheral asymm. oligarthritis
- RA-like symm. polyarthritis
- Arthritis mutilans
- Sacroiliitis
PA gender ratio
equal
HLA B27 associatio of:
Peripheral Arthritis
Spinal Arthritis
PA = 14-24%
SA = 35-100%
Cmmon skin change locations in PA
Periumbilical area, elbow
Pitting of nails
Intragluteal area
Radiological findings in PA
- DIP involvement
- Phalangeal osteolysis (hallux)
- Arthritis mutilans
- Oligarthritis
- Sacroiliitis
PA treatments
- Occ therapy for hand, physical therapy for large joint/back
- NSAID
- Remittive agents (MTX, gold, SSZ, AZT, Hydroxychloroquine, TNFa-blockers)
Enteropathic Arthritis(es)
- IBD (Crohns + UC)
- Reactive arthritis
- Bowel Bypass disease
- Whipple’s Disease
Whipples disease primarily affects
lamina propria of the small bowel
