Seronegative Spondyloarthropathies

Question 1

HLA associated with SNSA

Answer 1

HLA B27 (on chromosome 6)

Question 2

__% of AS patients have B27

Answer 2

90%

Question 3

Reactive arthritis =

Answer 3

bacterial triggered arthritis

(following enteric or venereal infection)

Question 4

Primary site of SNSA is ___

Answer 4

Enthesis

Question 5

Enthesopathic change is characterized by

Answer 5

fibrosis and ossification (and formation of bone spurs)

Question 6

SNSA has prediliction for ____

Answer 6

Spine

(sacroiliitis, spondylitis)

Question 7

SNSA are usually __-articular

Answer 7

oligo

Question 8

______ are usually affected by SNSA

Answer 8

young men

Question 9

Epidemiology of AS (gender and race)

Answer 9

male to female = 3 to 1

white more common

Question 10

Criteria for AS

Answer 10

4/5 on ASAS

1. Onset before 40
2. Insidious
3. Improved with excercise
4. Not improved with rest
5. Pain at night (improved by moving)

Question 11

Systemic featires of AS

Answer 11

Fever, weight loss, fatigue

Question 12

Characteristic features of AS

Answer 12

Sacroilic edema, obliteration

Bamboo spine

Question 13

Exam for AS includes _____

Specifically?

Answer 13

measurement of spine

Schober test = midpoint between Posterior iliac spines, measure distance changed upon bending over

Chest expansion + Occiput-to-wall distance

Question 14

Main extraarticular manifestation of AS?

Others?

Answer 14

Prostatitis

Others =

1. Iritis/Conjunctivitis
2. Upper lobe pulmonary fibrosis (late manifestation)
3. Amyloidosis
4. Cauda equina

Question 15

Ddx for AS

Answer 15

OA, RS, PA

Mechanical pain

Question 16

Most helpful modality for SI joint exam

Other special studies?

Answer 16

Pelvic Xray

• MRI possibly
• HLA-B27 is NOT favored but may assist diagnosis

Question 17

Treatment for AS

Answer 17

1. Flexibility and stretching
2. NSAIDs
3. Sulfasalazine (more effective for peripheral arthritis)
4. TNF blockers

Question 18

Reiters presentation

Answer 18

Prostatitis/cervicitis

Conjunctivitis, pain and erythema

Arthritis occurs LAST

Question 19

RS affects what joints

Answer 19

Large joint, LE

(Pauciarticular)

May have digit swelling - dactylitis

Question 20

RS similar to AS in that it may result in…

Answer 20

• bone spurs, enthesopathy
• low back pain, sacroiliitis

Question 21

Epidemic vs Endemic RS

Answer 21

Epidemic = enteric

Endemic = postvenereal

Question 22

B27 association rate for RS

Answer 22

80%

Question 23

Late manifestations of RS

Answer 23

Progressive iridocyclitis

Cardiac palp

CNS stuff

Question 24

Diagnosis of RS includes….

Answer 24

arthritis with one non-articular feature

Question 25

Diagnosis for RS Criteria for \_\_\_\_\_

Answer 25

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

Question 26

Special studies - RS

Answer 26

1. Joint aspiration 2. Genital/oral cultures for STD 3. AP pelvis film 4. HLA typing helpful \*ANA and RF should be Negative!

Question 27

RS treatment

Answer 27

NSAIDs are mainstay local injections might help Immunosuppressives can be used

Question 28

RS remittive drugs

Answer 28

sulfasalazine MTX, gold, AZT

Question 29

Psoriatic arthritis (PA) definition

Answer 29

seronegative inflammatory arthropathy with cutaneous psoriasis

Question 30

5 types of arthritis associated with PA

Answer 30

1. DIP 2. Peripheral asymm. oligarthritis 3. RA-like symm. polyarthritis 4. Arthritis mutilans 5. Sacroiliitis

Question 31

PA gender ratio

Answer 31

equal

Question 32

HLA B27 associatio of: Peripheral Arthritis Spinal Arthritis

Answer 32

PA = 14-24% SA = 35-100%

Question 33

Cmmon skin change locations in PA

Answer 33

Periumbilical area, elbow Pitting of nails Intragluteal area

Question 34

Radiological findings in PA

Answer 34

* DIP involvement * Phalangeal osteolysis (hallux) * Arthritis mutilans * Oligarthritis * Sacroiliitis

Question 35

PA treatments

Answer 35

1. Occ therapy for hand, physical therapy for large joint/back 2. NSAID 3. Remittive agents (MTX, gold, SSZ, AZT, Hydroxychloroquine, TNFa-blockers)

Question 36

Enteropathic Arthritis(es)

Answer 36

1. IBD (Crohns + UC) 2. Reactive arthritis 3. Bowel Bypass disease 4. Whipple's Disease

Question 37

Whipples disease primarily affects

Answer 37

lamina propria of the small bowel