Seronegative Spondyloarthropathies Flashcards
Is UE or LE usually more involved in reactive arthritis?
Lower extremity
First site of involvement in ankylosing spondylitis
SI joint
Most common site of fractures in AS?
Lower cervical and lumbar spine
What medication works best for psoriatic arthritis
The biologics such as anti-TNF antibodies adalimumab and infliximab
What other disease can reactive arthritis progress to?
3-10% can progress to ankylosing spondylitis
What kind of spine exercises do you prescribe for ankylosing spondylitis
Extension-based
Triad of reiter’s
- Conjunctivitis
- Nongonococcal urethritis
- Arthritis
What joints are involved in psoriatic arthritis associated with HIV?
Foot and ankle
5 main HLA-B27 diseases
- Psoriatic arthritis
- Ankylosing spondylitis
- Reactive arthritis
- Enteropathic arthritis
- Pauciarticular JRA
What joints are affected in enteropathic arthropathy?
Large joints such as knees, ankles, feet
What lab test is seen in enteropathic arthropathy not seen in other seronegative spondyloarthropathies?
ANCA
Preferred NSAID for ankylosing spondylitis
Indomethacin
How can the fingers manifest in reactive arthritis?
dactylitis (sausage digits)
How many joints are usually affected in reactive arthritis?
4 or fewer joints
What is the usual etiology of reactive arthritis?
GU = chlamydia GI = campylobacter, shigella, salmonella
What part of the spine is the last to be ankylosed in ankylosing spondylitis?
Cervical spine - after 16 years
What skin manifestation is seen on the palms and soles of feet in reactive arthritis?
Keratoderma blennorhagica - hypertrophic skin lesions on palms and soles of feet
What radiographic finding of the feet is seen in reactive arthritis?
Erosions at insertion of plantar fascia and Achilles’ tendon (“Lover’s heel”)
Color, viscosity, WBC, protein and glucose seen in reactive arthritis synovial fluid
Color = turbid Viscosity = low WBC = 5-50,000 PMNs Protein = increased Glucose = normal
What medications do you not want to use to treat psoriatic arthritis in someone with HIV?
No steroids or MTX
What physical exam test is used to diagnose ankylosing spondylitis?
Schober’s test
Arthritis mutilans
Osteolysis of the phalanges and metacarpals of the hand seen in psoriatic arthritis fresulting in telescoping of the hand, where there is shortening of the involved fingers.
Most common extraskeletal manifestation in ankylosing spondylitis
Iridocyclitis/acute iritis
In psoriatic arthritis, which joint usually demonstrates the pencil in cup deformity
DIP joint
What does bamboo spine refer to?
Ossification of spinal ligaments and ankylosis of facet joints leading to fusion of spine
How do you do schober’s test?
Measure point 5cm below iliac crest line and 10cm above iliac crest. Have patient flex forward and line should increase by more than 5 cm. If it doesn’t increase by more than 5cm, then there is restriction in lumbar flexion
Auspitz’s sign
Scraping of psoriatic lesion causes pinpoint bleeding
What skin manifestations can be seen in ulcerative colitis and Crohn’s disease?
Pyoderma gangrenosum - UC
Erythema nodosum - Chron’s
4 main classes of medications used to treat AS
- NSAIDs
- Steroids
- Muscle relaxants
- DMARDs
