Seronegative Spondyloarthropathies Flashcards by michael english

Seronegative spondyloarthropies (SNS) acronym?

PEAR

P: psoriatic arthritis
E: enteropathic arthritis
A: ankylosing spondylitis
R: reactive arthritis (reiter’s syndrome)

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Indications that a PEAR pt has SNS?

Absence of antibodies
RF neg
HLA-B27 
Uveitis 
Males <40

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Who gets ankylosing spondylitis?

White males <45

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What is ankylosing spondylitis?

Chronic inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine

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Describe ankylosing spondylitis

Inflammatory LTB/ascends the spine 
Pain + stiffness in 
- buttocks 
- Low back 
- Chest wall

Worsens at rest 
Pain at night 
Improves w exercise
Spine changes
Extra-articular manifestation

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Spine changes with ankylosing spondylitis?

Lumbar spine: loss of lordosis

Peripheral arthritis: hips shoulders, knees

Thoracic spine: kyphosis

Cervical spine: kyphosis, decreased lordosis

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Extra articular manifestations for ankylosing splondylitis?

Ocular : anterior uveitis
Cardiac : 1st degree av block
- aortic regurg
Pulmonary : upper lung fibrosis

Dactylitis
Psoriasis
IBD

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MC cardiac presentation of ankylosing splondylitis?

1st degree AV block

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Clinical diagnosis of ankylosing spondylitis?

1 clinical + 1 radiologic

Clinical

low back pain/stiffness x 3 months, improves w exercise and not rest
limitation of motion of the lumbar spine in both the sagittal and frontal planes
limited chest expansion <2.5cm at 4th ICS

Radiologic
- sacrolitis grade 2+ bilateral; grade 3-4 unilateral

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Labs for ankylosing spondylitis?

Elevated ESR
neg RF
Anemia
+ HLA-B27

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PE for ankylosing splondylitis

Abnormal schober test
- <5cm
FABER test

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Factors that facilitate earlier diagnosis of ankylosing spondylitis?

Back pain >/= 3 moths <45 y/o

And either:
- sacroliitis and >/= 1 SpA feature
Or
HLA-B27 and >/= 2 SpA features

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Therapy for ankylosing spondylitis?

NSAIDS (1st line)

PT, Exercise, WT loss

DMARDS (ulfasalazine)
TNF inhibitor
- infliximab (remicade)
- entanercept (enbrel)

Surgery

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Corticosteroids with ankylosing spondylitis

Not recommended

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Referrals for ankylosing spondylitis?

PT/OT
Rheum
Ortho
Cardiology
Ophthalmology

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Who gets reactive arthritis?

Young males

What causes reactive arthritis?

Well besides chlamydia…

Bacteria

dysentary-shigela
salmonella
yersinia
campylobacter

NOT VIRALS

MC cause of reactive arthritis?

Chlamydia

S/s of reactive arthritis?

1-4 weeks post “infection”

Cant see, cant pee, cant climb a tree

Post-infectious triad with rheumatology?

Conjunctivitis/uveitis
Asymmetric arthritis
Urethritis

Mucocutaneous features of reactive arthritis?

Keratoderma blenorrhagica or circinate balantitis

Systemic: fever, wt loss
Cardiac: carditis and aortic regurg

Diagnostics for reactive arthritis?

STI testing
Stool and serologic test for GI bugs

Low yield as the infection is usually cleared before onset (except you chlamydia)

Mainstay of therapy for reactive arthritis?

NSAIDS

DMARD if these fail

Goal of therapy for reactive arthritis?

Treat the infection(if it is still there)

Early STI/GU tx to prevent

Prognosis for reactive arthritis?

Most resolve after 6 months Small percent become chronic

Who gets psoriatic arthritis?

Men = women

What precedes arthritis with psoriatic arthritis

Psoriasis (god i hope the questions are like this)

5 patterns of psoriatic arthritis?

1. Asymmetric oligoarthritis of hands/feet 2. Symmetric polyartris (mimics RA but RF neg) 3. Fingers DIP w nail pitting 4. Arthritis mutilans 5. Psoriatic spondylitis

Sausage digits and psoriatic arthritis?

Mimics RA but is RF neg

Labs for psoriatic arthritis?

Elevated ESR Elevated uric acid Neg RF

Radiographs for psoriatic arthritis?

Pencil in cup - DIP | Periostitis in MCP, MTP, phalanges

Tx for psoriatic arthritis?

NSAIDS - 1st line Methotrexate - 2nd line Skin treatment (helps arthritis) Refractory: - sulfasalazine/leflunomide - biologic DMARD

With psoriatic arthritis you should avoid?

Steroids - postural psoriasis | Antimalarials

Enteropathic arthritis is aka?

IBD

Who gets enteropathic arthritis?

Men= women

Etiology of enteropathic arthritis?

chron’s and Ulcerative colitis Chron’s is MC

Types of enteropathic arthritis?

Peripheral (acute/early) - non-deforming asymmetric, oligoarthhrits of large joints Spondylitis - looks just li,e ankylosing spondylitis

Focus of therapy for enteropathic arthritis?

Controlling IBD

Meds to treat enteropathic arthritis?

- Salicylates (5-ASA, sulfasalazine) - Corticosteroids - Azathioprine - Biologics (anti-TNF) - NSAIDS (symptom control)