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rheumatology > seronegative spondyloarthropathies > Flashcards

seronegative spondyloarthropathies Flashcards

1
Q

what are the seronegative spondyloarthropathies

A

group of -inflammatory joint diseases that share the HLA-B27 antigen and are negative RF and ACPA

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2
Q

5 seronegative spondyloarthropathies

A 
ank spond
axial spond
reactive arthritis
psoriatic arthritis
arthropathy assoc. to IBD
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3
Q

pathogenesis of seronegative spondyloarthropathies

A

inflammatory enthesitis

and synovitis

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4
Q

what type of arthritis are ss

A

asymmetrical

oligoarthritis

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5
Q

extra-articular features of SS 9

A
  • mucosal inflammation
  • conjunctivitis
  • urethritis
  • nail dystrophy
  • uveitis
  • erythema nodosum
  • psoriasis
  • IBD
  • aortic incompetence
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6
Q

what joint is predominantly affected by ank spond

A

sacroiliac joint progresses to bony fusion of spine

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7
Q

ank spond name for fusion of bony spine

A

bamboo spine

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8
Q

male to female ratio for ank spond and age of onset

A

3:1
Often young males in teens to early 20s
Rare after 50

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9
Q

clinical features of ank spond -bone

A 
lower back pain
early morning stiffness
worse on inactivity
relieved by movement
reduced lumbar motion
fatigue
kyphosis
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10
Q

extra-articular features of ank spond 8

A 
dactylitis
uveitis
conjunctivits
aortic incompetence
urethritis
amyloidosis 
tendonitis of achilles and plantar
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11
Q

how many ank spond % have peripheral arthritis and what joints

A

40%
large joints
asymmetrical
10% have peripheral before spinal

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12
Q

disease score for ank spond and components

A

BASDAI-bath

  • fatigue /`10
  • pain/10
  • pain and swelling of other joints /10
  • level of discomfort from tender areas /10
  • discomfort from wake up time /10
  • morning stiffness last 0-2 hrs
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13
Q

difference in diagnosis of axial and ank spond

A

axial=sacroilitis on mri only not on x-ray

ank spond= bilateral sarcroilitis on x-ray

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14
Q

diagnosis of ank spond and axial spond criteria

A 
back pain >3 months 
improved by exercise
not relieved by resr
insidious onset
night pain
(>45 for axial)
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15
Q

differences between axial and ank spond

A
  • axial responds to nsaid not ank

- no fhx for ank spond

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16
Q

biomarkers for ank spond

A

esr and crp raised
negative antibodies
hla b 27

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17
Q

x-ray signs of ank spond in sc joint 3

A

loss of cortical margins
widening of joint space
sclerosis
joint space narrowing and fusion

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18
Q

x-ray of ank spond thoracolumbars spine 3 signs

A
  • ant. squarring of veretbrae due to erosion
  • bridging syndesmophytes-calcification bony growth into intervetebral joint space into the ligament
  • ossification of ant. longitudinal ligament= bamboo spine
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19
Q

management of ank spond

A
  • nsaid
  • analgesia
  • exercise
  • DMARDS only for peripheral (no effect on spine)
  • anti-tnf (other biologics don’t work)
  • steroids for enteropathies
20
Q

basdai score for anti-TNF

A

> 4

21
Q

male to female ratio for reactive arthritis

A

15:1

22
Q

what is the most common cause of inflammatory arthritis in males 16-35

A

reactive arthritis

23
Q

what is a risk factor for reactive arthrtis

A

HLA b27

24
Q

classic triad of Reiter

A

non specific urethritis
reactive arthritis
conjunctivitis

25
Q

extra-articular features of Reactive arthritis 12

A 
circinate balantis (20-50%)-penis
nail dystrophy
keratoderma blennorhagica 15%
buccal erosions 10%
conjunctivitis
uveitis
pustular psoriasis 
aortic incompetence
pericarditis
neuropathy
seizures
26
Q

5 main pathogens in reactive arthritis

A 
salmonella
shigella
campylobacter
yersinia
chlamydia (sexually active)
27
Q

cause of reactive arthritis

A

after having food poisoning or sti- get arthralgia in joint

28
Q

clinical features of reactive arthritis

A 
oligoarthritis
asymmetrical
lower limbs
can be single joint
systemic: fever and weight loss
achilles tenonditis/ plantar fasciitis
29
Q

what should reactive arthritis always be assumed as initially

A

septic arthritis

30
Q

risk of recurrence of reactive arthritis

A

> 60%

31
Q

investigation of reactive arthritis

A
  • joint aspiration (leucocyte rich- multinucleated macrophages Reiter cells)
  • raised esr and crp
  • 2 glass test urethritis- mucoid on 1st, clears by second
  • high vaginal swabs
  • serum agglutinin test for phx dysentry
  • antibodies-
  • x-ray
32
Q

x-ray signs of recurrent reactive arthritis

A 
joint space narrowing
eerosion
perositis
asymmetrical sacroiliits rather than bilateral in AS
syndesmophytes
33
Q

management reactive arthritis

A
  • start for septic
  • nsaid and anlagesia
  • steroid
  • antibiotics targeted
34
Q

what should be given for chlamydial urethritis

A

doxycycline or azithromycin

35
Q

what should be given for severe keratoderma

A

DMARD or anti-tnf

36
Q

criteria for psoriatic arthritis CASPAR

A

inflammatory articular disease (joint or enthesis) with >3

  • current psoriasis
  • hx of psoriasis in 1st/2nd degree relative
  • psoriatic nail dystrophy
  • negative IgM Rheumatoid factor
  • current dactylitis
  • hx of dactylitis
  • juxta-articular new bone
37
Q

genes assoc. to psoriatic arthritis

A

hla-b and hla c genes strongest

38
Q

clinical features psoriatic arthritis

A

pain and stiffness

tendons, joints and entheses

39
Q

5 types of psoriatic arthritis

A 
1=asymmetrical inflammatory oligoarthritis
2=symmetrical polyarthritis
3=DIP joint arthritis
4= psoriatic spondylitis
5=arthritis mutilans
40
Q

what is arthritis mutilans

A

deforming erosive arthritis of fingers and toes

  • enthesitis predominant
  • pitting
  • oncholysis
41
Q

where does psoriatic arthritis usually affect

A

dip and pip joints of hand, entheses and larger joints

42
Q

management of psoriatic arthritis

A
  • nsaid and analgesia
  • steroid injection
  • splint and rest
  • DMARD persistent synovitis
  • anti TNF
  • IL17
43
Q

first choice dmard for psoriasis rash and other beneficial treatment

A

methotrexate as effective for psoriasis

uv and sunlight helps psoriasis

44
Q

enteropathic spondyloarthropathies what are they and % involvement

A

IBD patients

20%

45
Q

what joints are typically targeted by enteropathic spondyloarthropathies

A

larger lower limb joints

46
Q

what treatment to avoid for enteropathic spondyloarthropathies 2

A 
nsaids= worsen IBD
etanercept= no efficacy in IBD

rheumatology (9 decks)

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