Seronegative Spondyloarthropathies - Darrow Flashcards
seronegative spondyloarthropathies
M > F
<40yo
spine and SI joints
HLA-B27 positive**
non-vertebral sx of spondyloarthropathies
enthesopathy
sausage digits
pustular psoriasis
etc.
HLA-B27
class I MHC - CD8 cells
often high in diseases
-but not absolutely necessary
10% of ankylosing spondylitis are HLA-B27 negative
diagnosis of spondyloarthropathy
often needs sarcoilitis
-low back pain - worse in morning gets better over day
Th17
tissue inflammation
ankylosing spondylitis clinical**
bamboo spine - lateral** SI inflammation kyphosis fatigue ocular inflammation reduced rib expansion weight loss AA subluxation pulmonary fibrosis - upper lobe aortic insufficiency
associations with ankylosing spondylitis
upper lobe pulmonary fibrosis
aortic insufficiency
schober test
for AS
when flex spine - should increase distance between points
MRI of AS
edema at enthesitis sites
before you get sclerosis
andersson lesion
simulate diskitis
-in AS
syndesmophytes
bamboo spine of AS
shiny corner sign
reactive sclerosis in AS
anterior and thick syndesmophytes**
more in DISH - diffuse interosseous skeletal hyperostosis
AS - lateral - bamboo spine
complications of AS
upper lobe pulmonary fibrosis
aortic regurgitation
bilateral sarcoilitis
AS
unilateral sarcoilitis, rash, sausage digits, pencil in cup
with psoriatic arthritis
most common pattern in psoriatic arthritis
type 1 - oligoarthritis
worst pattern in psoriatic arthritis
type 5 - opera glass
arthritis mutilans
gives pencil in cup
young male, hell pain achilles insertion, pain knees, hips, low back
month ago - clear penile discharge
reactive arthritis
not usual - death
Keratoderma blennorrhagicum
skin lesions - palms and soles
-in reactive arthritis
infections in reactive arthritis
MUS3Y2C3 - GI and GU bugs
mycoplasma genitalium
ureaplasma urealtyicum - men
shigella flexneri
salmonella sp
streptococcus
yersinia enterocolitica
yersinia pseudotuberculosis
campylobacter jejuni
clostridium dificile
chlamydia trichomatis
reiters syndrome
reactive arthritis
lovers heel
reactive arthritis
HLA-B27 positive, large joint arthritis, uveitis, urethritis, mouth ulcers, follows infection
reactive arthritis
IBD with arthritis
sacroilitis - acts independently of IBD
peripheral arthritis - corresponds to IBD
often crohns
hemophiliac
gets hemarthrosis
diarrhea, b/l ankle and elbow synovitis, b/l heel pain, effusion of right knee
hemarthrosis
persistant hemorrhage
knees ankles and elbows
boggy synovitis
drug abuser arthritis
streptococcus agalactiae
gram positive cocci
group B lancefield antigen
monoarthritis
septic - until proven otherwise
more joints involved
less likely septic
-unless - RA, group B strep, endocarditis
anti-TNF therapy
2x likely to get septic arthritis
joint effusion septic arthritis
WBC >50,000
gram stain and culture positive
diagnosis of septic arthritis
check for AFB in anti-TNF therapy or HIV
type III synovial fluid
purulent
opaque
low viscosity
>100,000 WBC
>75% polys
in septic arthritis**
string sign
for low viscosity of synovial fluid
-type III
septic arthritis
majority of septic arthritis
gram positives
-staph, MRSA, group B strep, pneumococcus
prosthetic joint infection
majority staph
> 24 months - seed from blood
3-24 months - coag negative staph from surgery
migratory arthritis, meningitis, pancarditis, and skin pustules
gonococcal arthritis
most common septic arthritis in young adults
disseminated - fitz hugh curtis - liver perihepatitis**
gonococcal arthritis
disseminated - arthritis/dermatitis syndrome
also - C5-9 deficiency is risk fx**
potts disease
TB septic arthritis to spine
vague presentation of arthritis
viral
severe joint pain and myalgias
HIV - no CD4
CD8 causes problems - sjogrens
hilar nodes - CD4 - sarcoid disease
diffuse infiltrative lymphocytosis syndrome
DILS
CD8 cell infiltration of organs
hilar lymphadenopathy in treated HIV patient, next test?
ACE
erythema nodosum with arthritis
BUMPS
boecks sarcoid bechets disease UC/Crohns mycoses pills - BCP strep
IRIS
immune reconstitution inflammatry syndrome
-driven by CD4 lymphocytes
RA, SLE, sarcoid, sjogrens
lyme disease association
bells palsy
heart block
diagnosis of lymes
confirmed with western blot
