SERONEGATIVE SPONDYLOARTHROPATHIES II

Question 1

what is the clinical presentation of RA?

Answer 1

reiters triad

• urethritis
• conjunctivitis
• arthritis

Question 2

labs done for RA?

Answer 2

ESR and CRP high
CBC w/ Dif shows neutrophils
serum urate negative
nonspecific synovial fluid analysis
stool and urine culture
HLA B27 testing

Question 3

what do the radiographic studies for RA pick up

Answer 3

enthesitis

sacroilitis

Question 4

RA diagnosis?

Answer 4

no single definitive diagnosis

MSK findings
preceding extra articular infection

excluded more likely causes of OA, SA, enthesitis
*If all three than RA

Question 5

treatment for RA?

Answer 5

self limiting in 80-90% of cases
NSAIDs
intra articular glucocorticoid injection (kenalog)
systemic glucocorticoid (prednisone 30 mg)
DMARDs (sulfasalazine or methotrexate)
biologics (TNF inhibitor)
antibiotics
ocular, skin, oral treatments

Question 6

inflammatory arthropathy associated with psoriasis?

usually RF negative
resembles RA
member of spondyloarthopathy family

Answer 6

psoriatic arthritis

Question 7

epidemiology of psoriatic arthritis?

Answer 7

psoriasis affects 2% of pop
7-12 affected develop arthritis
peak age for onset is 20s
progressive disease and erosions can develop within 2 years of being diagnosed
equal male to female distribution

Question 8

pathogenesis of PA?

Answer 8

unclear

strong genetic component

Question 9

PA 5 clinical patterns of PA?

Answer 9

asymmetric oligoarthritis
symmetric polyarthritis
predominant DIP involvement
predominant spondyloarthritis 
destructive arthritis-arthritis mutilans
-pencil in cup deformity

Question 10

clinical presentation of PA?

Answer 10

skin manifestations

• plaque psoriasis
• nail changes

articular manifestations

• oligoarthritis
• polyarthritis
• joint inflammation
• low back pain
• dactylitis
• joints of hands and feet with DIP involvement in 1/3 of patients and nail disease associated

extra articular manifestations

• skin/nails
• enthesitis
• conjunctivits
• IBS
• distal limb edema/lymphedema
• amyloid proteins

Question 11

what are the labs of PA?

Answer 11

RF negative
CRP,ESR,amyloid A elevated
no definitive diagnosis

Question 12

radiographic features PA?

Answer 12

plain film radiographs are gold standard

radiographic changes in 67% of patients with PA

asymmetric joint involvement
IPJ finger and toe involvement
IPJs feature erosions, resorption and hypertrophic bone proliferation at distal phalanx
joint space narrowing
enthesophytes
spinal involvement

Question 13

penci in cup deformity is indicative of?

Answer 13

PA

Question 14

diagnosis based on?

Answer 14

clinical presentation

Question 15

treatment for PA?

Answer 15

complicated clinical presentation

NSAIDs
intra articular steroid injections with oligoarticular disease or enthesopathy
DMARDs
Biologics