Seronegative spondyloarthropathies - Postlethwaite Flashcards
List group of disorders associated with Spondyloarthropathies
PAIR + 2
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis (Reiter Syndrome)
Undifferentiated Spondyloarthropathies
Juvenile chronic arthritis and Juvenile-Onset Ankylosing Spondylitis
Spondyloarthropathies
Rheumatoid factor (+ or -) ?
negative ghostrider
Spondyloarthropathies
High Association with what gene?
HLA - B27
Spondyloarthropathies
More often in males or females?
Males
Spondyloarthropathies
Axial or appendicular skeleton involvement?
Axial skeletal involvement with sacroiliitis and spondylitis
Spondyloarthropathies large joint features
Poly or oligoarthritis?
Symmetric or asymmetric?
Upper or lower extremities?
Large joint asymmetric oligoarthritis predominantly in lower extremites
Spondyloarthropathies
Familial involvement?
Yes, Significantly
Spondyloarthropathies
Absence of what (that are commonly seen in RA)
Absence of subcutaneous nodules and other extra-artiular manifestations of RA
HLA-B27 is what MHC class?
MHC Class I, binds antigenic peptides and presents them to CD8+ T cells
HLA-B27 is found in over 90% of patients with what disorder?
General population frequency?
Ankylosing Spondylitis
8% of general population has HLA-B27. means that just b/c you have it, doesn’t mean you have disorder
HLA-B27 is found in 75% of which patients?
Pts with Reactive Arthritis (Reiter’s)
Frequency of HLA-B27 in Psoriatic Arthritis?
50%
Ankylosing Spondylitis Epidemiology
Age?
Gender preference? Ratio?
Etiology?
Age: Adolescence to 35
Gender: Male:Female 3:1
Etiology: Unknown
Ankylosing Spondylitis has what pathologic findings (3)?
Inflammatory cell infiltrates
Synovial inflammation similar to RA
TNF alpha excess
Clinical features of Ankylosing Spondylitis?
Rapid vs insiduous onset?
Insidous onset
Clinical features of Ankylosing Spondylitis?
Pt pain usually begins where in body?
Overtime where does pain go? What does this cause?
Pain usually begins in lower back, vertebral bodies eventually involved, causing fusion of the vertebrae “bamboo spine”
Bamboo spine refers to what pathology of which disorder?
Vertebral fusion, seen in Ankylosing spondylitis
What extra-articular manifestation are seen in Ankylosing spondylitis? Which is most common?
Eye: Anterior Uveitis (25-30%) = MOST COMMON
Cardiac: Aortitis (leading to aortic regurgitation), heart block, pericarditis, Increased risk for MI
Lungs: Apical lung fibrosis, thoracic cage restriction
If AS patient has peripheral joint involvement, what extra-articular symptoms are more common?
Aortic regurg and heart block 2x more common
Describe spine of Ankylosing Spondylitis patient?
- Fusion of spine causes limited ROM in all directions
- Loss of lumbar lordosis & development of thoracic and cervical kyphosis
Ankylosing Spondylitis Exam findings (3) ?
- Abnormal Schober’s test (< 3 cm)
- Reduced chest expansion (<2.5 cm) measured at 4th Intercostal space
- Increased occiput to wall distance
Spine probs in Ankylosing Spondylitis lead to what feature?
generalized osteopenia, increased risk for fractures