Seronegative Spondyloarthropathies (SpA) Flashcards

Question

What is the clinical course and prognosis of PsA?

Answer 1

67% of patients have joint erosions at the time of initial presentation to clinic disease progression over time with an increased incidence of polyarthritis and an increase in joint damage both clinically and radiographically poor prognosis related to polyarticular disease and high medication level at presentation

Answer 2

sacroiliitis with asymmetric joint involvement apophyseal (facet) joint involvement with skip lesions syndesmophytes may be seen spine/back pain and stiffness is not as severe compared to AS

Answer 3

skin disease - psoriasis is a prerequisite, but may come after joint disease or occur at the same time nail dystrophy - thickened, opacified onycholysis and pitting hyperkeratosis (hypertrophy of skin under the nail) conjunctivitis and acute anterior uveitis/iritis is more common in patients with axial disease uretheritis is common as well as non-specific colitis or subclinical gut disease dilation of base of aortic arch resulting in aortic insufficiency

Answer 4

NSAIDs and corticosteroids for symptom relief MTX, sulfasalazine for peripheral TNFalpha inhibitors for axial involvement

Answer 5

additive, asymmetric pattern, oligoarticular or polyarticular bluish/purple discoloration over inflamed joints skin disease typically precedes joint disease by up to 10 years 10% will present with joint disease first no correlation between severity of skin and joint disease, although presence of joint disease is more likely with severe skin disease nail findings associated with joint disease

Answer 6

chronic, systemic inflammatory arthritis with both axial and peripheral involvement - especially sacroiliac joints and spine may have extra-articular manifestations (skin, eye, bowels, and heart) strongly associated with HLA-B27 (~90%) ~80% male, young adults

Answer 7

can be due to Klebsiella aeruginosa bacterial infection, but no conclusive evidence strong association with HLA-B27 positivity inflammatory disease

Answer 8

often a late diagnosis, although symptoms typically begin in 20s - children may present with peripheral disease presenting symptoms: - inflammatory back pain and stiffness - sacroiliitis - oligoarthritis - enthesitis - systemic symptoms (fatigue, imparied sleep)

Answer 9

found in ankylosing spondylosis ossification of spinous ligaments syndesmophytes (calcium deposites in posterior spinous ligament) are diffuse

Answer 10

found in ankylosing spondylitis presence of bridging syndesmophytes - intervertebral discs and spinal ligaments become calcified

Answer 11

inflammatory back pain and stiffness, ascend up the spin and results in loss of lumber lordosis sacroiliitis oligoarthritis enthesitis dactylitis systemic symptoms (fatugue, impaired sleep, fever, weight loss, loss of libido) dagger sign and bamboo spine \*\*also has diarrhea, which separates from ankylosing spondylitis

Answer 12

young man with inflammatory back pain (better with motion) and worse at night, and insidious in onset pain is worsened by rest and improved with exercise

Answer 13

conjunctivitis, acute anterior uveitis/iritis - not related to joint flares dilatation of base of aortic arch resulting in aortic insufficiency conduction abonormalities associated with peripheral joint involvemen inflammatory bowel disease present subclinically in 60% of patients 1% develop progressive upper lobe fibrosis or restrictive lung disease spinal fractuers, deformities, and disc disease can impinge nerves psoriatic lesions in 10-25%

Answer 14

pauciarticular, large joint arthritis (self-limited, flares with IBD activity)

Answer 15

polyarticular arthritis typically symmetrical involvement of small joints of hands independent of IBD activity

Answer 16

**exercise/physical therapy (most important)** NSAIDs corticosteroids sulfasalazine methotrexate TNFalpha antagonists

Answer 17

accompanies ulcerative colitis (UC) and Chron's disease (CD) periphearl joint pain/disease typically mirrors the gut disease, but this is not true for axial joint disease colectomy for UC can lead to complete resolution of peripheral joint disease although this is not the case for CD

Answer 18

sacroiliitis with symmetric joint involvement like AS asymmetric oligoarthritis that commonly involves the lower extremity (hips, knees, ankles, MTP are most commonly affected) enthesitis conjunctivitis, acute anterior uveitis/iritis erythema nodosum (panniculitis, pyoderma gangrenosum, oral ulcers

Answer 19

NSAIDs or corticosteroids sulfasalasine etanercept infliximab adalimumab

Answer 20

TNFalpha inhibitor useful for skin, jjoint, and extraarticular manifestations of PsA administered SC

Answer 21

chimeric (part mouse) monoclonal antib-TNFalpha antibody that is useful for skinm joint, an extraarticular manifestations of PsA has been shown to prevent radiographic progression of PsA administered IV

Answer 22

fully human anti-TNFalpha monoclonal antibody administered SC

Answer 23

fully human fusion protein that blocks interaction between LFA-3 on the antigen-presenting cell and CD2 on the T-cell or by attracting natural killer T-cells to interact with CD2 to yield apoptosis of particular T-cell clones useful for PsA and is administered IM

Answer 24

IV bisphosphonate that has been shown to improve bone metabolism, inflammation, and immune regulation

Answer 25

glutamic acid derivvative that produces anti-inflammatory and immunomodulatory effects , including a reduction of TNFalpha production

Answer 26

drug that is mtabolized to sulfapyridine, which is thought to have antibiotic porperties the other metabolite, 5-aminosalicylic acid (5-ASA) is thought to have the drug's anti-inflammatory therapeutic effect