Seronegative Spondyloarthropathy Flashcards

0
Q

spondylo

A

vertebra

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1
Q

ankylos

A

stiffening

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2
Q

seronegative means

A

RF
ANA
ANCPA

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3
Q

enthesis

A

site of attachment of tendon, ligament or joing capsule to bone; inflam here

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4
Q

key difference between RA w/ synovial inflam and SA is

A

inflammation starts at enthesis

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5
Q

enthesis is ___

A

metabolically active

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6
Q

4 types of arthridities taht dont equal RA

A

ankylosing spondylitis
reactive arthritis
psoriatic arthritis
inflammatory bowel disease arthrits

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7
Q

pattern of spondyloarthopathy

A
assymetric peripheral arthritis
radiographic sacrolitis
enthesitis
absence of RA
significant familial--HLAb27
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8
Q

Juvenile SA vs undifferentiated SA

A

juvenile- AS, ReA

undifferentiated- PsA, IBDA

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9
Q

definite AS dx

A

1 radiographic finding + > 1 clinical feature

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10
Q

pre-radiographic stage

A

undifferentiated axial spa
back pain
mri: active sacrollitis

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11
Q

radiographic stage AS

A

real AS

back pain, radigraphic sacrolitis–>ack pain + syndesmophytes

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12
Q

clinical features AS

A

back pain
low back pain with alternating buttock pain
slow onset, chronic
worse at 2-5 am, early morning
better with exercise nad nsaids, worse with exercise

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13
Q

most common extraspinal symptoms

A
eye-acute anterior uveitis
aoritis-rare but very dangerous 
subclinical colitis
pulmonary fiborsis 
Iga nephropathy, amyloidosis
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14
Q

why do you get pulmonary fibrosis

A

mechanical restriction–>decreased chest expansion

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15
Q

PE AS

A

occiput to wall distance >0
decrease spinal mobility, chest expansion
Shobers <15 cm
FABER-pain in contralateral SI joint is +
pelvic compression

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16
Q

early radiographic signs

A

shiny corners; romanus lesions

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17
Q

later radiographic signs

A

granulation inflammation

ossification of annulus–>syndesmophytes–>bridge and obliterate joint space–>bamboo spine

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18
Q

what marks severe sponylosis

A

PIP involvement

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19
Q

decreased surivial spond because

A

CVD

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20
Q

HLAb27

A

95% of patients have it, but only 5% of them develop HLAB27

if you have AS and are HLAb27, kids risk of getting it 20%

21
Q

hlab27 negative associated with

A

later onset

22
Q

Tx AS

A

nsaids, sulfsalazine

23
Q

TNF alpha antag

A

effective for both axial disease and uveitis- aggressive

24
Q

predinose

A

not effective for axial, but helps with uveitis

25
Q

MTX and other DMARdS

A

DO NOT WORK

26
Q

reactive arthritis

A

get 2-4 weeks after GI or GU infection
synovial culture negative
antibiotics dont help change course except clymidia

27
Q

85% of reactive arthritis is

A

HLA b27

28
Q

RA mostly affects

A

Lower extremities

29
Q

extraarticular reactive arthritis

A
uveitis/conjunctivitis
circinate balmus
keratoderm blenurrgium
urtherits
inflamation on achiles tendon insertion and plantar fascia
30
Q

circinuate balintus

A

ulcers and plaque like lesions on flans of penis

31
Q

keratoderm blenurrhgium

A

skin lesions palms and soles

32
Q

M=F for

A

GI infections

33
Q

M>F for

A

GU infection

34
Q

all of these infections have

A

LPS-pts with HLAb27 may have conserved t cell reaction that respond to it

35
Q

TX Reactive arth

A

nsaids
sulfasalazine anad dmards
prednisone

36
Q

reiter’s syndrome

A

subet of ReA with urethritis, chlamydia+ arthritis, ach tendo periositis, conjunctivitis

37
Q

psoriatic arthritis

A

patients will have skin change and nail pitting before getting a mild, oligoarticualr (mostly) arthritis

patients dont have to have psoriasis

38
Q

5 patterns PA

A
DIP
asym oligo
sym polyarth
arthritis mutilans
spondyloarthritis
39
Q

classification PA

A

inflammatory joint/spine/entheseal disease and >/= 3

current/hx/or fx of psoriasis
psoriatic nail dystrophy
rf negative
dactylitis at any point
xray
40
Q

xray should show

A

erosive, assymetric arthritis
pencil in cup deformity
non-marginal assym syndesmophytes taht are big bulky realtive to AS

41
Q

dactylitis

A

inflammation of tendons (not painful)–>sausage like fingers/toes

42
Q

treatments

A

nsads
sulfa
dmards
tnfa antag!!!

43
Q

prednisone with PA

A

may help arthritis but mays psoriasis worse

44
Q

hydroxychloroquine in PA

A

might exacerbate skin disease

45
Q

IBD arthropathy

A

peripheral arthritis–freq associated with skin disease (e nodosum, pyoderma grangrenosum)

can be oligoarticular or polyarticular
bad back does not equal bowel problem

46
Q

IBD more common in

A

crohn than UC

47
Q

colectomy

A

can induce remission in UC

48
Q

treatment IBD arth

A
underlying diease!
NSAIDS maybe for pain, but contraindicated
sulfa, mtx
tnfa!
azanthhioprine
mercaptupurine
49
Q

TNF a antag

A

adelimumb- crohns

infliximab- crohns, uc

50
Q

HLAb27 freq

A

AS>IBD spondylitis> psoriatic spondyltis>ReA>psoriatic>IBDA

51
Q

why is HLAb27 a double edged sword

A

provides anti-viral immunity (hep c clearance), but also increases autoimmunity (bacterial mimicry–>arthritogenic peptides) AND decreases intracellula rbacterial killing–>REA