SNSA and septic arthritis, part I Flashcards
What are the spondlyoarthropathies
AS psoriatic arthritis reactive arthritis with IBD undifferentiated spondlyarthropathy acute anterior uveitis
seroneg spondyloarthropathies demographic
male before age 40 inflammatory of spin and SI HLA B27 + RF CCP ANA -
what are the nonvertebral Sx of spondyloartropathies
entehsopathy asymmetric peripheral arthritis sausage digits uveitis mucocutaneous lesions
HLA MHC and CD cell in spondlyarthropathies
B27
MHC1
CD8 CTLs
What bacteria is in stools of AS patients
klebsiella
What is targeted in Tx for HLA B 27 diseases
Th17 because has main role in inflammation and enthesis
if HLA B27 what else do you need to Dx spondylarthropathy
2 features
how do Dx inflammatory back pain
morning sitffness > 30 min
pain at night or early morning
improves with exercise
Sacroiliitis on imaging and what Dx spondyloarthropathy
plus 1 feature
what are the features of spondylarthropathies!!!
arthritis enthesitis uveitis dactylitis psoriasis CD/UC response to NSAID FH HLA B27 elevated CRP aortic insufficiency
signs of ankylosing spondylitis!!!!
bamboo spine SI inflammation b/l!!! increased kyphosis fatigue ocular inflammation, uveitis reduced rib expansion- reduced inhalation weight loss (systemic sym) possible atlantoaxial subluxation pulmonary fibrosis-- upper lobe!! aortic insufficiency
Essentials for Dx AS
chronic LBP in young adults, insidious onset and worse in mroning progressive limitation back motion or chest expansion SI abnormalities peripheral arthritis inflammatory eye disease aortic insufficiency elevated ESR neg RF CCP HLA B27 when Dx unclear
what causes limitation of chest expansion in AS
upper lobe pulm fibrosis
What is schobers test
when measure on back and then bend over and space above iliac crest line does not stretch out, but stays same lenght (loss of curvature)
lab findings for AS
increased ESR - RF -anti CCP mild anemia HLA B27+
what are imaging for AS
MRI gadolinium whole body!!!
may show edema at enthesitis sites before sclerosis megins
CT scans
XR
What is Andersson lesion
degeneration of spine from AS
what is shiny corner sign
reactive sclerosis!!!
synchondrosis of spine anterior and thick
not in SI joint
DISH
diffuse interosseous skeletal hyperostosis
complications AS
uveitis upper lobe PF cauda equina fibrosis aortic regurg heart block
migratory asymmetric polyarthritis for 3-4 mo
RD CCP negative
unilateral sacroiliitis
dx?
psoriatic arthritis
patterns of psoriatic arthritis
unilateral sacroiliitis oligoarthritis asymmetrical polyarthritis DIP pencil in cup- arthritis mutilans- opera glass
labs in psoriatic arthritis
HLA B27 + RF CCP neg UA inc FE2+ dec!! Th17 inc IL 17 HIV assoc!!!
essential for Dx psoriatic arthritis
psoriasis precedes arthritis
sausage appearnance of fingers and toes
unilateral sacroiliitis
pencil in cup
What bacteria can cause reactive arthritis
chlamydia, ureaplasma, mycoplasma genitalium
shigella, salmonella, yersinia enterocolitica and yersinia pseudoTB, campylobacter, clostriduium difficile
strep
if reactive arthritis from venereal bacterium not responding to Tx
then search for ureaplasma or mycoplasma genitalium
What types chalmydia cause GUI
D-K
reactive arthritis assoc with
enthesopathy- lovers heels inflammatory eye disease circinate balanitis keratoderma blenorrhagicum oral ulcers sacroillitis
lovers heals
enthesopathy where achilles joins in
what is needed for Dx reactive arthritis
large joint oligoarthritis
sacroiliitis
uveitis, conjunctivitis
urethritis
IBD arthritis
b/l symmetrical sacroiliitis
acts independently of IBD!!!!!
peripheral arthritis corresponds to IBD status!!!!
hemophiliac cause of effusions usually
blood, hemarthrosis
best way to Dx hemarthrosis
MRI
XR can show hemosiderin
gram + cocci
group B lancefield Ag
strep agalactiae
septic arthritis
monoarthritis
multi joint- RA, group B strep or endocarditis
what patients more prone to septic arthritis
anti TNF therapy are twice as susceptible
essentials Dx septic arthritis
sudden acute monoarticular large joint
prebious joint damage or IV drug use
WBC >50,000
check for what in suspected septic arthritis in anti TNF therapy or HIV
AFB
appearance, viscosity, total WBC and PMN %
of noninflammatory I synovial fluid
clear yellow
high viscosity
<25% PMN
appearance, viscosity, total WBC and PMN %
of inflammatory II synovial fluid
opaque low viscosity 2-75,000 >50% PMN positive crystals
appearance, viscosity, total WBC and PMN %
of purulent type III synovial fluid
opaque green
low viscosity
>100,000 WBC
>75% PMN
noninflammatory synovival fluid found in what patients
OA
inflammatory synovial fluid in what patients
RA and crystal
majority septic arthritis microbes
staph aureus
MRSA
group B strep
pneumococcos
gram -: E coli pseudomonas gonorrhea salmonella-- SLE, HIV and SS
Prosthetic joints have what
biofilm to protect from staph and pseudomonas
prosethetic infections when have had prosthetic for >24 mo are caused how
seeding from blood
prosthetic infection within 3 mo of gettin prosthetic
staph from surgery
fever migratory polyarthralgias meningitis pancarditis most likely
disseminated gonorrhea
common sign of disseminated gonorrhea sequelae
fitz hugh curtis
perihepatitis because of adhesions below liver
most common septic arthritis in young adults
gonococcal arthritis
Signs disseminated gonococcal infection
oligoarthritis tenosynovitis rash on palms and soles fever osteomyelitis possible
risk factors for gonococcal arthritis disseminated
menstruation, pregnancy C5-9 deficiencies
What is needed to Dx disseminated gonococcal infection
urethral, throat, cervical and rectal cultures
What is Discitis
spinal septic arthritis
what are Sx of spinal septic arthritis
chronic unrelenting back pain, fever, local tenderness
thoracolumbar region
crosses disc space!!!!!
can lead to TB/ Potts
Gibbus deformity, paraspinal cold abscess
TB Potts disease
vague arthritis
viral
common agents for viral arthritis
parvo B19 HIV Hep B and C EBV adeno and coxsackie rubella mumps
how can viral arthritis present
migratory wrists hands kneed symmetric rash hep C can look like RA Hep B has urticaria and dec C'
dry eyes and mouth and cough SEVERE joint pain myalgias with weakness palmopustular psoriasis tender mm inc LFT enzymes CPK elevated all auto immune Ab negative b/l pulm infiltrates
HIV
What immune cell is implicated in Diffuse infiltrative lymphocytosis syndrome DILS
CD8
after Tx with HAART for HIV what can happen with inc CD4 count
CD4 can take over and attack
Immune Reconstitution inflammatory syndrome IRIS
Sarcoidosis presents how
erythema nodosum
hilar adenopathy
produces ACE
The immune reconsitituion inflammatory syndrome usually relates to what diseases
TB and cryptococcal meningitis
What cause erythema nodosum with arthritis
Boecks sarcoid bechets UC and crohns Mycoses Pills like BCP Strep
most common cause erythema nodosum
strep
Lofgrens syndrome
sarcoidosis
perihilar lymphadenopathy and erythema nodosum
stage II lymes
heart block, bells palsy, migratory arthralgias
stage III lymes
oligoarthritis, encephalitis, paresthesias
confirmation lyme
western blot
