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SpA Flashcards

1
Q

Seronegative Spondyloarthropathies

A

A group of overlapping disorders that share certain clinical features and Genetic associations

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2
Q

Spondyloarthritis (SpA)

A

Axial manifestations
Peripheral manifestations

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3
Q

Classification of spondyloarthritis

A

Ankylosis spondylitis
Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis
Acute Anterior uveitis
Juvenile idiopathic arthritis
Undifferentiation spondyloarthropathy

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4
Q

SpA is seronegative meaning

A

Rf negative

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5
Q

Axial spondyloarthritis may be

A

Non-Radiographic Axial-SpA (no Xray finding for Sacroiliitis)
Radiographic Axial-SpA ( Ankylosing Spondylitis)

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6
Q

Predominantly axial SpA

A

Non radiographic SpA
AS

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7
Q

Predominantly peripheral SpA

A

Reactive arthritis
Psoaritic arthritis
Enteropathic arthritis
Undifferentiated

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8
Q

Male to female ratio of axial SpA

A

2-9: 1

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9
Q

Familial aggregated associated with

A

HLA B27

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10
Q

Patho genesis of AS

A

Non genetic and genetic risk factors
Altered gut micro biome
Lymphoid cells released IL 17 and IL 22
Mechanical stress leading to inflammation

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11
Q

AS mainly affects

A

Sacroiliac joints and enthesis

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12
Q

In spine of AS inflammatory granulation tissue found at junction of

A

Annulus fibrosis and vertebral bone

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13
Q

In AS the outer annular fibers are

A

Eroded and replaced by bone forming syndesmophyte

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14
Q

Berlin criteria for inflammatory back pain (AS)

A

Morning stiffness >30 mins
Improvement with exercise
Awakening at night due to pain
Alternating buttock pain

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15
Q

Median age of axial SpA

A

23

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16
Q

Initial sx of ax-SpA

A

Dull aching pain
Insidious
Deep in lower lumbar or gluteal region alternating left and right
Back pain inflammatory

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17
Q

Modified New York criteria for AS

A

Low back pain and stiffness more than 3 months improve w exercise
Limitations of motion of lumbar spine
Limitation of chest expansion
Sacroilitisis grade 2 bilaterally or 3-4 unilaterally

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18
Q

Examinations for AxSpA

A

Fabertest
Schober test
Chest expansion
Occipital wall distance

19
Q

Present in 60-90% of pt with AxSpA

20
Q

Age of onset of Ax SpA

21
Q

SpA features

A

Inflammatory back pain
Arthritis
Enthesitis
Uveitis
Dactylitis
Psoriasis
Crohn’s
Good response to NSAIDs
FH of SpA
HLA B 27
Elevated CRP

22
Q

Spine changes

A

Squaring vertebral bodies
Loss of lumbar lordosis
Syndesmophyte ossification
Bamboo spine

23
Q

Neck pain and stiffness from involvement of cervical spine in AxSpA

A

Late manifestation

24
Q

Enthesis commonly involved

A

Achilles tendinitis.
Plantar fasciitis.
At the tibial tuberosity.
Superior and inferior poles of the patella.
Iliac crests.

25
Q

Extra articular manifestations

A

Anterior uveitis
Inflammatory ulceration of bowel
Aortitis,AR, conduction ab.
Secondary amyloidosis
Bladder or bowel incontinence

26
Q

Highly reliable tool for diagnosing AS

27
Q

1st line for AS

28
Q

Biological preferred for AS

A

TNF inhibitors (2nd line)adalimumab, infliximab

29
Q

Third line for AS

A

IL17 inhibitors

30
Q

Reactive arthritis

A

Can’t see (conjunctivitis)
Can’t pee (urethritis)
Can’t climb (arthritis)

31
Q

Etiology of reactive arthritis

A

Gut pathogens like shigella, salmonella, campylobacter, chlamydia

32
Q

Clinical manifestations of reactive arthritis

A

Asymmetrical inflammatory arthritis of lower limb
Dactylitis or sausage digit
Tendo Achilles tendinitis or plantar fasciitis
Urethritis
Uveitis

33
Q

Tests for ______ are positive in 75% of patients with sacroillitis

34
Q

Treatment of reactive arthritis

A

High dose NSAIDS
ANTIBIOTICS
INTRALESIONAL GLUCOCORTICOIDS
DMARDS IN REFRACTORY

35
Q

Psoriatic arthritis

A

Inflammatory arthritis in ppl with psoriasis

36
Q

In 60-70% of psoriatic arthritis

A

Psoriasis precede joint disease

37
Q

Nail changes such as pitting occur in

A

90% of patients with psoriatic arthritis

38
Q

Radiographic class deformity for psoriatic arthritis

A

Pencil in cup deformity

39
Q

Treatment of psoriatic arthritis

A

NSAIDs for arthritis
DMARDS like methotrexate or biological in severe resistant arthritis
IL 12 and 23 inhibitors

40
Q

Enteropathic arthritis

A

UC and CD are asssociated with SpA

41
Q

Two types of involvement of Enteropathic arthritis

A

Peripheral arthritis
Axial

42
Q

Treatment of IBD in Enteropathic

A

Sulfasalazine
Biological

43
Q

Undifferentiated SpA

A

patients who do not meet the definitive classification criteria of any other SpA subtypes.

About 50% are HLA-B27-positive, who eventually progress to classical AS.

Management same other SpA subtypes.

Rheumatology (3 decks)

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