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2a rrs > Spondlyoarthropie > Flashcards

Spondlyoarthropie Flashcards

1
Q

what are seronegative spondyloarthropathies

A 
a group of overlapping conditions with certain clinical features-
axial inflam - spine iliac joints
hla b27 assos
asymmetrical peripheral arthritis
RF absense (SERO NEG)
SPINE ACHE
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2
Q

overall features of spondyloarthropathies

A 
SPINE ACHE
Sausage digits (dactylitis)
Psoriasis
Inflam back pain
NSAID - good response
Enthesitis

Arthritis (asym)
Crohns/colitis/increase CRP
HLA-B27
Eye - uveitis

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3
Q

which gene assos w spodyloarthropathies

A

HLA-b27

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4
Q

what is ankylosing spondylitis

A

chronic inflammatory disorder of spine and sacroiliac joints

V strong assos w HLA-B27

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5
Q

epidemiology of ankylosing spondylosis

A 
1% prevalence
affects men more 
average onset is <30 YO 
often presents early teens to twenties
YOUNG MALES
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6
Q

Clinical features of Ankylosing spondylosis

A 
gradual onset of lower back pain
worse at night 
stiff in morning 
relieved by exercise 
pain radiating from sacroiliac joint to buttocks and hips 
chronic back pain
acute anterior uveitis
achileles tendonitis (enthesitis)
reduced lubar range of movement
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7
Q

diagnostic criteria for ankylosing spondylosis

A 
chronic back pain, under 50 YO. has 3 of the following:
morning stiffness 
worst at night- wakes them up 
alternating buttocks pain 
back pain improves with exercise
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8
Q

what is the name of the connective tissue between tendon or ligament and bone

A

enthesis

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9
Q

symptoms of ankylosing spondylosis

A

inflammatory back pain
enthesitis
Dyspnoea, due to costochondritis

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10
Q

complications of AS

A 
Kyphosis 
osetoporosis 
chostochondritis 
enthesis 
uvetits
bamboo spine
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11
Q

Investigation of AS

A

Bloods - increased ESR
HLA-b27 positive
MRI - erosion and narrowing = early
fusion = late
Xray- sclerotic erosions on sacroiliac joints,
enthesitis = blurring of upper/lower vertibral rims
syndesmophytes = boney spurs
bamboo spine - bony ankylosis and fusion
dagger sign - ossification of spinal ligaments = single radiodense line

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12
Q

what is bamboo spine

A

endstage of ankylosing spondylitis

fusion of vertibral bodies

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13
Q

stages of ankylosing spondylitis

A

enthesitis (lymphocyte and plasma infiltratino w local bone erosions at attachments of intervertebral and other ligaments)
SYNDESMOPHYTE - heals n new bone forms =bony outgrowths/spurs
sclerosis of underlying bone prevents flexion and rotation - BAMBOO SPINE

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14
Q

what are syndesmophytes

A

bony spurs

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15
Q

tx of AS why early?

A

early to prevent irreversible syndesmophyte formation and progressive calcifcation

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16
Q

tx of AS

A

morning exercise NOT REST
NSAIDS - symptom relief (+PPI)
TNF - alpha inhib = ADALIMUMAB or ETANERCEPT (stops sydesmophytes forming)
NOT BIOLOGICS (RA)

17
Q

what is psoriatic arthritis

A

a type of seronegative spondyloarthritis

less severe than RA

18
Q

Presentation of psoriatic arthritis

A 
symmetrical polyarthropathy 
DIPJ only 
synovitis 
joint pain and stiffness 
Dactylitis
PSORIASIS (scalp tender) 
80% of the time has finger nail changes (brittle, leukonychia, pitting, onycholysis)
arthritis mutiloans - telescopic fingers
19
Q

what is arthritis mutilans

A

periasrticular osteolysis and bone shortening (telescopic fingers)
=psoriatic arthritis

20
Q

nail changes in psoriatic arthritis

A

onycholysis - comes away from nail bed
leukonychia
pitting
brittle

21
Q

epidem of psoriatic arthritis

A

10-40% of people w psoriasis (can present prior to skin changes)
HLA-B27 pos (60%)
fam Hx

22
Q

Dx of psoriatic arthritis

A

bloods - high ESR, anaemic, RhF negative (vs RA)
xray - pencil in cup erosive changes DIPJ
synovial fluid aspirate

23
Q

Mx of psoriatic arthritis

A

NSAIDS and analgesia
DMARDS or infliximab (TNF inhib) if more severe
intraarticular corticosteroid injections FOR FLARE UPS

24
Q

what is Reactive arthritis

A

sterile inflam of synovial membrane tendons n fascia triggered by infection at a distant site (GI or GU)
typically 4 weeks later

25
Q

causes of reactive arthritis

A

triggered by infection at distant site
GU - chlamydia
dysentery- salmonella, shigella, e.coli

26
Q

presentation of reactive arthritis

A

cant see cant wee cant climb a tree
REITERS syndrome = conjuctavitis, urethritis, arthritis
cnat see - acute anterior uveitis
cant wee- circinate balanitis
climb a tree - enthesitis, pain and joint swelling

others = dactylitis, cervititis, keratoderma blennorrhagica (red painless raised plaques on hands n feet), nail dystrophy

27
Q

dx of reactive arthritis

A 
cultures - stool, GU
Bloods - high ESR/CRP
joint aspirate - not sterile = septic arthritis
X-ray - enthesitis
STI screen 
(RF and ANA neg)
28
Q

Mx of reactive arthritis

A

spnt joints
NSAID
intraartic steroid injections
DMARDs - sulfasalazine (6M+) -(in RA, IBD also)

2a rrs (26 decks)

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