SPONDY

Question 1

Where does Spondyloarthritis effect most

Answer 1

Spondyloarthropathies or Spondyloarthritis (SpA) encompasses a spectrum of dz characterized by inflammation of the sacroiliac (SI) joints, spine, or peripheral joints

Question 2

Who does Anky Spondylo effect most

Men or women ??

Answer 2

MEN 2/1

Question 3

What is the serum marker for Ankylosing Spondylitis

Answer 3

HLA B27

Question 4

What is the hallmark feature for ankylosing Spondylitits

Answer 4

Hallmark feature is LBP which improves with activity or exercise, worsens with rest
Awakens pt at night
Generally younger than 45 years of age

Question 5

What is the common Occular complication in a pt with Anklyosing Spondylotitis

Answer 5

Acute anterior uveitis
(inflammation of the iris, ciliary body & choroid)
- present in up to 50% over the disease course

Most common extra-articular manifestation

Typically abrupt, unilateral, intense pain, redness, photophobia

Question 6

How does AnkySpond effect the heart

Answer 6

Aortic root dilation and 1 degree AV block

Question 7

What is the threshold for a postive schober test in a pt with ankylosisng spondylitits

Answer 7

Decreased anterior flexion: Schober test (<5 cm)

loss of lordosis

Question 8

Are Anky Spond RF postive or negative

Answer 8

Negative

Question 9

A pt has low back pain x 3 months that improves with exercise but not with rest, with limited mobility of the lumbar spine, and limited chest expansion

Think

Answer 9

Anky Spondo

Will have postive X-ray findings

Question 10

Cervical spine fx is an independent risk factor for mortality in a pt with Anky spondo

Question 11

1st line tx for Anky Spondo

Answer 11

NSAIDS (COX-2/ Celecoxib) daily with combo PPI
(2nd line is biological DMARDS, not synthetics)

Physical Tx (active >passive)

Steroid injections (Avoid systemic)

Question 12

If a Anky Spondo pt has uveitis

What is the tx

Answer 12

Immediate referal and topical steroids

Question 13

What percent of IBD pts have arthritis

Answer 13

20%

More common with Chrons than UC

Question 14

What are the two main types of IBD associated arthritis

Answer 14

Peripheral
-Acute in onset, early in the disease
-Non-deforming, asymmetric, oligoarthritis of large joints, knee being the most common
Course/flares of arthritis parallels course/severity of IBD

Axial
Indistinguishable from Ankylosing Spondylitis by sxs or radiographs
70% HLA positivity (lower than AS without IBD which was 80-90%)

Question 15

If a pt has IBD assoc arthritis

What is the tx approach

Answer 15

NSAIDs are AVOIDED !!
-can lead to exacerbation of IBD

If Axial then TNF

Should be referred to Rheum and gastro

Question 16

What is the post infectious triad for Reactive arthritis

Answer 16

Conjunctivitis (cant see)
Arthritis (can bend the knee)
Urethritits (Can’t pee)

Question 17

What are the bacterial infections common to Reiters Arthritis

Answer 17

Campylobacter, Salmonella, and Shigella

Question 18

What is the serum marker for Reactive Arthiritis

Answer 18

HLA b27 pos in 50%

Question 19

What is the hallmark feature of enthesitis (reiters)

Answer 19

inflammation at sites where tendons attach to bone

Hallmark feature
Site may be swollen, warm & tender

MC at Achilles tendon & plantar fascia attachments

Question 20

What is Dactylitis

Answer 20

Swelling of the fingers

“Sausage like fingers”

In reactive Arthiritis

Question 21

What are the mucocutaenous manifestations of Reactive Arthritis

Answer 21

Circinate Balantitis

Keratoderma Blennorrhagica

Apthous Ulcers

Question 22

What ddx Reactive Arthrits and Anky Spondo

Answer 22

Sacroilitis is usually unilateral (good way to distinguish between the bilateral presentation of ankylosing spondylitis

Question 23

Tx for Reactive Arthritis

Answer 23

NSAIDS
Steroid Injections

ABX as needed

Consider DMARD If NSIAD fails

Question 24

What is a distinguishing feature of Psoriatic Arthritis

Answer 24

Enthesitis is a distinguishing feature in the pathogenesis of psoriatic arthritis

Question 25

What distinguishes Psoriatic from RA

Answer 25

Fingers (DIP) with stiffness, swelling, nail pitting

Distinguishes from RA

Question 26

What is the most common form of psoriatic arthritis

Answer 26

Asymmetric oligoarthritis affecting hands and feet

most common form

Question 27

What is arthritis mutilans

Answer 27

A sub catagory of psoriatic arthritis (pencil in cup deformity)

Question 28

If a pt has psoriatic spondylitis

What serum marker will be positive

Answer 28

HLA b27 (50%)

Question 29

Why do psoriatic arthirits pts have an elevated Uric acid ?

Answer 29

High skin turnover

Question 30

What is the Tx appraoch to Psoriatic Arthritis

Answer 30

1st NSAIDS

+steroids (local injections/tendon sheath)
(Systemic reserved for acute flares to bride to DMARDS)

DMARDS (second line)