SPONDY Flashcards
Where does Spondyloarthritis effect most
Spondyloarthropathies or Spondyloarthritis (SpA) encompasses a spectrum of dz characterized by inflammation of the sacroiliac (SI) joints, spine, or peripheral joints
Who does Anky Spondylo effect most
Men or women ??
MEN 2/1
What is the serum marker for Ankylosing Spondylitis
HLA B27
What is the hallmark feature for ankylosing Spondylitits
Hallmark feature is LBP which improves with activity or exercise, worsens with rest
Awakens pt at night
Generally younger than 45 years of age
What is the common Occular complication in a pt with Anklyosing Spondylotitis
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
How does AnkySpond effect the heart
Aortic root dilation and 1 degree AV block
What is the threshold for a postive schober test in a pt with ankylosisng spondylitits
Decreased anterior flexion: Schober test (<5 cm)
loss of lordosis
Are Anky Spond RF postive or negative
Negative
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
Anky Spondo
Will have postive X-ray findings
Cervical spine fx is an independent risk factor for mortality in a pt with Anky spondo
1st line tx for Anky Spondo
NSAIDS (COX-2/ Celecoxib) daily with combo PPI
(2nd line is biological DMARDS, not synthetics)
Physical Tx (active >passive)
Steroid injections (Avoid systemic)
If a Anky Spondo pt has uveitis
What is the tx
Immediate referal and topical steroids
What percent of IBD pts have arthritis
20%
More common with Chrons than UC
What are the two main types of IBD associated arthritis
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%)
If a pt has IBD assoc arthritis
What is the tx approach
NSAIDs are AVOIDED !!
-can lead to exacerbation of IBD
If Axial then TNF
Should be referred to Rheum and gastro
What is the post infectious triad for Reactive arthritis
Conjunctivitis (cant see)
Arthritis (can bend the knee)
Urethritits (Can’t pee)
What are the bacterial infections common to Reiters Arthritis
Campylobacter, Salmonella, and Shigella
What is the serum marker for Reactive Arthiritis
HLA b27 pos in 50%
What is the hallmark feature of enthesitis (reiters)
inflammation at sites where tendons attach to bone
Hallmark feature
Site may be swollen, warm & tender
MC at Achilles tendon & plantar fascia attachments
What is Dactylitis
Swelling of the fingers
“Sausage like fingers”
In reactive Arthiritis
What are the mucocutaenous manifestations of Reactive Arthritis
Circinate Balantitis
Keratoderma Blennorrhagica
Apthous Ulcers
What ddx Reactive Arthrits and Anky Spondo
Sacroilitis is usually unilateral (good way to distinguish between the bilateral presentation of ankylosing spondylitis
Tx for Reactive Arthritis
NSAIDS
Steroid Injections
ABX as needed
Consider DMARD If NSIAD fails
What is a distinguishing feature of Psoriatic Arthritis
Enthesitis is a distinguishing feature in the pathogenesis of psoriatic arthritis
What distinguishes Psoriatic from RA
Fingers (DIP) with stiffness, swelling, nail pitting
Distinguishes from RA
What is the most common form of psoriatic arthritis
Asymmetric oligoarthritis affecting hands and feet
most common form
What is arthritis mutilans
A sub catagory of psoriatic arthritis (pencil in cup deformity)
If a pt has psoriatic spondylitis
What serum marker will be positive
HLA b27 (50%)
Why do psoriatic arthirits pts have an elevated Uric acid ?
High skin turnover
What is the Tx appraoch to Psoriatic Arthritis
1st NSAIDS
+steroids (local injections/tendon sheath)
(Systemic reserved for acute flares to bride to DMARDS)
DMARDS (second line)
