Spondylarthropathies, polyarthritis rheumatica, fibromyalgia Flashcards
What antibodies are associated with spondyloarthropathies?
HLA B27 antibodies
Inflammation of sites where tendons and ligaments attach to bone
enthesitis
Chronic inflammatory disease of the joints of the axial skeleton. Changes seen in sacroiliac joints and hips
ankylosing spondylitis
Extra-articular manifestations of ankylosing spondylitis
anterior uveitis, aortic valvular disease, restricted chest expansion
How long must a patient have low back pain to be classified as ankylosing spondylitis?
3 months
Describe the stiffness/back pain associated with ankylosing spondylitis?
awakend by pain during 2nd half of night, morning stiffness, and pain that improves with excercise
Characteristic radiographic finding for ankylosing spondylitis
“bamboo spine”
What should always be ordered for any patient suspected of having ankylosing spondylitis?
AP view of the pelvis
Acute inflammatory arthritis occurring 1-3 weeks after infectious event
reactive arthritis
Triad of reactive arthritis
arthritis, urethritis, conjunctivitis
Most common cause of reactive arthritis
post-veneral onset (Reiter’s)
Chronic inflammatory arthropathy in setting of psoriasis
psoriatic arthritis
Nail changes often noted in psoriatic arthritis
pitting, dystrophy, onyholysis
Characteristic inflammatory changes associated with psoriatic arthritis
Arthritis in DIPs, sausage digits, and no rheumatoid nodules
Effective for inflammatory back pain, spinal stiffness, peripheral arthritis, enthesopathy. Doesn’t inhibit disease progression
NSAIDs
Considered when antiinflammatory therapy is insufficient to control symptoms. Progression of inflammatory axial disease noted. Active persistent polyarthritis or uncontrolled extra-articular disease
DMARDs
What needs to be supplemented for when a patient is prescribed methotrexate?
folate
Characterized by aching & stiffness in the shoulder and pelvic girdles and the neck. Usually responds to low doses of steroids
polymyalgia rheumatica
Age that polymyalgia rheumatica occurs
> 50yrs
Describe pain pattern associated with polymyalgia rheumatica
aching, morning stiffness that lasts 30 minutes. Is bilateral and worse w/movement
Exam findings of polymyalgia rheumatica that can differentiate it from other arthritides
little evidence of proximal joint swelling or tenderness
Treatment for polymyalgia rheumatica
Corticosteroids are drugs of choice (10-20mg/day) for 1-2 yrs.
How soon does polymyalgia rheumatica resolve after intitiation of treatment?
Complete or nearly complete resolution of sx is seen in a few days. absence of improvement should cause one to question diagnosis
Chronic vasculitis of medium and large vessels. Symptoms are due to end-organ ischemia. More common at age > 50
Giant cell arteritis
Most frequent symptom of giant cell arteritis
headache
Complications of giant cell arteritis
blindness, aortic aneurysms, stroke
Should be performed in all patients with suspected giant cell arteritis (GCA)
temporal artery biopsy
Initial treatment for GCA
high dose 40-60mg prednisone. IV pulse methylpresnisolone 1000mg x 3days if vision loss present
A clinical syndrome characterized by widespread muscular pain (usually chronic), fatigue and muscle tenderness
Fibromyalgia Syndrome (FMS)
What is thought to be the underlying pathology of fibromyalgia (FMS)?
abnormal sensory processing in CNS that causes them to be extremely sensitive to pain
Associated symptoms include: poor sleep*, HA, IBS, cognitive/memory problems, and paresthesias in fingers/toes
fibromyalgia (FMS)
important in transmission and amplification of pain signals to and from brain
substance P
Patients with what other rheumatologic disorders are more likely to develop FMS?
Rheumatoid arthritis and SLE (Lupus)
How many positive tender points are generally needed to make the diagnosis of FMS?
11 of 18
T/F fibromyalgia co-aggregates with somatoform disorder in families
false, it co-aggregates with major mood disorders in families
What are the levels of inflammatory markers (ESR, CPR) in FMS?
normal
What is the first-line approach for patients with moderate to severe pain due to FMS?
Trial with low-dose TCAs, SSRI, SNRI, or antiseizure medication
