spondyloarthritides Flashcards
symptoms of anklosing spondylitis
inflammatory back pain (morning stiffness)
bony tenderness
hip and shoulder arthritis
neck pain and stiffness from cervical involvement (late)
physical exam findings in ankylosing spondylitis
loss of spinal mobility
limitation of motion usually out of proportion to degree of bony ankylosis, reflecting muscle spasm secondary to pain and inflammation
pain in sacroiliac joints
what signs correlate with worse prognosis for AS
onset in adolescence and early hip involvement
most serious complication of AS
spinal fracture, which can occur with minor trauma to the rigid, osteoporotic spine (often lower cervical spine)
extraarticular manifestations of AS
acute anterior uveitis (most common) inflammation in colon or ileum (higher risk of IBD) higher risk of psoriasis aortic insufficiency 3rd degree heart block
signs of uveitis in AS
occurs in 40% and may antedate spondylitis
typically unilateral, causing pain, photophobia, and increased lacrimation
can lead to cataracts and glaucoma
labs in AS
HLA-B27 in 80-90% of patients
esr and crp may be elevated
criteria for inflammatory back pain of AS
chronic (>3 mo) back pain w/ 4 or more:
- age of onset below 40
- insidious onset
- improvement w/ exercise
- no improvement w/ rest
- pain at night w/ improvement upon getting up
treatment of AS
exercise
NSAIDs
anti-TNF alpha therapy (infliximab, etanercept, adalimumab, golimumab)
risks of anti-TNF therapy
serious infections, including disseminated TB
hematologic disorders (pancytopenia)
demyelinating disorders
exacerbation of CHF
SLE-related autoantibodies and clinical features
hypersensitivity infusion or injection site reactions
liver disease
bacteria that can cause reactive arthritis
shigella, salmonella, yersinia, campylobacteria, chlamydia
signs of reactive arthritis
spectrum: isolated, transient monoarthritis or enthesitis to severe multisystem disease constitutional symptoms (fatigue, fever, weight loss, malaise) asymmetric and additive arthritis dactylitis tendinitis and fasciitis urogenital lesions, prostatitis conjunctivitis, uveitis ral ulcers, keratoderma blenorrhagica nycholysis
how long does reactive arthritis last
usually 3-5 mo, up to a year
labs for reactive arthritis
50% positive for HLA-B27
high ESR
can have serologic evidence of recent infection
treatment of reactive arthritis
NSAIDs
no evidence that tx of infection after arthritis develops helps arthritis
types of spondyloarthritides
anklyosing spondylitis, reactive arthritis, psoriatic arthritis and spondylitis, enteropathic arthritis and spondylitis, juvenile-onset spondyloarthritis, and undifferentiated SpA
timeline of psoriasis vs psoriatic arthritis
60-70% psoriasis precedes joint disease
patterns of psoriatic arthropathy
- arthritis of the DIP joints
- asymmetric oligoarthritis
- symmetric polyarthritis similar to RA
- axial involvement (spine and sacroiliac joints)
- arthritis mutilans
nail changes in psoriatic arthritis
many: pitting, horizontal ridging, onycholysis, yellowish discoloration of the nail margins, dystrophic hyperkeratosis
extraarticular findings in psoriatic arthritis
nail changes, dactylitis, enthesitis, tenosynovitis
labs in psoriatic arthritis
no labs to diagnose
high ESR, CRP
HLA-B27 in 50-70%
criteria to diagnose psoriatic arthritis
inflammatory articular disease (joint, spine, or entheseal) w/ 3 or more:
- e/o psoriasis or FH of psoriasis
- typical nail dystrophy
- negative Rh
- current or h/o dactylitis
- radiographic e/o juxtaarticular new bone formation in hand or foot
treatment for psoriatic arthritis
best: anti-TNF alpha agents (etanercept, infliximab, adalimumab, golimumab)
also: alefacept (anti-T cell) + methotrexate
enteropathic arthritis
strong connection between both UC and CD and SpA; both are immune-meditated, but specific pathogenic mechanisms are poorly understood
sapho syndrome
synovitis, acne, pustulosis, hyperostosis, and osteitis (B27 is not associated)
treatment of enteropathic arthritis
anti-TNF
Whipple’s disease
rare chronic bacterial infection, where >75% develop oligoo or polyarthritis
type of arthritis in Whipple’s
joint signs may come before other symptoms
abrupt, migratory, and stops within a few days
treatment of whipple’s arthritis
antibiotics
