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Rheumatology > spondyloarthritides > Flashcards

spondyloarthritides Flashcards

1
Q

symptoms of anklosing spondylitis

A

inflammatory back pain (morning stiffness)
bony tenderness
hip and shoulder arthritis
neck pain and stiffness from cervical involvement (late)

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2
Q

physical exam findings in ankylosing spondylitis

A

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

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3
Q

what signs correlate with worse prognosis for AS

A

onset in adolescence and early hip involvement

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4
Q

most serious complication of AS

A

spinal fracture, which can occur with minor trauma to the rigid, osteoporotic spine (often lower cervical spine)

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5
Q

extraarticular manifestations of AS

A 
acute anterior uveitis (most common) 
inflammation in colon or ileum (higher risk of IBD) 
higher risk of psoriasis
aortic insufficiency 
3rd degree heart block
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6
Q

signs of uveitis in AS

A

occurs in 40% and may antedate spondylitis
typically unilateral, causing pain, photophobia, and increased lacrimation
can lead to cataracts and glaucoma

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7
Q

labs in AS

A

HLA-B27 in 80-90% of patients

esr and crp may be elevated

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8
Q

criteria for inflammatory back pain of AS

A

chronic (>3 mo) back pain w/ 4 or more:

  1. age of onset below 40
  2. insidious onset
  3. improvement w/ exercise
  4. no improvement w/ rest
  5. pain at night w/ improvement upon getting up
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9
Q

treatment of AS

A

exercise
NSAIDs
anti-TNF alpha therapy (infliximab, etanercept, adalimumab, golimumab)

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10
Q

risks of anti-TNF therapy

A

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

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11
Q

bacteria that can cause reactive arthritis

A

shigella, salmonella, yersinia, campylobacteria, chlamydia

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12
Q

signs of reactive arthritis

A 
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
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13
Q

how long does reactive arthritis last

A

usually 3-5 mo, up to a year

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14
Q

labs for reactive arthritis

A

50% positive for HLA-B27
high ESR
can have serologic evidence of recent infection

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15
Q

treatment of reactive arthritis

A

NSAIDs

no evidence that tx of infection after arthritis develops helps arthritis

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16
Q

types of spondyloarthritides

A

anklyosing spondylitis, reactive arthritis, psoriatic arthritis and spondylitis, enteropathic arthritis and spondylitis, juvenile-onset spondyloarthritis, and undifferentiated SpA

17
Q

timeline of psoriasis vs psoriatic arthritis

A

60-70% psoriasis precedes joint disease

18
Q

patterns of psoriatic arthropathy

A
  1. arthritis of the DIP joints
  2. asymmetric oligoarthritis
  3. symmetric polyarthritis similar to RA
  4. axial involvement (spine and sacroiliac joints)
  5. arthritis mutilans
19
Q

nail changes in psoriatic arthritis

A

many: pitting, horizontal ridging, onycholysis, yellowish discoloration of the nail margins, dystrophic hyperkeratosis

20
Q

extraarticular findings in psoriatic arthritis

A

nail changes, dactylitis, enthesitis, tenosynovitis

21
Q

labs in psoriatic arthritis

A

no labs to diagnose
high ESR, CRP
HLA-B27 in 50-70%

22
Q

criteria to diagnose psoriatic arthritis

A

inflammatory articular disease (joint, spine, or entheseal) w/ 3 or more:

  1. e/o psoriasis or FH of psoriasis
  2. typical nail dystrophy
  3. negative Rh
  4. current or h/o dactylitis
  5. radiographic e/o juxtaarticular new bone formation in hand or foot
23
Q

treatment for psoriatic arthritis

A

best: anti-TNF alpha agents (etanercept, infliximab, adalimumab, golimumab)
also: alefacept (anti-T cell) + methotrexate

24
Q

enteropathic arthritis

A

strong connection between both UC and CD and SpA; both are immune-meditated, but specific pathogenic mechanisms are poorly understood

25
Q

sapho syndrome

A

synovitis, acne, pustulosis, hyperostosis, and osteitis (B27 is not associated)

26
Q

treatment of enteropathic arthritis

A

anti-TNF

27
Q

Whipple’s disease

A

rare chronic bacterial infection, where >75% develop oligoo or polyarthritis

28
Q

type of arthritis in Whipple’s

A

joint signs may come before other symptoms

abrupt, migratory, and stops within a few days

29
Q

treatment of whipple’s arthritis

A

antibiotics

Rheumatology (10 decks)

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