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Rheumatology > Spondyloarthritis > Flashcards

Spondyloarthritis Flashcards

1
Q

What are the 4 diseases that make up the group of inflammatory arthritides that involve the axial spine?

A
  • Psoriatic arthritis
  • Enteropathic arthritis (IBD associated arthritis)
  • Ankylosing spondylitis
  • Reactive arthritis
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2
Q

In spondyloarthritides, the common pathophysiologic feature is spondylitis due to ________.

A

enthesopathy

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3
Q

Spondyloarthritides are associated with what gene mutation?

A

HLA-B27

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4
Q

All Spondyloarthriides are RF _______.

A

negative!

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5
Q

A young male presents with insidious, persistent back pain and morning stiffness that improves with exercise. What is the diagnoses?

a. psoriatic arthritis
b. enteropathic arthritis
c. ankylosing spondylitis
d. reactive arthritis

A

c. ankylosing spondylitis

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6
Q

What extra-articular manifestations are associated with ankylosing spondylitis?

A
  • inflammatory eye disease = anterior uveitis

- cardiovascular disease = conduction abnormalities, aortic root dilation

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7
Q

Which test is associated with ankylosing spondylitis?

A

Schober’s test

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8
Q

What is a positive finding on a Schober’s test for ankylosing spondylitis?

A
  • when patients lean forward the distance between 2 points on the tape measure remain the same as when standing
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9
Q

How is ankylosing spondylitis diagnosed?

A
  • clinical (history and exam findings)
  • pelvic radiograph can be done for sacroiliitis*
  • ESR/CRP will be high, can do HLA-B27*
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10
Q

In a patient with ankylosing spondylitis you need to beware of what type of fractures?

A

spinal fractures

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11
Q

What is the first line treatment for ankylosing spondylitis?

What is the long term treatment for ankylosing spondylitis?

A
  • first line: NSAIDs for 2-4 weeks

- long term: lifestyle modification (exercise, smoking cessation)

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12
Q

Which of the following 2 treatment options is not indicated for ankylosing spondylitis?

a. NSAIDs
b. lifestyle modification
c. steroids
d. DMARDs
e. opiates

A
  • steroids and opiates are not effective!
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13
Q

Which is least likely to be a trigger for reactive arthritis?

Chlamydia
Yersinia
Campylobacter
Salmonella
Shigella
Gonorrhea
A

Gonorrhea

gonorrhea can cause septic arthritis but NOT reactive arthritis

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14
Q

In a patient with a reactive arthritis when you tapped the joint what would you see?

A

inflammatory synovitis, but negative culture!

*The term reactive arthritis was introduced in 1969 as “an arthritis which developed soon after or during an infection elsewhere in the body, but in which the microorganisms cannot be recovered from the joint”

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15
Q

A young male presents to the clinic complaining of constellation of symptoms including urethritis, back pain, conjunctivitis, and a rash on his palms/soles. What is the diagnosis?

a. psoriatic arthritis
b. enteropathic arthritis
c. ankylosing spondylitis
d. reactive arthritis

A

d. reactive arthritis

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16
Q

How can you differentiate circinate balanitis from herpes?

circinate balanitis is a penile rash seen in reactive arthritis

A

circinate balanitis is painLESS while in herpes it is painFULL

17
Q

How is reactive arthritis diagnosed and treated?

A
  • diagnosis: clinical

- treatment: NSAIDs and time (consider antibiotics for active infection)

18
Q

How do you describe a classic psoriasis rash?

A

Scaly silver plaques

19
Q

DIP arthritis and arthritis mutilans are presentations of what disease?

a. psoriatic arthritis
b. enteropathic arthritis
c. ankylosing spondylitis
d. reactive arthritis

A

a. psoriatic arthritis

20
Q

How is psoriatic arthritis diagnosed?

A
  • clinical (both psoriasis and inflammatory arthritis)
21
Q

What is the treatment for psoriatic arthritis if it is mild vs. refractory/severe disease?

A
  • mild: NSAIDs

- severe/refractory: DMARDs (nonbiologic first)

22
Q

This form of inflammatory arthritis is associated with inflammatory bowel disease.

a. psoriatic arthritis
b. enteropathic arthritis
c. ankylosing spondylitis
d. reactive arthritis

A

b. enteropathic arthritis

23
Q

How is enteropathic arthritis treated?

A

effective treatment of the underlying inflammatory bowel disease

24
Q

Which of the following is NOT considered a spondyloarthropathy?

  • Psoriatic arthritis
  • Enteropathic arthritis
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Reactive arthritis
A
  • Rheumatoid arthritis
25
Q

How do you differentiate between uveitis and conjunctivitis?

A
  • in conjunctivitis you should see a small hallow around the iris
26
Q

What is keratoderma blennorrhagica?

A

psoriasiform lesions on palms/soles associated with reactive arthritis

27
Q

Why do we not treat psoriatic arthritis with steroids?

A

it increases the risk of pustular psoriasis

28
Q

What famous golfer has psoriatic arthritis?

A

phil Mickelson

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