Spondyloarthritis Flashcards
A 25 yo male presents complaining of lower back pain and stiffness that he’s had for the past 4 months. The pain only improves when he walk or goes for his daily run. It started out as a duller pain in his lower back, but now the pain has become more tender. What do you suspect? What is the underlying pathophys?
Ankylosing spondylitis
Unclear etiology
Fusion of spinal vertebrae
A 19 yo male presents complaining of dull lower back pain that he’s had for the past few months. He has also noticed stiffness, but both are somewhat relieved with walking. What would you expect to see on X-ray assuming he has ankylosing spondylitis?
Sacroiliitis grade > 2 bilaterally
Sacroiliitis grade 3-4 unilaterally
A 64 yo female presents with lower back pain and stiffness. She’s had it for a while but doesn’t really know exactly how long. Imaging shows a “bamboo spine”. What lab findings would you expect?
Ankylosing spondylitis
CRP - elevated
HL-B27 positive
Describe the Schober test
Measure PSIS to midline standing and during spinal flexion
Normal is an increase of up to 15 cm
A 34 yo female with a history of Crohn’s Dz presents complaining of arthritis in her right hand and in her spine. What do you suspect? What other condition should you test for and what lab findings would you expect?
IBD-Associated Arthritis
CBC for anemia
Elevated ESR & CRP
A pt presents with severe arthritis of her hands. Her fingers have a sausage-like appearance. X-ray shows a “pencil in cup” deformity of the DIP joint and a “fluffy” appearance which seems to be periosteal new bone growth. What is your diagnosis? What do you recommend?
Psoriatic arthritis Reduce pain/stiffness: NSAIDs, glucocorticoids, sulfsalazine, methotrexate, BRMs (TNFs) Educate the pt Joint protection PT for life to slow progression
What BRM (biologic response modifiers) can be used to treat psoriatic arthritis?
Etanercept (not IBD-related) Infliximab Adalimumab Golimumab Certolizumab
A 32 yo female presents with arthritis, uveitis, and urethritis. Exam shows that her knees and ankles appear swollen and she has oral ulcers. What is the most likely diagnosis based on her Hx and exam? What are some likely etiologies?
Reactive Arthritis
Infection: chlamydia, shigella, salmonella, campylobacter, yersinia
A pt presents with arthritis, conjunctivitis, urethritis, sausage digits, oral ulcers, keratoderma blenorrhagicum, and a scaly rash on his hands and feet. What would you expect to see on x-ray?
Reactive arthritis Periosteal rxn Proliferative bone at tendons Bony erosion w/ adjacent proliferation Paravertebral ossification Bony akyloses Calcaneal spurs with a "fluffy" appearance
A pt presents with arthritis, uveitis, and urethritis. Serology shows a chlamydia infection. What treatment do you recommend?
Reactive Arthritis
3 mo Doxycycline (preferred) or Tetracycline
How do you treat reactive arthritis?
Antibiotics based on the pathogen
