Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HMS IDD > Spondyloarthritis > Flashcards

Spondyloarthritis Flashcards

1
Q

Psoriatic arthritis general description

A

Patients have general psoriasis symptoms and arthritis. Tends to be an asymmetrical oligoarthritis in the lower extremities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Spondyloarthritis is associated with this subset of cytokines

A

Th17-type

Although not necessarily Th17 cells themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

enthesitis

A

inflammation at the bony insertions of tendons and ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

dacylitis

A

inflammation of whole digits manifesting as ‘sausage toe” or “sausage finger”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spondyloarthritis general description

A

Group of diseases wherein there is inflammation of spinal joints, sacroiliac joint, and peripheral joints. Often associated with:

Enthesitis

Dactylitis

Psoriasis

IBD

Uveitis (inflammation of uvea of eye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Spondyloarthritis Venn Diagram

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prototypic ankylosing spondylitis

A

Inflammation in the spine and back joints manifests as back pain and morning stiffness. Chronic inflammation leads to fusion of bony segments of spine to one another.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Characteristics of reactive arthritis

A
  • Part of spondyloarthritis family
  • Occurs within 4 weeks of Chlamdyia UTI
  • However, joints are culture negative, this is an aseptic arthritis
  • 50/50 remission and chronic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Psoriatic arthritis occurs in __% of patients with psoriasis.

A

Psoriatic arthritis occurs in 30% of patients with psoriasis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HLA gene associated with all forms of spondyloarthritis

A

HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

__% of patients with spondyloarthritis are positive for HLA-B27

A

85% of patients with spondyloarthritis are positive for HLA-B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HLA-B27 is normally present within __% of the US population.

A

HLA-B27 is normally present within 6.1% of the US population.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical manifestations of enthesitis

A

Heel pain when the Achilles tendon enthesis is involved, foot pain at the plantar fascia insertion, or swelling of entire digits (dactylitis or sausage digit) due to inflammation of the flexor and extensor tendons and their attachments at the bones of the fingers or toes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spondyloarthritis histopathology

A

Histologically, the inflammation in spondyloarthritis is characterized by chronic inflammatory infiltrates that are nonspecific and largely indistinguishable from rheumatoid arthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

While rheumatoid arthritis is associated with pathological bone ___, spondyloarthritis is associated with pathological bone ___.

A

While rheumatoid arthritis is associated with pathological bone erosion, spondyloarthritis is associated with pathological bone production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The usual presenting symptom of axial spondyloarthritis is. . .

A

. . . back pain!

Particularly inflammatory back pain which starts low in the back or in the deep gluteal region.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A classic presentation of axial spondyloarthritis

A
  • Began very slowly, over years
  • Started in deep gluteal region and began creeping up the spine
  • Worsened by rest and improved by exercise (characteristic of all forms of inflammatory arthritis)
  • Difficulty sleeping or sitting in one position for long periods of time due to discomfort
  • Age of onset <40 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A patient beginning to present with clinical symptoms of axial spondylarthropathy will have lost ___.

A

A patient beginning to present with clinical symptoms of axial spondylarthropathy will have lost lumbar lordosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Schober test

A

With the patient standing erect, a horizontal line is drawn at the L5–S1 region at the level of the “dimples of Venus” and another line 10 cm above that in the midline of the back.

With forward flexion, the distance between these two ends of the 10-cm line should increase by about 5 cm in the normal lumbar spine.

20
Q

Psoriasis

A

Psoriasis affects 2-3% of the population. Up to 30% of patients with psoriasis may develop an inflammatory arthropathy. Nail psoriasis is associated with arthritis in the distal interphalangeal (DIP) joints. In the vast majority of patients with PsA, the skin disease is present first or arises at the same time as the joint disease

21
Q
A

Classical presentation of psoriasis

22
Q

While common in spondylarthritis, dactyltis may be associated with other diseases such as. . .

A

. . . gout.

23
Q

___ of patients with ankylosing spodylitis have subclinical inflammation in their intestine.

A

2/3 of patients with ankylosing spodylitis have subclinical inflammation in their intestine.

24
Q

Entheses map

A
25
Q
A

Achilles tendon enthesis

26
Q

Laboratory findings for spondyloathritis

A
  • Hematologic studies normal except in severe cases where there is normocytic-normochromic anemia
  • Normal to slightly elevated ESR and CRP
  • Rheumatoid factor, anti-CCP and antinuclear antibodies (ANA) negative
  • Normal levels of serum complement
  • HLA-B27 positive may be highly suggestive in proper clinical context. Negative HLA-B27 does not rule out.
  • Radiographic finding of new bone formation along the sacroiliac joints or spine are highly specific, also highly suggestive in peripheral joints with characteristics of inflammation. Sclerosis of bone edges may also be seen. Pencil-in-cup pattern and bone narrowing commonly seen on peripheral spondyloarthritis. Negative radiography does not rule out.
    *
27
Q

Normocytic anemia

A

Your blood cells are normal, you just don’t have as many as you should.

28
Q

Normochromic anemia

A

Your blood cells have the proper concentration of anemia, there just aren’t enough of them

29
Q
A

Sacroiliac fusion in severe case of ankylosing spondylitis

30
Q
A

Pencil-in-cup X-ray finding of psoriatic arthritis

31
Q

Treatment of axial spondylarthritis

A
  • NSAIDs
  • Physical therapy
  • Erect posture maintenance
  • Firm bed and as small as possible of a pillow to prevent neck flexion while sleeping
  • Breathing exercises to maintain chest expansion
  • DMARDs (like methotrexate) and corticosteroids NOT effective
  • For extreme cases, anti-TNFs or anti-IL-17A
32
Q

An ideal diagnosis of spondylarthritis

A

HLA-B27, high CRP, positive family history for spondyloarthrits, positive MRI

33
Q

Treatment of peripheral spondylarthritis

A
  • NSAIDs
  • Physical therapy
  • Erect posture maintenance
  • Firm bed and as small as possible of a pillow to prevent neck flexion while sleeping
  • Breathing exercises to maintain chest expansion
  • DMARDs (like methotrexate) and corticosteroids ARE effective (unlike in the axial form of the disease)
  • For extreme cases, anti-TNFs or anti-IL-17A
34
Q

For many, ____ is the first reason to seek medical care as an adult

A

For many, acute low back pain is the first reason to seek medical care as an adult

Many cases of acute low back pain are selflimited and resolve with little intervention. About 1/3 of patients will not fully recover within six months, although most will improve

35
Q

Acute / subacute / chronic for back pain

A

acute (< 1 month), subacute (1-3 months) and chronic (> 3 months) low back pain

36
Q

Lumbago

A

synonym for low back pain

37
Q

Sciatica

A

pain radiating from the low back into one or both legs

38
Q

pain may originate from ___

A

pain may originate from many spinal structures

39
Q

Differential for lower back pain

A
40
Q

Mechanical back pain

A
  • Related to structural damage of the spine.
  • Exacerbated by movements and relieved by lying down and resting
  • Lumbar strain or sprain, idiopathic low back pain, and nonspecific low back pain are terms used to describe an episode of acute low back pain without a clearly defined cause that is typically self-limited.
41
Q

The terms lumbar strain or sprain . . .

A

The terms lumbar strain or sprain lack a clear anatomic definition.

42
Q

Non-mechanical back pain

A
  • Etiologies include malignancy, infection, axial spondyloarthritis
  • Typically not relieved by lying down or resting
  • Inflammatory back pain is the hallmark of axial spondyloarthritis
43
Q

Visceral back pain

A
  • Low back pain may also arise from non-spinal structures
  • Diseases of the gastrointestinal tract and pathologies in the pelvis or retroperitoneum may present with low back pain.
  • Usually referred pain
44
Q

‘Red flag’ histories for back pain

A
45
Q

Recommendations for managing back pain

A
46
Q

The Schober test is ___ sensitive and specific.

A

The Schober test is not particularly sensitive and specific.

HMS IDD (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions