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PHTH 565 RHEUMATOLOGY > SPONDYLOARTHRITIS > Flashcards

SPONDYLOARTHRITIS Flashcards

1
Q

WHAT DOES SERonegative mean

A

does not have a rheumatoid factor in the blood

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2
Q

What are the common features of ankylosing spndylitis

A
  • Inflammation in the spine
  • Synovitis
  • Enthesopathy (inflammation at bony attachment sites)
  • Inflammatory eye disease
  • blood work
  • Tendency to run in families
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3
Q

What does synovitis affect? does it occur bilaterally or unilaterally

A

peripheral joints of the legs>arms

Typically unilateral

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4
Q

who develops Psoriatic arthritis

A

15-30% of people with psoriasis

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5
Q

Is there a genetic component to psoriatic arthritis?

A

Yes, appears in families

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6
Q

When does psoriatic arthritis typically present

A

30-50 years old

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7
Q

What may occur with psoriatic arthritis

A
  • Dactylitis

- Enthesitis

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8
Q

What is dactylitis

A

Sausage like fingers & toes due to swelling

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9
Q

In psoriatic arthritis where does enthesitis commonly occur

A

Heels & back

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10
Q

What are the 5 subgroups of psoriatic arthritis

A
  1. DIP Arthritis: Primarily joints of fingers &toes
  2. Asymmetric oligoarthritis: Joints of limbs -2-4 joints involved
  3. Symmetrical polyarthritis: Multiple joints - symmetric - resembles rheumatoid arthritis
  4. Arthritis mutilans: rare, deforming
  5. Psoriatic spondylitis: Sacroiliac joints & spine
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11
Q

What are the two main categories of spondyloarthritis

A
  1. Axial spondyloarthritis (spine + pelvis)

2. Peripheral spondyloarthritis

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12
Q

What is enteropathic spondylitis

A

intestinal arthropathy

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13
Q

What may be seen with enteropathic sondylitis

A
  • Ulcerative colitis and crohn’s disease
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14
Q

Is reactive arthritis typically symmetrical or asymmetrical

A

asymmetrical

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15
Q

What does reactive arthritis cause? where does it typically occur?

A

Hot, swollen joints. Maybe stiffening of spine

In lower limbs

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16
Q

what triggers reactive arthritis

A

Infection in the bowel or genitourinary tract

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17
Q

What does ankylosing mean

A

stiffening or fusing

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18
Q

What is ankylosing spondylitis

A

stiffness/fusing of the spine by inflammation

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19
Q

When is the onset of ankylosing spondylitis

A

adolescence/young adulthood

Average age: 26

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20
Q

Is ankylosing spondylitis easy to detect

How is it normally diagnosed

A

no- typically a delayed diagnosis

MRI is hallmark tool for diagnosis

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21
Q

how does Ankylosing spondylitis pain present

A

worst when youre resting better when youre moving

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22
Q

which ethnic group has a high prevalence of ankylosis spondylitis

A

Haida Indigenous

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23
Q

Ankylosing spondylitis M:F ratio?

A

1:1

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24
Q

Causes of ankylosing spondylitis?

A

Unclear!

  • Familial clustering
  • associated with genetic marker
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25
Q

Features of ankylosing spondylitis?

A 
MSK Involvement 
- Sacroiliitis 
- Enthesitis 
- Synovitis 
Other systems & organs involved?
- Eyes 
- Bowels 
- Lungs 
- Heart
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26
Q

What is the hallmark sign of ankylosing spondylitis?

A

Sacroiliitis

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27
Q

___% of cases of ankylosing spondylitis start with sacroiliitis

A

> 90%

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28
Q

How does sacroiliitis present

A

Deep, dull, diffuse pain in their buttock - worse when sitting better when moving

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29
Q

What is sacroiliitis

A

inflammation in SI jointst

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30
Q

is sacroiliitis uni or bilateral

A

Normally bilateral at some point - will come and go on one side then the other

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31
Q

Is sacroiliitis ____ can occur over time

A

fusion

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32
Q

What is an entheses

A

places where tendons, ligaments, and joint capsule attach to bone

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33
Q

What is enthesitis

A

Inflammation of the sites, leading to bony erosion bony overgrowth, possibility bony fusion and rigidity

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34
Q

Where does enthesitis begin

A

at SI joints, progresses in ascending fashion affecting all levels of the spine

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35
Q

Is diagnosis quick or long for enthesitis

A

long - 5-6 years

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36
Q

What is a big difference between RA and ankylosing spondylitis?

A

RA - reduction of bone

Ankylosing spondylitis - laying down more bone

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37
Q

What is seen in early stage enthesitis

A

bony loss - osteopenia

38
Q

what is seen in later stage enthesitis

A

Osteoporosis and Fusion/rigidity - risk of fractures

39
Q

What is an area of concern for fractures

A

impinge on spinal nerves

40
Q

What is the proposed sequence of structural damage in ankylosing spondylitis?

A
  • inflammation
  • Erosive damage repair
  • New bone formation
  • The beginning of syndesmophytes
  • Grows side to side
  • Results in fusion
41
Q

What is synovitis

A

inflammation of the synovium

42
Q

Where is commonly affected by synovitis

A

peripheral joints: shoulders, hips, knees

43
Q

Peripheral joint involvement occurs in about ___% of ankylosing spondylitis cases?

A

30%

44
Q

What is the clinical criteria for diagnosing ankylosing spondylitis? (New York Criteria)

A
  • LBP and stiffness for >3months that improves withe exercise but is not relieved by rest
  • Limitation of motion of the lumbar spinne in both the sagittal and frontal places
  • Limitation of chest expansion relative to nromal values correlated for age and sex
45
Q

What is the radiological criterion for ankylosing spondylitis? (New York Criteria)

A
  • Sacroiliitis grade >2 bilaterally or grade 3-4 unilaterally
46
Q

What is the needed for definite diagnosis of ankylosing spondylitis? (New York Criteria)

A

The radiological criterion is associated with at least 1 clinical criterion

47
Q

What is the ASAS Classification criteria for Axial Spondyloarthritis

A
  • In Pt with >3mths back pain ang age at onset <45 years

- Sacroiliitis on imaging plus 1 of more SpA feature OR HLA-B27 plus 2 or more SpA features

48
Q

What are SpA features according to ASAS Classification Criteria

A
  • Inflammatory back pain
  • arthritis
  • enthesitis (heel)
  • Uveitis
  • Dactylitis
  • Psoriasis
  • Crohn’s/colitis
  • Good response to NSAIDs
  • Familial history for SpA
  • HLA-B27
  • Elevated CRP
49
Q

is the New York Criteria or ASAS Classification Criteria more commonly used now

A

ASAS Classification Criteria

50
Q

Is there a seperate ASAS Classification Criteria for Peripheral spondyloarthritis ?

A

yes

51
Q

Other systems involved in spondyloarthritis?

A
  • Eyes
  • bowels
  • Lungs (decreased chest expansion due to rigidity)
  • Heart (inflammation + scarring of conduction system, incompetent valves)
52
Q

Clinical features of spondyloarthritis?

A
  • Pain - worse after rest
  • stiffness (AM in the spine, after inactivity)
  • Decreased spine ROM
  • Deformity/instability
  • Decreased strength (due to disuse, joint effusion, and pain)
  • Altered posture/muscle imbalances
  • Altered breathing mechanics
  • Fatigue
  • Deconditioning
53
Q

What causes the deformity/instability seen in spondyloarthritis

A

Bony fusion
Flexion deformity of the hips
C1-C2 instability
2nd degree OP

54
Q

What causes the fatigue seen in spondyloarthritis

A
  • Disease process
  • Cardiac involvement
  • Decreased vital capacity
55
Q

What is the posture seen in Ankylosing spondylitis

A
  • Forward posture of the head
  • Flattening of the anterior chest wall
  • Thoracic kyphosis
  • protrusion of abdomen
  • Flattening of the lumbar lordosis
  • Slight flexion of the hips on pelvis
56
Q

What is the criteria for inflammatory back pain

A
  • Back pain > 3months
  • Improvement with exercise
  • Pain at night
  • Insidious onset
  • Age of onset <40 years
  • No improvement with rest
    If 4/5 criteria are fulfilled,
57
Q

AM Stiffness for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • Usually prolonged >60mins

- Minor <40mins

58
Q

Max. pain/stiffness for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • Early AM

- Later in the day

59
Q

Exercise/activity effect on symptoms for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • Improves symptoms

- Worsens symptoms

60
Q

Duration for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • Chronic

- Acute/chronic

61
Q

Age of onset for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • 12-40 years

- 20-65 years

62
Q

Radiographs for:

  • Inflammatory back pain
  • Mechanical back pain
A
  • Sacroiliitis, syndesmophytes, spinal ankylosis

- Osteophytes, disc psace narrowing, malalignment

63
Q

What are some outcome measures for ankylosing spondylitis

A
  • Function - BASFI
  • Pain - NRS for last week and night time (BASDI)
  • Spinal mobility
  • Patient global assessment - NRS (BAS-G)
  • Stiffness - using last 2 questions in BASDI
  • Fatigue - BASDI
  • Swollen joint count/entesitis
64
Q

what are the components of a physical assessment for ankylosing spondylitis

A
  • Posture - tragus to wall
  • Trunk lateral flexion
  • Trunk flexion/extension: Modified schobers + smythe test
  • Trunk rotation
  • Chest expansion
  • Cervical mobility
  • Peripheral joint scan
  • Enthesitis sites
  • Major muscle groups
65
Q

What are the common enthesitis sites in Psoriatic arthritis

A
  • achilles tendon
  • Patella (on corners)
  • Plantar fascia
  • Anseranus bursa
  • Greater trochanter of femur
  • iliac crests
  • rotator cuff
  • costochondral
66
Q

What are major muscle group affected by ankylosing spondylitis

A
  • Short neck flexors
  • Mid trapezius
  • lower trapezius
  • lower abdominals
  • Gluteus maximus
67
Q

4 major management areas for spondyloarthritis

A
  • Medication
  • Physical interventions
  • Lifestyle/Self-management
  • Surgery
68
Q

What is the difference between ankylosing spondylitis and spondyloarthritis

A
  • ankylosing spondylitis is when the spinal fusion (progression from spondyloarthritis)
69
Q

What are 4 classes of MEdications used for treating spondyloarthritis

A
  • NSAIDS
  • DMARDS
  • Corticosteroids
  • Biologics
70
Q

benefits and downsides of NSAIDs in treatment of spondyloarthritis ?

A

Benefits:
- Improve BASDI, BASFI, and disease activity
- Slow progression of bone formation
Downsides:
- GI upsets, ulcers, bruising, headache, drowsiness
- Increase CV morbidity (in already at risk group)

71
Q

Are DMARDS used in Peripheral or axial spondyloarthritis?

A

Peripheral

72
Q

What are the downsides of DMARDS

A 
Nausea 
Vomiting 
Rashes 
Mouth ulcers 
Hair loss 
cough 
Bruising
73
Q

what are risks of longterm corticosteroid use

A

Skin Flares

Osteoporosis

74
Q

What are local corticosteroid injections used for

A

Enthesitis
Dactylitis
Peripheral joints
SI Joint

75
Q

What are topical corticosteroids used for

A

Uveitis

76
Q

benefits and downsides of Biologics in treatment of spondyloarthritis ?

A 
Benefits: 
- Responsive to all domains (pain, am stiffness, peripheral arthritis, dactylitis, enthesitis, uveitis, IBD 
- Slows radiographic progression - syndesmophytes 
Downsides: 
- Nausea, abdominal pain 
- headache 
- infections 
- Risk of TB reactivation 
 - 20% are non-responders
77
Q

what are the benefits of physical interventions

A
  • Control and decrease inflammation
  • pain management
  • Reduce spinal stiffness/increase ROM
  • Increase spinal/peripheral soft tissue flexibility
  • Posture correction
  • Increase muscle strength and endurance
  • Increase cardiovascular and fitness level
78
Q

How do the physical fitness levels of those with AS compare to controls

A
  • Lower cardiorespiratory levels and reduced flexibility
  • lower amounts of vigorous activity
  • Higher disease activity = lower PA levels
79
Q

What are the results of manual therapy on ankylosing spondylitis

A

Significant improvements in chest expansion, posture, spinal mobility, and BASMI

80
Q

When can you not perform manual therapy on an ankylosing spondylitis patient

A

when a joint has acute inflammation

81
Q

how do you best control inflammation in AS

A
  • Activity/rest
  • Ice
  • Compression
  • Exercises
82
Q

how do you best control pain in AS

A
  • Pain neurophysiology education
  • exercise
  • Thermal modalities
  • pool
  • ice
  • electrical modalities
  • manual therapy
83
Q

What are the target areas for exercises in AS

A
  • Pectorals
  • Rib cage
  • C- T- and L- spine
  • Neck posture
  • T- spine, L-spine, pelvis
  • pelvic/LE
84
Q

What is the goal of exercises for the pectorals

A

Stretch

85
Q

What is the goal of exercises for the rib cage

A

Breathing exercises & cardio

86
Q

What is the goal of exercises for the C- T- and L- spine

A

Improve ROM

87
Q

What is the goal of exercises for neck posture

A

Stretch suboccipitals

Strengthen short neck flexors

88
Q

What is the goal of exercises for the T-spine, L-spine, and Pelvis

A

Strengthen mid & lower traps, back extensors, gluts & core

89
Q

What is the goal of exercises for the pelvis and lower limb

A

Stretch hip flexors, adductors, quads, hams & calves

90
Q

What adapted equipment/ergonomics may be useful for someone with AS

A
  • Swivel chair
  • Tilted work surface/drafting table
  • additional rear view mirrors
  • long handled appliances/reacher
  • Back support
91
Q

What are 3 options for surgical management of AS

A
  • Realign - osteotomy
  • Rest - arthrodesis
  • Replace - arthroplasty

PHTH 565 RHEUMATOLOGY (7 decks)

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