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MSK II Exam 2 > SpondyloArthropathies > Flashcards

SpondyloArthropathies Flashcards

1
Q

Characteristics of seronegative spondyloarthropathies

A 
male - before 40
inflammatory arthritis of spine and SI jts
HLA B27++ (also ankylosis spondylosis)
RF - 
CCP - 
ANA -
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2
Q

Non-vertebral symptoms of spondyloarthropathies

A 
asymmetric peripheral arthritis
arthritis of Toe IP joints
sausage digits
Enthesopathy - achilles, plantar fasciitis, costochondritis
Uveitits
mucocutaneous lesion
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3
Q

What does HLA B27 interatct with

A

CD 8 cells

CD 4 t cells

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4
Q

what bacteria in stool of AS patients produces HLA-B27

A

klebsiella

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5
Q

What diseases is HLA-B27 associated with

A

ankylosis spondylitis
reactive arthritis
IBD w/ spondylitis
Whipples disease

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6
Q

How to make diagnosis of spondyloarthropathy

A

chronic(>3 months) low back pain ( 30 mins
improvement by exercise

HLA-B27 positive + 2 features
sacroillitis on imaging + 1 feature

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7
Q

what are the features of spndyloarthropathy

A 
arthritis
enthesitis*
uveitis*
dactylitis
psoriasis
CD/UC
NSAID response
FH
HLA-B27
Elevated C-RP
aortic insuffiency*
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8
Q

Symptoms of AS

A 
bamboo spine
SI inflammation/pain
increased kyphosis
fatigue
Ocular inflammation, uveitis
reduced rib expansion
weight loss
atlantoaxial subluxation
pulmonary fibrosis
aortic insuffiency
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9
Q

AS - essentials of diagnosis

A 
chronic LBP in young adults
limitation of chest expansion - upper lobe pulmonary fibrosis
SI abnormalities
Peripheral arthritis - knees esp
Inflammatory eye disease
aortic insuffiency
ESR elevated, neg RF and CCP
HLA-B27
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10
Q

Shobers test

A

rheumatolgy test for low back flexion
5cm below L5 and 10 cm above - touch toes
< 5cm of elongation is bad

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11
Q

Lab findings in AS

A

ESR increased
RF and antiCCP - negative
mild anemia
HLA-B27 +

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12
Q

imaging findings in AS

A

X rays
CT-scans
MRI - whole body w/ gadolinium*
may show edema at enthesitis sites

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13
Q

Andersson lesions are

A

inflammatory involvement of intervertebral discs
simulates diskitis
found in AS

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14
Q

what is shiny corner sign

A

reactive sclerosis (small erosions) on corners of vertebral bodies - found in AS

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15
Q

Syndesmophytes

A

bony growth inside of cartilage - bamboo spine

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16
Q

how are DISH and AS different

A

in DISH no involvement of SI joints and syndesmophytes are anterior and thicker

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17
Q

SI joints and AS

A

Sclerosis, bilaterally on iliac side

sclerosis appears triangular with base inferior

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18
Q

Other complications of AS

A 
uveitis
upper lobe PF
cauda equina fibrosis
heart block
aortic regurg
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19
Q

Treatment of AS

A 
Phys/Occ therapy
exercise
NSAIDS - watch for CHF
sulfasalazine - for peripheral arthritis
ANTI TNF-a agents
exclusion criteria - active/recent infections
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20
Q

psoriatic arthritis patterns

A 
oligoarthritis - pencil in cup
arthritis mutilans  "opera glass hand"
unilateral sacroilitits
asymmetrical polyarthritis
DIP
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21
Q

psoriatic arthritis - labs

A 
HLA-B27 + - 30-50%
RF/CCP neg
UA increased
FE++ decreased
Th17 w/ increased IL-17
HIV - associated**
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22
Q

Psoriatic Arthritis - essentials

A

psoriasis precedes arthritis 80% - search for PsA
asymmetric sausage appearance of fingers/toes-dactylitis
X-ray: osteolysis, pencil in cup, lack of osteoporosis, bony ankylosis, atypical syndespophytes
may have uveitis, pleruitis, aortitis

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23
Q

psoriatic arthritis - management

A 
topicals
PUVA
NSAIDs
Methotrexate
Anti-TNF agents - good for nail and cutaneous lesions of psoriasis
IL17/IL23 blockers  IL23 triggers proinflamatory cascade
apremilast(PDE4 inhibitor)
surgery
NOT STEROIDS
24
Q

reactive arthritis

A

has antecedent bacterial infection or HIV*

25
Q

what are the bacteral for reactive arthritis

A 
S3YC3
Shigella
Salmonella
Streptococcus
Yersinia (enterocolitica, pseudoTB)
Camplylobacter
Clostridium
Chlamydia
and Ureaplasm
26
Q

Chlamydia induced arthritis

A

genital forms containing ocular forms carried by monocytes to jts and chronically stim Th1 rxn
producing - IL1, TNF a, IFN g
can come from pneumonic forms also

27
Q

Chlamydiaceae forms

A 
C. pneumoniae
psittaci
tracomatis
    A-C - trachoma
   D-K - NGU gential tract infections - PID/sterility
    L1-L3 - Lymphogranuloma venereum
28
Q

Reiters’ Syndrome - reactive arthritis

A

AI condition in response to infxn in body

- following urethritis/cervicits/infections diarrhea

29
Q

Reactive arthritis associations

A 
enthesopathy - Lovers heals
inflammatory eye disease
palmar pustulosis
circinate balanitis**
keratoderma blenorrhagicum***
oral ulcers - painless - unlike behcets
sacroilitis in 20%
30
Q

reactive arthritis - diagnosis

A 
50-80%   HLA-B27 +
large joint oligoarthritis or sacroiliits
uveitis conjunctivitis**
urethritis**
mouth ulcers
follows dysentery or STI
self limited 15% relapse  and 15% chronic
may have carditis and AR
31
Q

management of reactive arthritis

A 
antibiotics***  doxy+rifampicin  or AZT+rifampicin
     - effective in Chlamydia
NSAIDS***  
opthalmic drugs
sulfasalazine
biologics - anti-TNF
32
Q

IBD w/ arhtritis

A

especially chrons 15% HLAB27 +
1.) non deforming asymmetric oligoarhtritis athat parallels bowel disease
2.) bilateral and symmetrical sacroilitis 50% HLA B27+
acts independently of IBD

33
Q

treatment of peripheral arthritis of IBD

A 
corresponds to status of IBD so treat IBD
   sulfasalazine
   corticosteroids
    AZA or 6-MP
   TNF inhibitor
34
Q

hemearthrosis is

A 
recurrent hemorrhage in 
knees/ankles/elbows
synovial hypertrophy
hemosiderin deposition
persistent boggy synovitis
cartilage erosion
fibrosis and ankylosis
35
Q

diagnosis of hemarthrosis

A

mri better than xray for early damage

xray can show hemosiderin

36
Q

treatment of hemarthrosis

A

prophylactic clotting factors QOD non on demand

37
Q

septic arthritis

A

monoarthritis is septic arthritis until proven otherwise
more jts == less likely except for
RA, group B strep, endocarditis
anti TNF therapy patients - 2x as likely

38
Q

septic arthritis - risk factors

A

sudden onset of acute arthritis, usually monoarticular
- usually large weight bearing jts
previous jt damage or IV drug abuse
Infection w/ causative organisms commonly found elsewhere
joint effusions are large with WBC > 50,000

39
Q

diagnostic approach to septic arthritis

A

blood culture + in 50% - check for AFB in anti-TNF therapy or HIV
synovial fluid
gram stain + in 50-75%, culture + in 80%
WBC > 50,000 often > 100,000
glucose, crystals, serologic studies
MRI good to find early changes of osteomyelitis
arthrocentesis - watch for allery to anesthetic, bleeding, or anti coag

40
Q

serologic fluid

A

string sign - high viscosity?????

41
Q

septic arthritis - organisms

A

Gram + 90%
staph aureus (50%) MRSA, GBS, pneumococcal
Gram - 10%
e coli, pseudomonas, DGI, Salmonela

42
Q

prosthetic jt infections

A

have a biofilm that stops staph(coag+ and -) and pseudomonas
infxns > 24 months seeded from blood
tx depends on prosthetic loosening

43
Q

treatment of septic arthritis

A

3rd gen cephalosporin - ceftriaxone/cefotaxime
vancomycin
4-6 weeks and drain

44
Q

Gonococcal arthritis

A

most common septic arthritis in young adults

asymptomatic pharyngitis and proctitis in gay men

45
Q

Risk factors of Gonococcal arthritis

A

menstruation, pregnancy

C5-C9 deficiencies

46
Q

Gonococcal arthritis labs

A

synovial fluid + in 25%
culture + in 50%
need urethral, throat, cervical and rectal cultures

47
Q

Gonococcal arthritis treatment

A

3rd gen cephalosporins IV x 2 days then cefixime

48
Q

Disseminated gonococcal infrection(DGI)

A 
Arthritis/Dermatitis syndrom
olioarthritis form - preceded by migratory polyarthritis
tenosynovitis
rash - pustules (palms/sole
fever
may also get osteomyelitis
49
Q

spinal septic arthritis (discitis)

A

chronic unrelenting back pain, fever, local tenderness
thoracolumbar region
Infection usually crosses disc space(not in malignancy)
TB(potts disease): T10-L2 region
gibbus deformity, paraspinal cold abcess

50
Q

viral arthritis - common agents

A 
parvo B19
HIV
hep b/c
EBV
adeno/coxsackie
rubella
mumps
51
Q

Viral arthritis presentation

A

megratory arthralgia/itis or polyarthritis
wrists, hands, knees
frequently symmetric
rash may be present
Hep C may look like RA (anti-CCP)
Hep B similar to serum sickness w/ urticaria and decreased complement

52
Q

HIV and Diffuse Infiltrative Lymphocytosis Syndrome (DILS)

A 
CD 8 cells infiltrate the organs
Sjogrens and bells palsy
myositis
reactive arthritis
peripheral neuropathy - sensory motor
hepatitis
interstitisal nephritis
Pneumonia
psoriasis esp palmo-pustular
responds to steroids and HAART
53
Q

immune reconstitiution inflammatory syndrome

iris

A 
Conditions driven by CD 4 lymphocytes
RA
SLE
sarcoid
Sjogrens
immune system begins to recover but then responds to previously acquired opportunistic infection w/ overwelming inflammatory response that make worse
TB and cryptococcal meningitis
54
Q

Erythema Nodosum w/ Arthritis

A 
BUMPS
Boeck's sarcoid
bechets disease
ulcerative colitis/crohns
mycoses - blasto, histo, TB, mycoplasma
Pills (
BCP
Streptococcus
55
Q

what is lofgren’s syndrome

A

sarcoidosis w/ perihilar lympheadenopath and erythema nodosum

56
Q

Lyme disease

A

stage I - flu syndrome w/ rash(ECM)
Stage II - dissemination heart, joints nerves
heart block, bells palsy, miratory arthralgias
Stage III - joints oligoarthritis, encephalitis, paresthesias
HLA-DR4 risk factor

57
Q

how to confirm lyme disease

A

Western blot

treat w doxy, amoxicillin, ceftriaxone

MSK II Exam 2 (8 decks)

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