Spondyloarthropathies Flashcards
The Spondyloarthropathies
- Ankylosing spondylitis (AS)
- Reactive arthritis (ReA)
- Psoriatic arthritis (PsA)
- Enteropathic arthritis (EA)
- Undifferentiated (USpA)
Seroegative Spondyloarthropathies
- spine, SI joints
- new bone formation at sites of infl
- joint ankyloses, fusion, rigidity/kyphosis
- asymmetric peripheral arthritis
- enthesitis (inflamed tendon insertion into bone)
- B27
- ocular infl
which are more Male predominant?
- ankylosing spondylitis (10x)
- reactive arthritis (3x)
What are the Spondyloarthropathies?
- axial spine, peripheral joints, periarticular structures; assoc w HLA B27 gene; w extra-articular manifestations
- GI/GU infl
- ant ocular infl
- psoriasis skin/nail lesions
- aortic root lesions
- absence of RF and ACCP
- peripheral asymmetric oligo arthritis
- plantar fasciitis, achilles tendonitis, costochondritis
- enthesitis
Spondyloarthropathies- assoc w?
-HLA B27
Ankylosing Spondylitis- in who
- most common infl disorder of axial skeleton!!!
- 3x M > F
- 2-3 decade
Ankylosing Spondylitis- pathogenesis
- immune mediated
- inflamed SI joint- TNF alpha
- enteric bacteria
Ankylosing Spondylitis- clinical manifestations
- low back pain > months
- morning stiffnes, improved w exercise
- fatigue, wt loss, fever
- symmetrical SI joint pain
- tendonitis, plantar fasciitis, enthesitis
Ankylosing Spondylitis- extra-articular
- eye- ant uveitis (iritis), photophobia, eye pain, blurred vision
- aortic insuff
- pulm fibrosis
- IBD
- psoriasis
Ankylosing Spondylitis- PE
- restricted chest expansion
- FABERE test
- loss of spinal mobility- flexion of lumbar spine- Schober test
Ankylosing Spondylitis- lab
- inc ESR, CRP
- HLA B27 + (80-90%)
- anemia of chronic dz
- neg RF, ACCP, ANA
Ankylosing Spondylitis- imaging
- radiograph- b/l SI changes
- erosions of SI joints, pseudo widening, sclerosis, fuses, ankyloses, symmetric
- vertebrae- squaring (loss of ant convexity); shiny corners (sclerosis at edge of vertebral bodies)
- bridging of vertebrae (ankylosis)- bamboo spine
Ankylosing Spondylitis- tests
- CT- more sensitive for erosions
- MRI- detects infl before changes seen on Xrays or CT
Ankylosing Spondylitis- diff dx
- DISH (diffuse idiopathic skeletal hyperostosis)- calcification along lateral aspect of 4 contiguous vertebrae bodies (SI joints ok)
- Osteitis condens ilii- young, middle aged females- normal SI joints- Xray shows sclerosis on iliac side of sI joint
Ankylosing Spondylitis- late complications
- restrictive lung dz
- compression fractures
- cauda equina syndrome
Ankylosing Spondylitis- key points
hx of infl back pain
- age of onset < 40 yo
- insidious onset
- > 3 months b/f medical attention
- AM stiffness, reduction in spinal mobility (lumbar flexion)
- improvement w exercise or activity
- FH
Ankylosing Spondylitis- tx
- exercise, PT
- NSAID
- TNF-alpha inhibitors
- metrotrex/sulfasal- ok for peripheral arthritis; not for aial dz
if suspecting reactive arthritis- what q’s do you want to ask?
- recent GU or GI tract infection
- oral ulcers, penile rash, fever
- venereal dz (GC, syphilis)
- IV drug use
Reactive Arthritis
- autoimmune dz, asymmetric mono or oligo-arthritis in LE’s
- assoc w infection from GI/GU tract
- GI- salmonella, Shigella, yersinia, campylobacter
- GU- chlamydia
Reactive Arthritis- in who? clinical manifestations
- young men!!!!!
- arthritis- asymmetrical, oligo-arthritis, LE’s
- enthesitis- achilles tendon, plantar fasciitis
- dactylitis- sausage digit
- SI pain- asymmetrical
- Reiter’s syndrome
- circinate balanitis (vesicles/ulcers on glans penis)
- Keratoderma blenorrhagicum (painless eruption of palms/soles)
- conjunctivitis/uveitis
Reiter’s syndrome
-urethritis, arthritis, conjunctivitis, oral ulcers
Circinate balanitis
(in reactive arthritis)
-vesicles/ulcers on glans penis
dactylitis
(in Reactive arthritis)
-sausage digit- infl and swelling of an entire toe or finger
Keratodermia blenorrhagicum
(in reactive arthritis)
-painless eruption of palms/soles
