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M2F > Spondyloarthropathies > Flashcards

Spondyloarthropathies Flashcards

1
Q

The Spondyloarthropathies

A
  • Ankylosing spondylitis (AS)
  • Reactive arthritis (ReA)
  • Psoriatic arthritis (PsA)
  • Enteropathic arthritis (EA)
  • Undifferentiated (USpA)
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2
Q

Seroegative Spondyloarthropathies

A
  • 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
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3
Q

which are more Male predominant?

A
  • ankylosing spondylitis (10x)

- reactive arthritis (3x)

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4
Q

What are the Spondyloarthropathies?

A
  • 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
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5
Q

Spondyloarthropathies- assoc w?

A

-HLA B27

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6
Q

Ankylosing Spondylitis- in who

A
  • most common infl disorder of axial skeleton!!!
  • 3x M > F
  • 2-3 decade
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7
Q

Ankylosing Spondylitis- pathogenesis

A
  • immune mediated
  • inflamed SI joint- TNF alpha
  • enteric bacteria
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8
Q

Ankylosing Spondylitis- clinical manifestations

A
  • low back pain > months
  • morning stiffnes, improved w exercise
  • fatigue, wt loss, fever
  • symmetrical SI joint pain
  • tendonitis, plantar fasciitis, enthesitis
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9
Q

Ankylosing Spondylitis- extra-articular

A
  • eye- ant uveitis (iritis), photophobia, eye pain, blurred vision
  • aortic insuff
  • pulm fibrosis
  • IBD
  • psoriasis
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10
Q

Ankylosing Spondylitis- PE

A
  • restricted chest expansion
  • FABERE test
  • loss of spinal mobility- flexion of lumbar spine- Schober test
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11
Q

Ankylosing Spondylitis- lab

A
  • inc ESR, CRP
  • HLA B27 + (80-90%)
  • anemia of chronic dz
  • neg RF, ACCP, ANA
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12
Q

Ankylosing Spondylitis- imaging

A
  • 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
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13
Q

Ankylosing Spondylitis- tests

A
  • CT- more sensitive for erosions

- MRI- detects infl before changes seen on Xrays or CT

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14
Q

Ankylosing Spondylitis- diff dx

A
  • 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
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15
Q

Ankylosing Spondylitis- late complications

A
  • restrictive lung dz
  • compression fractures
  • cauda equina syndrome
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16
Q

Ankylosing Spondylitis- key points

A

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
17
Q

Ankylosing Spondylitis- tx

A
  • exercise, PT
  • NSAID
  • TNF-alpha inhibitors
  • metrotrex/sulfasal- ok for peripheral arthritis; not for aial dz
18
Q

if suspecting reactive arthritis- what q’s do you want to ask?

A
  • recent GU or GI tract infection
  • oral ulcers, penile rash, fever
  • venereal dz (GC, syphilis)
  • IV drug use
19
Q

Reactive Arthritis

A
  • autoimmune dz, asymmetric mono or oligo-arthritis in LE’s
  • assoc w infection from GI/GU tract
  • GI- salmonella, Shigella, yersinia, campylobacter
  • GU- chlamydia
20
Q

Reactive Arthritis- in who? clinical manifestations

A
  • 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
21
Q

Reiter’s syndrome

A

-urethritis, arthritis, conjunctivitis, oral ulcers

22
Q

Circinate balanitis

A

(in reactive arthritis)

-vesicles/ulcers on glans penis

23
Q

dactylitis

A

(in Reactive arthritis)

-sausage digit- infl and swelling of an entire toe or finger

24
Q

Keratodermia blenorrhagicum

A

(in reactive arthritis)

-painless eruption of palms/soles

25
Q

Reactive arthritis- lab

A
  • same as AS

- infl synovial fluid (WBC 2,000-50,000; PMN’s)

26
Q

Reactive arthritis- tx

A
  • self-limiting in 6 months usually
  • NSAIDs, steroids (intra-articular)
  • if chronic progression, use DMARD
  • urethritis- chlamydia- azithromycin or doxycylcine
27
Q

Psoriatic Arthritis

A
  • 40-60 yo; equal sex ratio
  • arthritis is in 20% of pts w psoriasis
  • SI and axial involvement
  • pitting nails
  • dactylitis and enthesitis
  • DIP arthritis- pencil in cup!!!
28
Q

Psoriatic Arthritis- tx

A
  • NSAID
  • non biologics
  • methotrexate, sulfasal, hydroxychlor
  • biologics- TNF inhibitors
29
Q

Enteropathic Arthritis

A
  • arthritis assoc w IBD- Crohn’s or UC
  • axial involvement- asymmetric SI
  • peripheral arthritis- parallels activity of IBD; large joints of LE, small joints of UE
  • extra-articular manifestations more common in CD
30
Q

Enteropathic Arthritis- extra-articular manifestations

A
  • pyoderma gangrenosum, erythema nodosum
  • uveitis
  • CD/UC
  • nephrolithiasis
  • thrombolism
  • bones- low bone density, vit D def
31
Q

Enteropathic Arthritis- TX

A
  • NSAIDs
  • steroids
  • methotrex/sulfasal
  • TNFalpha for IBD arthritis
32
Q

Tx summary for SpA

A
  • exercise
  • NSAID
  • glucocorticoids
  • methotrexate- peripheral arthritis- not for axial dz or AS
  • sulfasalazine
  • DMARDs
  • abx- chlamydia urethritis

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