Spondyloarthropathies Lecture Powerpoint Flashcards

1
Q

Spondyloarthropathies definition

A

Family of inflammatory arthropathies characterized by axial skeletal involvement, peripheral arhtropathy, enthesitis, dactylitis, and extra articular manifestations in genetically predisposed individuals

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2
Q

Common features of the spondyloarthropathies (5)

A
  • association with the HLA-B27 gene
  • Enthesitis
  • inflammatory back pain (gets better with exercise, stiff in morning, younger person)
  • extra-articular manifestations
  • family aggregation
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3
Q

Ankylosing spondylitis clinical findings (3)

A
  • age of onset late childhood to young adulthood
  • long delay in diagnosis due to insidious onset of symptoms
  • male predominant
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4
Q

Ankylosing spondylitis physical exam findings (6)

A
  • tenderness over sacroiliac joints
  • restricted motion (schober’s maneuver)
  • decreased chest expansion
  • decreased cervical spine motion
  • peripheral arthritis and enthesitis
  • extra articular manifestations
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5
Q

Schober’s maneuver

A

Test for ankylosing spondylitis, while standing, make a mark at sacral dimples and measure 10cm to make another mark, have patient bend forward and touch toes, measure distance between marks, >15cm is normal, excursion is decreased in ankylosing spondylitis

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6
Q

Radiologic evals of ankylosing spondylitis (2)

A
  • radiographs displaying sacroilitiis, spondylitis, bamboo spine (late stage, see squaring off of vertebrae) and entheses (periosteal new born formation and erosions)
  • MRI scan if still uncertain
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7
Q

Sacroilitis radiographic finding

A

See irregular border, sclerosis on either side of the joint indicating presence of sacroilitis (typically bilateral in ankylosing spondyliis)

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8
Q

Areas where enthesopathies are more likely to occur (4)

A
  • heel (achilles tendon insertion on calcaneous)
  • knee (superior and inferior aspect of patella)
  • foot
  • back and buttocks (iliac spines and crest, ischial tuberosity)
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9
Q

Extra-articular manifestations of ankylosing spondylitis (6)

A
  • acute anterior uveitis
  • apical pleural thickening and fibrosis
  • aortic insufficiency (diastolic murmur)
  • amyloidosis of kidney
  • neurologic complications of severe spinal disease
  • prostatitis or inflammatory bowel disease
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10
Q

Psoriatic arthritis clinical manifestations (5)

A
  • asymmetric oligoarthritis
  • distal interphalangeal joints predominantly
  • severe deforming arthritis (arthritis mutilans)
  • rheumatoid like arthritis with negative RF
  • spondylitis (large asymmetrical bulky syndesmophytes opposed to the thin symmetrical ones in ankylosing spondylitis)
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11
Q

Reactive arthritis (reiter’s syndrome) diagnostic criteria (4)

A
  • seronegative asymmetric oligoarticular arthritis as well as
  • urethritis/cervicitis
  • dysentary
  • inflammatory eye disease conjunctivitis or uveitis
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12
Q

Possible infectious etiologies of reactive arthritis (3)

A
  • genitourinary dz
  • GI disease
  • lyme disease
  • genetically predisposed individuals often with HLAB27
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13
Q

Musculosekeltal manifestations of reactive arthritis (3)

A
  • Asymmetric oligoarthritis predominantly of lower extremities
  • sacroilitis usually asymmetric
  • enthesitis
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14
Q

Extra-articular manifestations of reactive arthritis (4)

A
  • urethritis
  • conjunctivitis or uveitis
  • aortic insufficiency
  • pleuritis and infiltrates
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15
Q

Management of spondyloarthropathies (8)

A
  • NSAIDS and cox2 inhibitors effective for inflammatory symptoms
  • sulfasalazine
  • corticosteroids
  • methotrexate
  • apremilast
  • bDMARDS
  • PT
  • orthopedic surgery
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