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30 Cards in this Set
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- Back
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Patient 28yrs old, who couldn’t look raise his head or his proximal shoulder muscles. Patient noticed weight loss, loss of sleep. Initially presented with stiffness that was midly elevated in the morning. Patient reports occasional flare ups in the following years, leading to difficulty walking. Patient reports only episodic pain during flare ups. Patient noticed pain in left hip, when it gave away. Since then the patient has had hip replacements. Iritis also noticed by patient. Genetic association with Uncle who had similar problem.
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ANKYLOSING SPONDYLITIS
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Characteristics of Seronegative Spondyloarthropathies
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Axial skeletal arthritis vs RA (in extremities)
With minimal morning exercise Seronegative ( Absence of RF) Begins in sacroiliac and spinal joings If peripheral then predominantly in lower limb Associated with enthesopahty ( transitional place between tendon and bone) Genetic predilection of HLA-B27 Extrarticular features |
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Different types of Spondyloarthropathies
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AS
Psoriatic Arthritis Reiters Arthritis(Reactive arthritis) – urethritis, uveitis, Enteropathic arthritis – Regional, Ulcerative Juvenile AS |
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HLA B27
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Not all those who have it are at real risk. There are 25 subtypes of HLA B where some are more susceptible than others
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Frequency of B27 in AS ?
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>95%. Relative risk is 100-150
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Reiters
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75% freq and 35-50 relative risk
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B27 in psoriasis and IBD
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Low, except if ther eis spondylitis involved then it is 50
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Acute anterior uveitis B27 ?
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60-65%
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Characteristics of Backpain in Ankylosing spondylitis
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Onset before 40
Insidious Duration longer than 3 months Associated with Morning Stiffness Decreases with Exercise |
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Mechanical backpain
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>50 normally. Use this to differentiate. This also gets worse as you exercise more
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Back problems seen in AS
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Vertebrae get fused by normal daily activities. Therefore it is important to maintain a straight posture through out daily life
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Initial target of inflammation in AS
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Vertebrae get fused by normal daily activities. Therefore it is important to maintain a straight posture through out daily life
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Sclerosis of joints with inflammation
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Stage 2 sacroillitis
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Bridging ankylosis
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Ligament normally that bridge the bones are calcified and the bone is continuous causing loss of movement
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Bamboo spine
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Seen in AS
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Schobers test
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Tests the amount of reversing of the lordosis when asked to bend over. Usually curving back with straight lumbar section. No lengthening is usually seen. Usually around 10-12cm
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Reactive arthritis
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Asymmetric arthritis with
- Urethritis or cervitis - Infectious diarrhea – salmonella, shigella, yersinia Often associated with - Inflammatory eye disease - Balanitis, Oral ulceration or Keratodermia - Enthesopathy - Sacroiliitis |
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Conjunctivitis
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Seen in Reiters. Wispy small vessels with inflammed conjunctiva
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Iritis
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Scarring and inflammation
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Circinate Balanitis
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Inflammation of penis
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Keratoderma blennorragicum
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Looks like duct tape psoriasis on the SOLE and PALMS
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Tongue ulceration
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Seen in reactive arthritis but are NOT PAINFUL
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Psoriatic arthritis
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Can present as spoondylitis and can present as DIP joint disease associated with nail lesions
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Symmetric polyarthritis
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Resembles RA
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DIP predominany arthritis
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5% - resemles RA
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Arthritis mutilans
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Telescoping hands – oper aglass hands
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Nail changes with psoriatric arthritis
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Finger pitting with onycholysis(this is seen with fungal infection, and the most common reason is psoriasis)
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Other changes in the feet ?
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Dactylitis (aka sausage digits) – flexor and extensor tendom mechanisms are inflammed, and therefore leads to diffused swelling of these joints
Destruction of joints, there is no new bone formation. There is a destruction of the proximal phalanx with WINGING out of the distal phalynx. There is a classic PENCIL IN CUP deformity |
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Psoriatric arthritis in the hand
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Asymmetric arthritis that is not RADIAL type. The RA is more radial and array like
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RA vs PsA ?
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Relatively little involvement, and can involve all 3 finger joints and will involve them in a sequential fashion
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