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32 Cards in this Set
- Front
- Back
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Spondylarthritis characteristics
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Spinal and periph join oligoarth, inflamm of attach of ligaments and tendons to bones (enthesitis), mucocut, ocular and cardiac manifestations.
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Seronegative
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Negative rxn to serologic tests (mainly RF and ANA)
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Ankylosis
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stiffening of join
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spondylosis
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vertebra.
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arthron
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joint.
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Associated bamboo spine with...
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ANKYLOSING SPONDYLITIS
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Diff btwn spondylarthritis and spondylitis
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there is none.
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Involvmenet of enthesis differentiates btwn..
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RA from SNSA (seronegative spondyloarthritis)
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Different spondylarthropathies
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Ankylosing spondylitis
Psoriatic arthritis Reactive arthritis Enteropathic arthritis Crohn’s disease Ulcerative colitis Juvenile ankylosing spondylitis Undifferentiated spondylarthropathies |
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Isolated acute anterior uveities or complete heart block or lone aortic regurg with HLA-B27
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Treat them as if they had ankylosing spond. (tnf-alpha inhib)
can't use steeroids long-term. |
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Nonvertebral manifestations of spondylarthritides
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A-aortic insufficiency, aortitis, heart block
N-neurologic: atlantoaxial subluxation (imp for ANES), cauda equina K-kidney: secondary amyloidosis S-spine: cervical fracture, spinal stenosis, osteoporosis P-pulmonary: upper lobe fibrosis, restrictive changes O-ocular: anterior uveitis N-nephropathy (IgA) D-discitis |
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Type of person who gets ank spond
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HLA-B27 (1% of them)
Thin, medium height, long face, narrow chin. Male:female is 4:1 Younger males. |
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Back pain in ank spond
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Early back discomfort, insidious onset, duration > 3 months, morning stiffness and improv with exercise (inflammatory presentation)
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Physical for ank spond
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Occiput-to-wall test (can't get head to wall)
Chest expansion (diminished) Schober test - Expansion of lower back when bending over is small. Pelvic compression gives pain. Flexion, abduction, ext rot (Patrick's test) |
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Radiograph/histo of ank spond
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Bamoboo spine, squaring of teh vertebrae, disk spaces preserved often times.
Sacroiliitis (eventual loss of the SI joint) Aortic inflamm Iridocyclitis with synechiae - this is recurrent uveitis with scarring. Pupil will not react to light. |
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Tx of ank spond
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NSAIDs, salfasalazine, TNF-antag, phys therapy.
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Class 1 mhc
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HLA a, b, c (alpha chain) with Beta2 microglob.
Note that HLAB27 thus presents to CD8+ cells. |
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Class II mhc
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HLA DR, DP, DQ (alph aand beta chain)
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HLA-B27 is associated with...
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Ank spond, reactive arthritis, psoriatic spondylitis, periph psoriatic arth, spondylitis and inflamm bowel disease (IBD), acute anterior uveitis.
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When to test for B27
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inflamm eye disaese, unexplained palpitations (heart block?), young man with back pain.
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Psoriatic arth - musculoskel char
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Asymm arthritis, sausage digit (dactylitis), tenosynovitis - inflamm of tendons, heel pain, sacroiliitis, spondylitis.
Note that ank spond has symmetric invovlement. |
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Cutaneous manif of psoriatic arthritis
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Nail pitting!!!
onycholysis, valvular heart disaease, psoriasis.... |
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Hands of a pt with psoriatic arthritis
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nail changes, rash, and arthritis
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Which hand joints does psoriatic arthritis affect?
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DIP and PIPs.
NOT THE MCPS!!!! (but rheum arth does...) |
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Pencil and cup change on radiograph
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Pathognomic for psoriatic arthritis.
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Tendon changes in psoriatic arthritis
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achilles tendonitis.
due to inflammation of enthesis. |
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Raadiographic hcanges in psoriatic arthritis
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erosive arthritis (asymm often)
pencil in cup deformity arthritis mutilans - destorys joints and shortens fingers asymm sacroiliitis |
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Tx of psoriatic arthritis
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NSAIDS, MTX, sulfasalazine, TNF-alpha antag, PUVA.
Prednisone is tricky because as you taper it off, psoriasis gets worse. |
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Reactive arthritis - general
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seroneg asymm arthritis following urethritis, cervicitis, or infectious diarrhea.
Associated with inflamm eye disease, enthesopathy, circinate balanitis, oral ulceration, asym sacroiliitis, or keratoderma blennorrhagica (skin disease often on feet) |
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Enteropathic arthritis
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Inflamm bowel disease.
Especially ulverative colitis and Crohn's disease. Periph arthritis vs. axial (spondylitis) Less of an HLA-B27 association. The spondylitis and sacroiliitis is usually asymm as opposed to ankylosing spondylitis. |
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How to prev progression of some of these disease
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TNF-alpha and MTX early in disease
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HLA associations
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Ankylosing spondylitis > 90% (white males)
with uveitis or aortitis ~100% Reactive arthritis 50-80% with sacroiliitis or uveitis 90% Juvenile spondylarthropathy 80% Inflammatory bowel disease Peripheral Not increased Axial Crohn’s disease 50% Ulcerative colitis 70% Psoriasis Peripheral Not increased Axial 50% |
