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96 Cards in this Set
- Front
- Back
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What does "seronegative" mean?
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means NOT positive for Rheumatoid factor, so must be associated w/ some other dz
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What are spondyloarthropathies?
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Spondyl = spine
- so abnormalities w/ the spine Ankylosing spondylitis Reiter's Syndrome Reactive Arthritis Psoriatic Arthritis IBD Assoc. Arthritis Juvenile Onset Spondyloarthropathy Undifferentiated sponyloarthropathy |
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Where does inflammation occur in seronegative sponyloarthropathies?
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Axial skeleton (spine +SI)
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What is inflammation at the site of ligamentous/tendonous insertion into bone?
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Enthesitis (due to a medical condition)
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Do spondyloarthropathies have symmetrical or assymetrical involvement of peripheral joints?
-upper or lower extremities more common? |
ASSYMETRICAL
- Lower > Upper |
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Besides joint problems, what other problems may be involved w/ seronegative spondyloarthropathies
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other organs
-often the eye |
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What HLA associated w/ Spondyloarthropathies?
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HLA-B27
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Name 5 dz's HLA-B27 common w/?
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Ankylosing Spondylitis
Retier's Syndrome Reactive Arthritis Psoriatic Arthritis IBD |
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What is a red scaly rash on the hands?
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Psoriasis
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Peak age onset Psoriatric arthritis?
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30-55 years
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Does skin or joint dz usually appear first in Psoriatric Arthritits?
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SKin usually first
can be other way though or can coexist |
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Psoriatric Arthritits has acute or gradual onset??
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2/3 gradual
1/3 acute |
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What puts people at risk for Psoriatric Arthritits?
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Genetic factors
Enviro. factors like infectious agents or some type of trigger HLA-B27 is factor for SPINAL involvement |
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what is oligoarthritis?
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5 or fewer joints
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Where does Psoriatric Arthritits typically strike?
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DIP joints
Sacroilitus Arthritis mutilans Spondylitis **transition from one pattern to another not uncommon and may result in a heterogeneous combo of jt. dz |
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Psoriatric Arthritits and HLA-B27 - what more at risk for?
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axial involvement
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What is sausage digit?
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Dactylitis
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What is involvement w/ fingernails where look all crusty
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Onycholysis
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Dactylitis (sausage fingers) predominent in what 2 types of arthritis?
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Psoriatric arthritis
Reactive arthrites (also sarcoidosis, flexor tendon sheath infections, gout, perineoplastic) |
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What hand joints most often affected Psoriatric Arthritits?
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DIP arthritis w/ overlying nail changes
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What is the joint distribution of Psoriatric Arthritits?
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mono or oligoarticular arthritis
-2-5 joints -ASSYMETRIC -can evolve into symmetirc -typically lower and upper extremities |
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How is Psoriatric Arthritits Polyarthritis (>5 joint involvement) of small joints, hands, feet, wrist, ankles, knees,
Different from Rheumatoid arthritis? |
-Nail changes
DIP involvement -Bony ankylosis X-ray changes Note: RA has rheumatoid nodules |
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What is a form of Psoriatric Arthritits that is
rare and aggressive telescoping of digits Ostolysis of fingers or toes |
Psoriatric Arthritits: Arthritis Mutilans
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Inflammation at site of attachment of tendons and ligament to bones
(esp achilles tendon, plantar fascia attachment into calcaneous and in hand and feet) |
Enthesitis
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What is sausage digit?
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Dactylitis (inflammation of digit)
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What are 2 nail changes unique to Psoriatric Arthritits?
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-Nail pitting*** - failry specific
-Onchylosis: seen in ALL of the seroarthropathies (not as specific) |
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Could conjunctivitis, uveitis, aortic insufficiency, pumonary fibrosis, and amyloidosis be seen in Psoriatric Arthritits?
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yes
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What is an x-ray finding that can help differentiate Psoriatric Arthritits from Rheumatoid arthritis?
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"Pencil in Cup Deformity"
will also observe -bone erosion -bony proliferation -joint space loss |
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Psoriatric Arthritits is typically a symmetrical arthritis?
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false
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name 3 joints Psoriatric Arthritits might typically invovle?
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DIP
SI Spine |
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Inflammation of a tendinous insertion into bone is called?
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enthesitis
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Name a radiographic finding common in Psoriatric Arthritits?
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Pencil in Cup
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Name 2 non-articular findings on phys. exam
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nail pitting
psoriasis |
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Ankylosising SPondylitis is an inflammatory dz of the?
-Hallmark? |
Axial skeleton
-SI joint hallmark also hips, shoulders, and peripheral joints can be involved |
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what is joint fusion
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Ankylosis
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What is spinal inflammation
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Spondylitis
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What is Ankylosing Spondylitis?
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joint fusion w/ spinal inflammation
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when does ankylosis appear in Ankylosing Spondylitis?
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late stages dz
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What HLA assoc. w/ Ankylosing Spondylitis?
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HLA-B27
-genetic and enviro. factors appear to play role |
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Ankylosing Spondylitis symptoms begin when?
male or f/m more common? |
Late adolescence and early adulthood
(can have juvenile onset) Male:female ration 3:1 **most seronegative dzs affect males > f/ms |
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Ankylosing Spondylitis is a dz believed to be triggered by?
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Molecular Mimicry
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How long should Ankylosing Spondylitis? (b/c many people complain of paint)
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3 months
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is back pain associated w/ Ankylosing Spondylitis releived by rest??
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no
- in fact improved w/ exercise, so patients don't like to sit still |
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What might observe on x-ray of Ankylosing Spondylitis w/ Si joint involvement?
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erosions and irregularities of the SI joint
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Ankylosing Spondylitis is rare b/4 what age, and what is avg age??
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rare before 16-18
avg. 26 yo |
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what is first manifestation in >75% Ankylosing Spondylitis people?
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back pain
-insidious, dull, difficult to localize, and felt in deep gluteal area |
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When are people w/ Ankylosing Spondylitis most stiff?
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Am and after INactivity
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Why might it be difficult to figure out if Ankylosing Spondylitis or something else?
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patient may have constitutional symptoms of anorexia, fever, wt loss, malaise
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Ankylosing Spondylitis typically starts where and goes where?
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starts low back
ascends the spine over years to produce progressive spinal pain and restriction |
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What might observe lower back of standing patient w/ Ankylosing Spondylitis?
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lose lumbar lordosis
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What observe about neck of Ankylosing Spondylitis?
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loss of neck ROM w/ forward stoop of neck (increased occiput to wall dist.)
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What might notice about thoracic involvement w/ Ankylosing Spondylitis?
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Limited respiratory excursion
thoracic kyphosis |
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What extra-articular features may be invovled w/ Ankylosing Spondylitis?
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eye (dryness, conjunctivitis, acute anterior uveitis (iritis)
Neurological (complications of spinal fracture) Cardiac conduction defects Aortitis and dilation of aortic valve |
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Aortitis and dilation of aortic valve are common in who?
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any patient who is HLA-B27+, whether or not have Ankylosing Spondylitis
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What might observe spinal x-ray of Ankylosing Spondylitis?
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Bamboo spine
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What is the most sensitive way to detect early Ankylosing Spondylitis dz?
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MRI of the SI joints b/c plain films can be negative early in the illness
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Ankylosing Spondylitis, as progresses, what will plain films show?
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sacroiliitis and then
ankylosis |
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What are 2 markers that can help track dz progression of inflammatory dzs?
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C-reactive protein (CRP))
ESR |
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about how much tilt in pelvis might observe to make Ankylosing Spondylitis dx?
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30 degree (this is probably more than we need to know)
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Ankylosing Spondylitis, although spinal inflammation tends to be unremittive, what might help affect dz course?
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use of anti-TNF medications
-thus, blood testing to test for HLA-B27 good idea to identify people at risk |
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W/ cercial spinal involvement, what is abnormal on physical exam of Ankylosing Spondylitis?
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loss of ROM, stoop forward neck
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typical age of onset of Ankylosing Spondylitis?
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late adolescent to early adult
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What are 2 things patient may complain of when visit office for Ankylosing Spondylitis?
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lower back pain
early morning stiffness loss range of motion |
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blood test that might be sent in workup of Ankylosing Spondylitis?
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HLA-B27
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Ankylosing Spondylitis tx?
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anti-TNF alpha
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inflammatory arthritis which has its onset shortly after an infection of the
genitourinary gastrointestinal tract HIV |
Reactive arthritis
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Reactive arthritis, genitourinary infection?
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Chlamydia
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Reactive arthritis, gastrointestinal problem?
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infectious diarrhea
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What is frequent in Reactive arthritis?
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Extra-articular manifestions
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What is Reiter's syndrome (reactive arthritis used to be called reiter's syndrome)
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conjunctivis (can't see)
urethritis (can't pee) arthritis (can't climb a tree) (knee and ankle) |
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HLA type Reactive Arthritis?
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HLA-B27
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typical hx of Reactive Arthritis?
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Venereal infection (chlamydia)
or Infectious diarhea (Salmonella, shigella, campylobacter, Yersinina) and 2-4 weeks later inflammatory arthritis |
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Reactive Arthritis symmetrical or assymetrical inflammatory joints?
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Assymmetric
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What joints does Reactive Arthritis usually involve?
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LE joints > UE joints
-caucasions>AA -Men>women |
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Why might patient hx be difficult ot figure out full Reactive Arthritis symptoms?
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may not mention things like conjunctivits b/c may be mild and transient
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What symptoms last to appear w/ Reactive Arthritis?
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Joints
-many times the urethral and ocular inflammation resolved by this point |
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Describe arthritis of Reactive Arthritis?
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-Additive
-Assymetric -Oligoartcular (5 or less joints) |
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What joints usually affected by Reactive Arthritis?
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LE joints
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What observe abouts joints Reactive Arthritis?
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Dactylitis (sausage digit)
Enthesitis (inflammation at bony dites where tendons, ligaments or fascia attach) (esp achilles, ischial tuberosities -50% SI joint involvement |
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What is Keratoderma Blennorrhagicum (associated w/ Reactive Arthritis?)
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papulosquamous skin rash on the soles or palms, become hyperkerototic and scaly like psoriasis (form of pustular psoriasis)
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What might observe w/ nails of Reactive Arthritis?
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Oncholysis (also observed with Psoriatric arthritis)
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What are lesions of flans or shaft of the penis, moist shallow ulcer or dru plaque-like lesion that looks like psoriasis?
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Cicinate balanitis associated w/ Reactive Arthritis
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What are 2 dzs that may present w/ palatal ulcers
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Reactive Arthritis
Lupus |
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Does Reactive Arthritis plague a person for entire life?
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NO
-75% complete remission after 2 years -most arthritis is self limiting and last less than 6 mos -some dz will go into remission but recur intermittently |
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Worst case scenario Reactive Arthritis?
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few patients have severe inflammatory dz many years and may develop features of destructive arthritis or ankylosing spondylitis
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Risk factors poor prognosis Reactive Arthritis?
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HLA-B27 mainly
also male or have extraarticular lesions |
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What are the two main IBD bad guys associated w/ arthropathies?
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Crohn's
Ulcerative colitis |
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about how many people get IBD seronegative arthropathies
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peripheral arthritis occurs 15-20%
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What types of joints involved w/ IBD seronegative arthropathies
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-large, lower extremity joints involved
-Assymetric districution -Joint activity correlates w/ activity of bowel dz |
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are most seronegative arthropathies symmetric or assymetric
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assymetric
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IBD seronegative arthropathies, how can improve probs?
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tx bowel dz usually makes peripheral arthritis improve
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Can spondylitis occur w/ IBD seronegative arthropathies?
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yes
-may mimic AS -usually occurs w/ B27+ patients and does not correlate w/ the bowel dz |
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3 presentations reiter's?
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can't pee
can't see can't climb a tree |
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2 infections precede reiter's?
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chlamydia
infectous diarrhea HIV also mentioned |
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2 joints typical for reactive arthritis?
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knees, ankles, SI joint
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In IBD seronegative arthropathie, what is arthritic, peripheral or axial?
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Peripheral
**this is not immune arthritis |
