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19 Cards in this Set

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List three Spondyloarthropathies (SpA)
1. Ankylosing Spondylitis (AS)
2. Reactive Arthritis (ReA) = Reiter's
3. Psoriatic Arthritis
Pathogenesis of Spondyloarthropathy.
Inflammation caused by Th1 autoimmune response to bacteria
Ankylosing Spondylitis definition.
Chronic inflammation of the sacroiliac joint and spine.
Ankylosing Spondylitis epidemiology:

- age
- gender
- ethnicity
Young (avg: 26 y.o.)

Males

Caucasian / Native American
What gene is associated with ankylosing spondylitis?

What is important to remember about this?
HLA-B27

Since lots of US whites have this, it is NEITHER specific nor diagnostic.
Radiographic characteristics of SpA (AS in particular). x5
Bamboo spine

Enthesitis

Spinal fusion

Sacroiliitis

Syndesmophytes
Describe the 3 types of inflammations associated with Aknylosing Spondylitis
1. Spondylitis
2. Enthesitis
3. Synovitis
Describe the manifestations of spondylitis in AS. x3
Worse in AM with inactivity

Improved with activity

Costovertebral joint involvement manifested by decreased chest expansion.
Describe the manifestations of synovitis in AS. x3
Asymmetric

Oligoarticular

Episodic
List the systemic / extra-articular symptoms associated with AS. x4
CV - Aortic regurgitation

Pulmonary - Fibrosis in upper lobe

Eyes - acute anterior uveitis

Neurologic - spinal fx
Physical exam for AS would reveal what? x4
1. Decreased chest expansion (less than 2.5 cm)

2. Occiput-Wall distance showing kyphosis

3. Tenderness over sacroiliac joint

4. Schober's Test showing decreased mobility of spine.
Schober's Test

- tests what?
- done how?
- test interpretation
Spinal motility

Draw two horizontal lines 10 cm apart at posterior superior iliac spine. Patient bends over and distance is remeasured.

Change of less than 3-5 cm is abnormal.
Occiput to wall distance test will test what?
Kyphosis
What is the famous triad for Reactive Arthritis (aka - Reiter syndrome)?
Conjunctivitis

Arthritis

Non-gonococcal Urethritis
Reactive Arthritis typically follows what?

What does this represent?
GI or GU infection
(e.g. - chlamydia)

Represents an autoimmune reaction to bacteria
and
NOT persistent active infection
What inflammatory symptoms of SpA are common x2 and uncommon x2 in ReA?
COMMON:
Peripheral arthritis in LE
Enthesitis

UNCOMMON:
Sacroiliitis
Spondylitis
What are the mucocutaneous manifestations of Reiter syndrome (aka - ReA)? x4
Conjunctivitis
Oral ulcers (painless)
Circinate balanitis
Ketoderma blennorhagica
In Psoriatic Arthritis (PsA), what is the main joint involved?
DIP
What are the distinctive features of Psoriatic Arthritis? x4
Cutaneous psoriasis
(silver, scaly plaques on skin)

Ocular manifestations
(conjunctivitis or iritis)

Nail involvement
(nail pitting, dystrophy)

Sausage digits