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19 Cards in this Set
- Front
- Back
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List three Spondyloarthropathies (SpA)
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1. Ankylosing Spondylitis (AS)
2. Reactive Arthritis (ReA) = Reiter's 3. Psoriatic Arthritis |
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Pathogenesis of Spondyloarthropathy.
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Inflammation caused by Th1 autoimmune response to bacteria
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Ankylosing Spondylitis definition.
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Chronic inflammation of the sacroiliac joint and spine.
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Ankylosing Spondylitis epidemiology:
- age - gender - ethnicity |
Young (avg: 26 y.o.)
Males Caucasian / Native American |
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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. |
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Radiographic characteristics of SpA (AS in particular). x5
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Bamboo spine
Enthesitis Spinal fusion Sacroiliitis Syndesmophytes |
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Describe the 3 types of inflammations associated with Aknylosing Spondylitis
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1. Spondylitis
2. Enthesitis 3. Synovitis |
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Describe the manifestations of spondylitis in AS. x3
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Worse in AM with inactivity
Improved with activity Costovertebral joint involvement manifested by decreased chest expansion. |
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Describe the manifestations of synovitis in AS. x3
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Asymmetric
Oligoarticular Episodic |
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List the systemic / extra-articular symptoms associated with AS. x4
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CV - Aortic regurgitation
Pulmonary - Fibrosis in upper lobe Eyes - acute anterior uveitis Neurologic - spinal fx |
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Physical exam for AS would reveal what? x4
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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. |
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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. |
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Occiput to wall distance test will test what?
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Kyphosis
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What is the famous triad for Reactive Arthritis (aka - Reiter syndrome)?
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Conjunctivitis
Arthritis Non-gonococcal Urethritis |
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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 |
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What inflammatory symptoms of SpA are common x2 and uncommon x2 in ReA?
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COMMON:
Peripheral arthritis in LE Enthesitis UNCOMMON: Sacroiliitis Spondylitis |
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What are the mucocutaneous manifestations of Reiter syndrome (aka - ReA)? x4
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Conjunctivitis
Oral ulcers (painless) Circinate balanitis Ketoderma blennorhagica |
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In Psoriatic Arthritis (PsA), what is the main joint involved?
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DIP
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What are the distinctive features of Psoriatic Arthritis? x4
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Cutaneous psoriasis
(silver, scaly plaques on skin) Ocular manifestations (conjunctivitis or iritis) Nail involvement (nail pitting, dystrophy) Sausage digits |
