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9 Cards in this Set
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Spondyloarthropathies
Definition: Includes: (name the 4 diseases) |
1. Definition:
spondylos = spine arthron = joint pathos = disease 2. Includes: ankylosing spondylitis psoriatic arthritis reactive arthritis spondylitis of inflammatory bowel disease |
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Shared Features of Spondyloarthropathies (6)
Symmetry? Junction between tendon/bone? Skin/Eyes? Heart? Rheumatoid factor? Familial? |
1. asymmetric arthritis if peripheral joints involved (knee in one leg, ankle in other)
2. Enthesopathy: Achilles tendonitis, plantar fascilitis 3. Skin and Eye: conjunctivitis, iritis, uveitis 4. Heart: cardiac conduction defects, AI 5. Sero negative = absence of rheumatoid factor 6. familial clustering of disease |
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Which HLA is associated in spondyloarthropathies?
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HLA B27
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Prototype Disease:
Ankylosing Spondylitis 1. Definition: 2. Male:Female? 3. Onset? 4. Prevalence 5. Joint Involvment: a. Axial? b. Peripheral? |
1. Ankylos = bent or crooked; Spondylos = spine
2. Epidemiology: male: female = 3:1 onset age 20-40 prevalence 4/1000 3. Joint involvement Axial: apophyseal, sacroiliac, symphysis pubis Peripheral: hips, knees, shoulders |
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What are the "only 2 diseases in Rheum" that you only see more in men than women?
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Ankylosing Spondylitis
Gout |
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Characteristic Features of Spondylitic Back Pain
Age of onset? Intensity of onset? Duration? Morning/Day/Night predominance? Genetic? |
Age of onset < 40 years
Insidious onset (gradual and persists) Duration > 3 months Associated morning stiffness Improved with exercise Family history |
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Physical Findings in Ankylosing Spondylitis
Tenderness where? How do you test poor lumbar motion? Loss of _______ lordosis _________ chest expansion _________ hip/shoulder motion eye/heart findings? |
Tender spine (particularly in the middle where tendons run), SI joints, symphysis pubis, pelvic brim
Poor lumbar motion (Schober test) Loss of lumbar lordosis Decreased chest expansion Decreased hip and shoulder motion Possibly iritis, aortic insufficiency |
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Radiographic Findings in Ankylosing Spondylitis
1. Reflecting enthesopathy? 2. Reflecting synovitis? |
1. Reflecting enthesopathy:
straightening of spine squaring of vertebrae marginal syndesmophytes bamboo spine pelvic whiskering 2. Reflecting synovitis: SI irregularity, erosions, sclerosis apophyseal joint sclerosis SI, apophyseal fusion |
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Treatment Principles for Spondyloarthropathies
Sponydlitis? Peripheral arthritis: |
1. Spondylitis: NSAID’s (esp. indocin)
- extension exercises - avoidance of smoking - Optho referral for uveitis - TNF blockers 2. Peripheral arthritis: NSAID’s - intraarticular steroids - physical therapy - methotrexate - sulfasalazine |
