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26 Cards in this Set
- Front
- Back
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definition of spondyloarthropaties?
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spine joint disease
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examples of spondyloarthropathies?
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ankylosing spondylitis
psoriatic arthritis reactive arthritis spondylitis of inflammatory bowel disease |
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6 common features of spondyloarthropathies?
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1. asymmetric arthritis of peripheral joints
2. enthesopathy: achilles tendonitis, plantar fascilitis 3. conjunctivitis, iritis, uveitis 4. cardiac conduction defects, AI 5. absence of rheumatoid factor 6. familial clustering |
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what gene is highly associated with spondyloarthropathies?
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HLA
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prototype disease of spondyloarthropathies?
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ankylosing spondylitis (AS)
ankylos = bent or crooked |
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epidemiology
male: female? onset age? prevalence? joint involvement? |
m:f = 3:1
age = 20-40 prevalence 4/1000 axial - apophyseal, sacroiliac, pubic symphysis peripheral - hips, shoulders, knees |
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characteristics of spondylitic back pain?
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age <40
insidious onset duration >3 months morning stiffness improved w/ exercise family Hx |
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physical findings in AS?
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tender spine, SI joints, pubic symphysis, pelvic brim
poor lumbar motion loss of lumbar lodosis decreased chest expansion decreased hip and shoulder motion possibly iritis, aortic insufficiency |
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what is schober test?
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measure of lumbar spine flexibility
10cm skin should spread more than 15 cm |
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what is occiput to wall test?
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measure mobility of the cervical spine
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radiologic findings in AS?
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enthesopathy:
straightening of spine squaring of vertebrae marginal syndesmophytes bamboo spine pelvic whiskering reflecting synovitis: SI irregularity, erosion, sclerosis apophyseal joint sclerosis SI, apophyseal fusion |
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Tx principles for spondyloarthropathies?
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spondylitis:
NSAID (esp indocin) extension exercise no smoking ophtho referral for uveitis TNF blockers peripheral arthritis: NSAID intraarticular steroid physical therpay methotrexate sulfasalazine |
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etanercept in AS: how good?
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very good. also in terms of QOL
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Dx criteria for reactive arthritis?
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a seronegative asymmetric arthropathy plus one or more of:
1. urethritis/cervicitis 2. dysentery 3. inflammatory eye disease 4. mucocutaneous disease (circinate balanitis, oral ulceration, keratoderma blenorrhagica, onycholysis) |
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organisms associated w/ reactive arthritis?
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salmonella
shigella yersinia campylobacter chlamydia klebsiella |
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time course of reactive arthritis?
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infection -> (14day) arthritis, conjunctivitis -> (7day) balanitis -> (7 day) keratodermia
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Tx for reactive arthritis?
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regimen same as AS
doxycycline for documented chlamydia association |
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significance of HIV and reactive arthritis?
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arthritis may be presenting manifestation
reactive arthritis or psoriasis may denote poor prognosis arthritis may respond poorly to NSAIDS methotrexate contraindicated (already immune suppressed) |
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psoriatic arthritis epidemiology
age? m:f? |
age: 20-40
MF = 1:1 occur in 7-10% of psoriasis patients |
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patterns of psoriatic arthritis?
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1. asymmetric arthritis (70%)
2. symmetric polyarthritis: RA like w/o extra articular RA features 3. DIP arthritis w/ nail disease 4. arthritis mutilans |
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relationship between psoriasis and psoriatic arthritis?
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skin lesions usually precede arthritis but also may follow
nails are involved 80% of time with arthritis. 30% without extent of skin disease does not predict extent or severity of arthritis activity of skin and joint disease is usually unrelated |
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Tx of psoriatic arthritis?
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methotrexate and TNF blockers improve arthritis and skin lesion
steroids may cause flare of skin disease antimalarials cause severe rash avoid arthrocentesis through psoriatic plaque |
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what are some diseases related to arthritis?
(enteropathic arthritis) |
classical: crohn's ulcerative colitis
uncommon: intestinal bypass, diverticular disease |
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epidemiology of enteric arthritis?
age MF |
age 25-45
MF 1:1 15-20% of IBD patients |
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clinical manifestation of IBD assoc arthritis?
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oligoarticular
bowel disease usually precedes arthritis but may follow associated conditions: oral ulcers, conjunctivitis, uveitis, erythema nodosum |
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issues in Tx of enteropathic arthritis?
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sulfasalazine , TNF blockers efficacious and may treat both joints and bowel
peripheral arthritis but not spondylitis parallels GI disease avoid misoprostol (synthetic PGE2) use NSAId w/ caution |
