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27 Cards in this Set
- Front
- Back
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SPONDYLOARTHROPATHIES
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1. Ankylosing spondylitis*
2. Psoriatic arthritis (spondylitis type) 3. Reactive arthritis* 4. Enteropathic arthritis* |
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Ankylosing spondylitis
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-a chronic,systemic, inflamm disorder involving sarcoiliac joints, the spine and often the hips
-axial joints always involved, but peripheral joints are frequently affected -recurrent back pain and loss of spinal mobility -In severe cases, extensive fusion (ankylosis) of spinal vertebrae can increase the risk of spinal deformity, fracture, and disability4 |
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finger to floor test
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-cannot flex at waist
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epidemiology
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-white pops
-M>F -many are dx late |
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etiology
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-unclear
-multigenic inheritance -HLA-B27 key role and assoc!!! -infective mechanisms -mucosal bowel inflammation in many individuals |
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criteria of dx
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1. low back pain for 3 months improved with exercise not relieved by rest
2. limited lumbar motion in all planes 3. reduced chest expansion 4a. unilateral,grade 3-4 sacrolitis 4b. bilateral, grade 2-4, sacrolitis (on xray) |
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early sx
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-onset: late adolescence or early adulthood
-axial sx often include dull, pain of the lower back and or butt -bone tenderness, may be present -peripheral joints involved -extra-articular manifestations may precede diagnosis of AS |
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progression
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-first 10 yrs predictive of future course
-initially, the SI joints are involved; may progress and involve the entire spine -hips predicts more severe dz |
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complications
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1. loss of spinal mobility
2. restricted expansion of chest 3. progressive, ascending involvement of the spine may lead to complete fusion, or "bamboo spine" and inc risk of spinal fxs -10-30% requiring joint replacement surgery -involvement of peripheral joints -extra-articular disorders |
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extra-articular manifestations
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-acute ant uveitis
-IBD -prostatitis -aortic regurgitation -arrhythmias, conduction disorders, complete heart blocks |
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peripheral arthritis
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-tissue gradually replaced by fibrocartilage that becomes ossified
-in severe cases of the dz, outer annular fibers are replaced by bone and vertebrae become fused, with fusion ascending the spine and forming a long, bony column commonly referred to as "bamboo spine" |
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dx
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-labs no diagnostic
-CRP and ESr may be inc -HLA-B27 + 90% to 95% of caucasians -xray preferred |
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Reactive arthritis (Reiters syndrome)
(ReA) |
triad:
1. arthritis 2. uveitis/conjunctivitis 3. urethritis -arthritis lasting >1mo -assymetric, lower extremity, oligoarticular -knees and ankles (large) -toes and fingers (small) -sausage digits (fusiform swelling) |
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ReA- infectious agents
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-urinary: chlamydia
-shigella, salmonella, campylobacter, yersinia |
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rective arthritis xray findings
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-periosteal rxn and proliferative bone at tendons
-boney erosions with adjacent proliferation of bone, and paravertebral ossification, and bony ankylosis occur -calcaneal spurs with fluffy irregularity common -interphalangeal joint of the great toe strongly suggest the dx of either reactive arthritis or psoriatic arthritis |
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ReA features
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-conjunctivitis, uveitis
-oral ulcers -KERATODERMA BLENORRHAGICUM HANDS AND FEET SCALY RASH |
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ReA tx
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-abx
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Enteropathic arthritis
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-assoc with Crohns, ulcerative colitis
-prevalence is 10-22% of pts with IBD -higher incidence in Crohns than IC -arthritis may precede GI tract sx -can occur in a peripheral axial joint pattern or mixed pattern |
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enteropathic arthritis-axial arthritis
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-indistinguishable from AS
-does not parallel GI disease -Surgery for UC or CD does not affect associated spondylitis |
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enteropathic arthritis- peripheral arthritis
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-Pacuicarticular
-assymetric -may be migratory |
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enteropathic arthritis diagnostic studies
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-anemia
-GI blood loss -inc ESR, CRP -X-rays of the SIJ and spine are similar to AS -HLA-B27 is associated axial but not with peripheral arthritis |
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psoriatic arthritis (PsA)
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-age of onset b/t 30 and 55 yrs
-M=W for psoriatic arthritis -M>F for psoriatic spondylitis |
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PsA clinical spectrum
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1, nail pitting
2. onycholysis 3. dactylitis of the 2nd toe is present 4. DIPJ can be involved 5. Arthritis mutilans-severe destruction of fingers 6. Sacroiliitis with or without spinal involvement |
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PsA hand
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-pencil in cup deformity -> n with arthritis mutilans
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PsA extra articular features
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1. elbows
2. knees 3. behind ear 4. umbilicus 5. gluteal cleft |
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PsA-xray
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-Pencil in cup
-periosteal new bone-fluffy at enthesis |
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spondylitis tx
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1. NSAIDs
2. steroids 3. sulfasalazine 4. methotrexate 5. bio response modifiers |
