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65 Cards in this Set
- Front
- Back
list the spondyloarthropathies
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ankylosing spondylitis
psoriatic arthritis reactive arthritis enteropathic arthritis undifferentiated spondyloarthropathy |
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what are the common features of spondyloarthropathies?
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spinal and sacroiliac joint inflammation
large joint asymmetrical oligoarthritis RF negative enthesopathy specific extra-articular features family history of psoriasis, IBD or spondyloarthropathy increased prevalence of HLA-B27 |
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what is the prevalence of ank spond?
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0.1%
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which gender is more likely to have ank spond? what is the peak age of onset?
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3M:1F
peak age onset: 20-30 |
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what is the major presentation of ank spond?
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back pain (75%)
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what is the enthesis?
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site where ligaments and tendons join bone
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where in the joint does inflammation occur in ank spond?
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enthesis
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which sites are affected in ank spond?
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fibrocartilaginous sites: SI joint, pubic symph, fibrocartilaginous entheses, manubriosternal junction, intervert disc, specific areas of some tendons, fibrocartilage also in root and wall of aorta
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which cells infiltrate the subchondral bone in ank spond?
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CD8+ T cells and macrophages
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in ank spond, what occurs following infiltration by immune cells?
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destruction of cartilage and subchondral bone->new bone formation->formation of syndesmophytes
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what is a syndesmophyte?
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bony growth attached to a ligament
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where does the pain of ank spond begin?
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thoraco-lumbar junction or SI joints
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t/f... ank spond is not associated with systemic features like fatigue and weight loss
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false
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t/f... ank spond is associated with inactivity stiffness and pain
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true
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when is the inactivity stiffness and pain of ank spond worse?
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night or early morning
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t/f... the loss of lumbar lordosis occurs late in ank spond
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false, this occurs early
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restriction of which movement occurs earliest in ank spond?
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lateral flexion
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what is the most common extraspinal feature of ank spond?
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peripheral arthritis (occurs in 50%)
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which joints are usually involved in the arthritis of ank spond?
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large joints in the lower limbs
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what extraspinal feature of ank spond affects the eyes?
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acute anterior uveitis/acute iritis
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what percentage of those with ank spond have acute anterior uveitis?
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25%
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which sites are affected by enthesitis in ank spond?
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lateral epicondyle
plantar fascia achilles tendon |
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what are the rare extraspinal features associated with ank spond?
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aortitis
upper lobe pulmonary fibrosis cauda equina syndrome |
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how long do radiological changes of ank spond take to develop?
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5-6 years
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in what situation will ESR and CRP be elevated in ank spond?
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when peripheral arthritis present
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what percentage of those with ank spond are positive for HLA-B27?
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90-95%
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what percentage of the caucasian population are positive for HLA-B27?
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10%
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what is the management of ank spond?
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exercise
education NSAIDs (control pain and stiffness) DMARDs in severe disease (sulphasalazine, methatrexate, TNF-alpha inhibitors) |
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what is the mean age of onset of psoriatic arthritis?
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45 years
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what is the peak age of onset of psoriatic arthritis?
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30-55
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t/f... more men than women are affected by psoriatic arthritis
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false, ratio is 1:1
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t/f... more women than men are affected by psoriatic arthritis
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false, ratio is 1:1
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what percentage of those with psoriatic arthritis have skin manifestations before arthritis?
joints before skin? simultaneous onset? |
75%
10% 15% |
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what is the prevalence of psoriatic arthritis?
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2%
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what percentage of those with psoriasis have arthritis?
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20%
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t/f... presence of arthritis is related to the severity of psoriasis
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false
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where does psoriasis usually occur?
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extensor surfaces
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t/f... psoriatic arthritis is associated with nail changes such as pitting and onycholysis
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true
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what are the five patterns of psoriatic arthritis?
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oligoarthritis
DIP joints polyarthritis arthritis mutilans spondylitis |
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what is the commonest pattern of psoriatic arthritis?
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oligoarthritis (70%)
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what percentage of those with psoriatic arthritis have the DIP type?
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10%
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how is the polyarthritis pattern of psoriatic arthritis distinguished from RA?
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asymmetry and involvement of DIPs
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what percentage of those with psoriatic arthritis suffer from arthritis mutilans?
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5%
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what occurs in arthritis mutilans?
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severe joint destruction and osteolysis
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t/f... sacroiliitis and spondylitis can be the only manifestation of psoriatic arthritis
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true (occurs in 5%)
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what is the management of psoriatic oligoarthritis?
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NSAIDs
intra-articular corticosteroids if loss of joint function, DMARDs synovectomy |
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what is the management of psoriatic polyarthritis and arthritis mutilans?
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DMARDs (methotrexate, salazapyrin, TNF-alpha inhibitors)
intra-articular corticosteroids physio and exercise |
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what is the management of psoriatic spondylitis?
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physio and exercise
NSAIDs |
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what is reactive arthritis?
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arthritis that occurs 10-14 days after a genital and enteric infection
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what causes reactive arthritis?
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persistence of bacterial antigen (lipopolysaccharide) in the joint
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which infections are associated with reactive arthritis?
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chlamydia
shigella salmonella yersinia campylobacter C. difficile |
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what is the peak age of onset of reactive arthritis?
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20-40
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what is the male to female ratio of reactive arthritis?
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1:1
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what percentage of those with an enteric or gential infection develop a reactive arthritis?
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1-5%
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how long after an infection does reactive arthritis occur?
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10-14 days
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what is the average number of joints affected in reactive arthritis?
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3
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which joints are most commonly affected in reactive arthritis?
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knee
ankle MTP wrist |
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what percentage of those with reactive arthritis have sacroiliitis?
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9%
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what is the average duration of reactive arthritis?
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5 months
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what percentage of those with reactive arthritis are asymptomatic at 1 year?
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85%
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which infections are associated with recurrent reactive arthritis?
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chlamydia (50%)
campylobacter (33%) salmonella/yersinia (15%) |
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t/f... radiography is a useful investigation for acute reactive arthritis
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false, radiography has limited value at acute stage
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what is Reiter's syndrome?
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more severe form of reactive arthritis consisting of arthritis, conjunctivitis and urethritis
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t/f... those with Reiter's syndrome are more likely to develop a chronic arthritis
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true
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apart from arthritis, conjunctivitis and urethritis, what are the other clinical features of Reiter's syndrome?
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skin lesions (keratoderma blenorrhagicum, circinate balanitis)
eye involvement (conjunctivitis and anterior uveitis) carditis (conduction defects) nephritis (mild proteinuria, macroscopic haematuria) |