Spondyloarthropathies
psoriatic arthritis 5 forms of arthritis (5)
asymmetric oligoarthritis (sausage toes/fingers-dactylitis), symmetric polyarthritis (like RA), articular mutilans (osteolysis), asymmetric spondylitis, DIP predominant disease (psoriatic nail disease)
Spondyloarthropathy articular features are (3)
asymmetric, oligoarticular, axial skeleton
Psoriatic arthritis involves __ and __ joints
axial, peripheral
spondyloarthropathies increase risk of ___ mortality/morbidity
cardiovascular
measure thoracic spine
chest expansion
Reiter syndrome is characterized by triad of:
conjunctivitis, arthritis, urethritis
synovial histology in psoriatic arthritis differs from rheumatoid arthritis by 3 points
more angiogenesis, less lining layer hypertrophy, increased neutrophil infiltration
seronegative refers to
negative RF
ankylosing spondylitis articular characteristics (8)
nocturnal back pain, morning stiffness, accentuated kyphosis, diminished chest expansion, Achilles or patellar tendinitis, anterior uveitis, aortitis, cardiac conduction abnormalities
Acute anterior uveitis can lead to
photophobia
what kinds of arthritis can you get with enteropathic arthritis?
polyarticular, oligoarticular
pencil in cup appearance on X-ray is associated w/
psoriatic arthritis
keratoderma blennorrhagica
psoriatic rash on palms and soles of feet
reactive arthritis is also known as
reiter syndrome
Ankylosing spondyloarthritis involves the ___ joints and ___
sacroiliac, spine
diagnostic feature of ankylosing spondylitis
sacroilitis on x-ray
places to check for psoriasis
scalp, umbilical, natal cleft
enteropathic arthritis are ____ associated w/ flares
sometimes
tx of choice for IBD associated arthritis
sulfasalazine
symmetry of AS sacroilitis
symmetric
exam maneuver to measure kyphosis
tragus to wall measurement
measure SI joint mobility
FABER test (flexion, abduction, external rotation)
Genetic association for seronegative spondyloarthropathies
HLA B27 (strongest w/ ankylosing)
syndesmophytes are characteristic of ___ and lead to development of _____
ankylosing spondylitis, bamboo spine
3 types of spondyloarthropathies
ankylosing spondyloarthritis, reactive arthritis, psoriatic arthritis
Aortitis can lead to
aortic regurgitation
symmetry of PsA sacroilitis
asymmetric
symmetry of reactive arthritis sacroilitis
asymmetric
What are spondyloarthropathies
joint disease of the vertebral column
IBD-associated arthritis is more ___. symptoms include
mild, enthesopathy, uveitis, skin lesions (erythema nodosum, pyoderma gangrenosum)
Reiter syndrome presents as ___ ___ and ___ and occurs in _____ (usually ___) weeks after a __ or ___ infection
joint pain, swelling, young adults, male, GI, Chlamydia trachomatis
reactive arthritis extra articular symptoms
keratoderma blennorrhagica, circinate balanitis, painless palantal ulcers, conjunctivitis, uveitis
Use NSAIDS then which DMARD for tx in psoriatic arthritis
leflunomide
the most common clinical presentation of spondyloarthropathy is __. It is unique in that it ___.
low back pain, improves with activity
Schober's test measures patient's ____
lumbar flexion
AS demographic
16-30, male, Native American
Enthesitis often occurs at
Achilles tendon, plantar foot
enteropathic arthritis is associated with
IBD
first line tx of seronegative SpA
NSAIDs
AS is typically treated by ____
NSAIDs (Etoricoxib is most effective)
tx which exacerbate IBD
NSAIDs, methotrexate
Ankylosing spondyloarthritis results in fusion of the vertebrae, which is called
bamboo spine
what is a syndesmophyte
bony growth originating inside spinal ligament
diffuse swelling of toes
dactylitis (sausage toe)
what exam finding is most specific for a diagnosis of ankylosing spondylitis
decreased lumbar spine flexion
chronic uveitis will lead to
distortion of pupil
arthritis does/does not always precede psoriasis in PsA
does not (we have to look for it!)
poor prognosis factors for AS
early hip involvement, elevated ESR, hypergammaglobulinemia, early limitation of spinal movements
___ is a clinical manifestation commonly present w/ seronegative spondyloarthropathies
enthesitis
Synechiae results when inflamed iris adheres to cornea or lens and can lead to (2)
glaucoma, cataracts
HLA B27 is ___ sensitivity, ___ specificity for AS
high, low
Avoid ___ for tx in psoriatic arthritis
hydroxychloroquine
Enthesitis definition
inflammation of ligament and tendon insertion points