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