Shared Flashcard Set

Details

SNSA
Dewhan Lecture
19
Anatomy
Professional
01/18/2011

Additional Anatomy Flashcards

 


 

Cards

Term




Spondyloarthropathies(SpA)

Definition

Ankylosing Spondylitis (AS)
Reactive Arthritis (ReA) – Reiter Syndrome
Psoriatic Arthritis/Spondylitis (PsA)
Enteropathic Arthritis (EnA)

Term




SpA – Shared Features

Definition

Inflammation of axial spine (sacroiliitis and spondylitis)
Asymmetric peripheral arthritis
Enthesopathy
Inflammatory eye disease
Mucocutaneous features
Absence of  rheumatoid factor
Familial aggregation – HLA-B27

Term




Ankylosing Spondylitis (AS) –
Definition

Definition

Chronic inflammatory disease of sacroiliac joints and spine  (Spondylitis).
Extraspinal manifestations in some patients.

Term




AS - Epidemiology

Definition

Young adult onset common – Average 26 years old.
Males > Females – 5:1
Caucasian and Native American > African, African-American, Eskimo populations.
Ethnic frequency of AS generally but not exclusively reflects prevalence of HLA-B27.

          - Haida Native Americans – 6%

          - Caucasian (UK and USA) – 0.5-1.0    (B27 9%)

          - African and Eskimo – 0.1%    (B27 2%)

Term

 

 

 

AS- Clinical Features

Definition

SPONDYLITISInflammatory pain and stiffness in buttock (sacroiliitis) and lower back (spondylitis)

  - Worse in morning and with inactivity

  - Improved with activity

  - Calcification of spinal ligaments gradually             ascends spine over years.

  - Costo-vertebral joint involvement manifested by decreased chest expansion.

  - May involve lumbar, thoracic and cervical spine.

ENTHESITISEntheses are attachments of tendons and ligaments to bone

- Spine – pain and “squaring” of vertebrae 

 - Calcaneus – Plantar fascia and Achilles’ tendonattachments causing heel pain and bone spurs

SYNOVITIS – Inflammation of synovial joint lining.

  - Lower extremity most common

  - Inflammatory, oligoarticular, asymmetric.

   - Often episodic rather than persistent like RA.

    - May have joint erosions.

 



Term




AS – Clinical Features  SYSTEMIC / EXTRA-ARTICULAR

Definition

SYSTEMIC / EXTRA-ARTICULAR

EYES Acute anterior uveitis; Conjunctivitis
CARDIOVASCULARAortitis and aortic regurgitation (1%).
PULMONARYFibrosis in upper lobes (1%); Shortness of breath from costovertebral involvement.
NEUROLOGIC – Cord and nerve root lesions after spinal fracture with subluxation.

Term




AS – Physical Examination

Definition

Tenderness over sacroiliac joints
Decreased mobility of spine

          - Schober’s Test

Kyphosis

          -  Increased Occiput-Wall Distance

Decreased chest expansion

          - Less than 2.5 cm is abnormal

Term




AS – Laboratory Tests

Definition

Non-specific indicators of chronic inflammation may be detected:

          - Elevated ESR

          - Elevated C-reactive protein

          - Elevated platelet count

          - Anemia

Rheumatoid factor may be positive in up to 15% of   patients with “seronegative spondyloarthropathy”   (SNSA) but is probably just a coincidence.

Term




AS and HLA-B27

Definition

-HLA-B27 is positive in 95% of white patients with Ankylosing Spondylitis (A-A 50%). 

 

-HLA-B27 Is present in ~9% of the U.S. white   population, and back pain occurs in most   people at some point in their lives. 

 

-Therefore, HLA-B27 neither specific nor diagnostic for either the etiology of back pain or the diagnosis of AS or other SpA.

Term




AS – Radiographic Features

Definition

Radiographic characteristics of SpA   (AS in particular):

         Sacroiliitis

         Syndesmophytes

         Bamboo spine

            Spinal Fusion

         Enthesitis

Term




Reactive Arthritis/Reiter Syndrome (ReA/RS)

Definition

  Triad  of

Arthritis (asymmetric oligoarthritis)

Conjunctivitis

Non-gonococcal Urethritis

Term





ReA - Epidemiology

Definition

Typically follows Gastrointestinal or Genitourinary infection with:

  Campylobacter

  Shigella

  Salmonella 

  Yersinia

  Chlamydia

 

The arthritis represents an autoimmune reaction to the bacteria and does NOT necessarily   represent persistent active infection.

Term

 

 

 

ReA- Spondylitis and Arthritis

Definition

Peripheral arthritis

          - Inflammatory asymmetric oligoarthritis

          - Lower extremity predominance

Enthesitis - Common
Sacroiliitis – less common

          - 20 % by radiographs

          - 50% low back pain

Spondylitis with ankylosis – uncommon

          - 10 to 12 % of patients

Term




Reiter  Syndrome :
Mucocutaneous manifestations

Definition

Conjuctivitis

Keratoderma blennorhagica

Circinate balanitis

Painless oral ulcers

Term




Psoriatic Arthritis (PsA)

Definition

5 Types of Joint Involvement in PsA

Predominant DIP involvement
Arthritis Mutilans
Symmetric polyarthritis similar to RA
Asymmetric oligoarthritis
Spondyloarthropathy – 20 - 40%

Term




PsA – Peripheral Arthritis

Definition

Inflammatory, asymmetric oligoarthritis
Arthritis  occurs in 7-42% of psoriatic patients vs 2-3% of general population
“Sausage swelling” from enthesitis

Term




PsA – Extra-articular Manifestations

Definition

Cutaneous Psoriasis
Nail Involvement

          - 90% of psoriatics with PsA

          - 41% of psoriatics without PsA

Ocular Manifestations

          - Conjunctivitis or iritis in 7 - 33%

Term




Distinctive  Features of  Each  SpA

Definition

AS:   Sacroiliitis,  axial  arthritis,  rarely  peripheral arthritis

 

ReAFollows  infection; Triad of arthritis, urethritis and conjunctivitis  in  classic form Mucocutaneous  lesions prominent

 

PsASilvery  scaly  plaques on skin,  nail  changes

 

EnAInflammatory  Bowel  Disease (IBD) or  similar  history

Term




Treatment  of  SpA

Definition

1.  Continued activity and Physical Therapy with special emphasis on postural training (sleep without a pillow).

2.  Drug therapy - Similar to other non-crystalline inflammatory arthropathies such as rheumatoid arthritis:

  NSAIDs

  TNF inhibitorsadalimumab, etanercept,

                   inflixamab – demonstrated to modify AS disease course.

  Sulfasalazine – main benefit to peripheral arthritis.

  Methotrexate – no conclusive evidence of benefit.

          Leflunomide – no conclusive evidence of benefit.  

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