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Terms in this set (24)
What are the major categories of seronegative arthropathies?
(Mnemonic:PAIR) Ankylosing spongylitis, Reiter's/Reactive Arthritis, Psoriatic Arthritis, Inflammtory Bowel Disease
What is common in the seronegative arthropathies?
Absence of RF, usually involves SI joint, peripheral arthritis, association to HLA-B27, enthesitis/enthesopathy, common extra articular features
Which of the seronegative arthropathies has the strongest association with HLA-B27?
Characteristics of Ankylosing spondylitis
Back pain before the age of 40 and longer than 3 months associated with early morning stiffness and gets better with exercise not relieved by rest
What radiographic changes are seen on Xray in ankylosing spondylitis?
Erosion leading to psuedowidening of the joint spaces, followed by new bone growth that results in joint space widening and fusion (ankylosis), syndesmophytes, bamboo spine
What physical exam test can you do for ankylosing spondylitis?
What other findings are present in akylosing spondylitis?
Peripheral oligoarthritis, enthesitis like in the Achilles tendon, iritis, aortitis and aortic deficiency, pulmonary fibrosis
Treatment for ankylosing spondylitis
Physical therapy stretching and swimming, Immunosuppression with Indomethacin (inhibits prostaglandin synthesis) and Methotrexate (inhibits DHF), and etanercept (soluble TNF alpha receptor) and infliximab (murine/human anti TNF-alpha receptor antibody)
What is reactive arthritis?
Peripheral arthritis of more than one month's duration occuring in association with GI or GU infection
Examples of organisms that can be associated with reactive arthritis?
chlamydia mycoplasma ureaplasma campylobacter jejuni salmonella yersinia enterocolitica shigella
True/False: most patients with Reiter's/Reactive arthritis present with urethritis or cervicitis; spinal pain is a late finding
Other findings in reactive arthritis?
conjunctivits irits keratoderma blenorrhagicum mouth ulcers circinate balantis enthesopathy sacroilitis arthritis
Treatment for Reactive arthritis
NSAIDS and physical therapy
Do antibiotics help prevent and shorten duration of reactive arthritis?
It depends. Yes for reactive arthritis caused by GI bugs but no for reactive arthritis caused by GU bugs
What is typical of psoriatic arthritis?
sausage digits, pencil cup defomity, inflammatory arthritis in the digits at the DIP joints leading to pencil cup deformity,asymptomatic sacroilitis, enthesopathy, asymmetric arthritis, onycholysis, no rheumatoid nodules
What is the treatment for psoriatic arthritis?
TNF inhibitors like infliximab or etanercept, NSAIDS, methotrexate, sulfasalazine, leflunamide
Pathogenesis in Ankylosing Spondylitis?
Enthesitis and secondary fibrosis and new bone formation leading to ankylosis
True/False: early in Ankylosing spondylitis the SI joint may show pseudowidening
Are disc spaces preserved in Ankylosing spondylitis?
Why is there buttock pain in Ankylosing spondylitis?
referred from SI joint inflammation
Rx for early ankylosing spondylitis?
Exercise and NSAIDS
True/False: 90% of persons with Ankylosing Spondylitis have HLA_B27
True/False: 85% of persons with Reactive Arthritis have HLA-B27
True/False: 50% of persons with Psoriastic arthritis and inflammatory bowel disease have HLA-B27