Flashcards in Psoriatic and Reactive Arthritis Deck (65)
What is a type of seronegative spondyloarthopathy that presents as a combination of EROSIVE and PRODUCTIVE asymmetric oligoarthritis mainly in the DIPs and PIPs?
PsA (Psoriatic Arthritis)
On avg, what percentage of patients with psoriasis will develop PsA?
T/F After 1960, PsA was thought to be a type of RA
True, before 1960 it was considered a type of RA
T/F Pts in their 60s are the most susceptible to PsA
Note: Female = Male in incidence
How long after the development of psoriasis can it take for a pt to develop PsA?
1 out of __ people with PsA will have arthritis as a condition which will lead to psoriasis
5 distinct subtypes of PsA. What are they?
mnemonic maybe?: Ao, Pd, SSA
Asymmetric Ologoarthritis 55-70%
Polyarthritis in DIPs
Symmetric (resembes RA)
Arthritis mutilans (3-5%)
What is the etiology of PsA?
What lab test marker will be elevated in 60% of patients who have sacroiliitis?
What are some factors that may trigger the onset of PsA or exacerbations of psoriasis?
Recent infection, likely, GABHS organism (Strep A)
Clinically, what would you see in a patient with PsA?
Note: Guttate and Pustular psoriasis may manifest with more severe arthritis
80% of cases of PsA will have what physical condition?
Psoriatic nail disease
What is an important factor of PsA in the distal LE?
Enthesitis at the achilles and plantar fascia insertion
PsA with sacroiliitis and spondyloarthropathy shows greater association with what ocular manifestations?
Uveitis and Keratoconjunctivitis
T/F PsA may present with more severe pain and in more joints than RA?
FALSE, PsA may present with less severe pain and in fewer joints
What is a key Dx finding that may lead you to the dx of PsA?
Morning stiffness and joint tenderness in asymmetrical distribution - esp. DIP and PIP
Note: MCP and wrist not commonly involved
Soft tissue swelling especially in the ____ tendons may be seen
What can be observed involving the entire digit, also known as a 'sausage digit' in PsA.
Pathology of PsA is seen as reactive ____ causing ___ and productive osseous changes...
T/F: Proliferative processes of PsA may lead to periostitis, osseous sclerosis and thickening of tissues especially of the digits...
T/F: Much like RA bone erosions, these begin marginally but are followed by enthesitis with reactive periostitis, whiskering and fuzzy bone formation seen as "mouse ears" in the distal tufts...
What three presentations can periostitis take in PsA?
Thin periosteal layer of new bone
Thick irregular layer
Irregular thickening of cortex itself
Erosions may proress leading to more aggressive artilage and subchondral bone destruction leading to ______ with "________" deformity
arthritis mutilance, "pencil in cup"
T/F: overall mineral bone density is affected like it is in RA
False; overall mineral bone density is NOT affected like it is in RA, aka bone density is maintained in PsA
Severe cases of PsA, one can see a telescope formation of an "_-___"
Spinal involvement with PsA is seen as what?
Bilateral sacroiliitis - asymmetric involvement
What is the presentation in the thoraco-lumbar area of PsA?
Bulky paravertebral ossifications, aka. non-marginal syndesmophytes
T/F: PsA and ReA spinal involvement is not distinctly different from AS
False, PsA and ReA spinal involvement IS distinctly different from AS
At what vertebral level in the cervical spine should PsA and ReA be considered as a possible cause of instability and ligamentous laxity?
Note: not frequent but has been seen
What are the hallmark changes seen in PsA?
Fluffy periostitis combined with severe erosive bone changes - can see an "ivory phalanx" - also pencil in cup deformity is common in the interphalangeal joints
T/F: in PsA sometimes erosions of the entire phalanx can be seen in addition to other patterns of erosive and productive bone changes
Ankylosing spondylitis will present with marginal syndesmophytes in the spine, what does PsA present with?
Non-marginal syndesmophytes, aka. paravertebral ossifications
PsA is a type of arthritis that can lead to complete destruction of joints and adjacent bone which is known as?
Concertina (like an accordion) this describes the telescoping of the digits in what type of arthritis when the patient has arthritis mutilans?
PsA arthritis (concertina deformity is also opera glass deformity)
Treatment for PsA is what 5 things?
MANIPULATION - HIGHLY CONTRAINDICATED!
ReA (Reactive arthritis) is formerly known as what?
ReA can be defined as a triad of what?
Arthritis (affecting heels and knees commonly)
Note: this is present in less that 35% of cases...
How does ReA develop?
autoimmune response to an infections agent
(salmonella, shigella, campylobacter, GU infection - chlamydia)
ReA develops _____ weeks following infectious illness
There is a possible 4th component of development, what is this?
Mucosal and cutaneous features
ReA is 3:1 ___ : ___ and generally develops in 3-5 cases per 100,000 people
Males in their 20-30's
What immune histocompatibility complex is present in over 80% of people with ReA?
What is the classic saying for ReA?
"Can't see, can't pee, can't climb a tree"
Is ReA asymmetrical or symmetrical?
Asymmetrical as distal oligoarthritis
_____ may present with burning, erythema, photophobia and ocular pain with reduced vision?
_______ can be significant as keratoderma blennorhagicum and onychodystrophy, painful pustular eruptions on dorsum of extremities.
Hands - Palms (dorsum)
Feet - Soles (not dorsum but yuri thinks so)
Psoriaiform lesions can be seen along with circinate blanatis... What is this?
Inflammation about the glans of penis
Are there any bacterial species identified in the synovial fluid of ReA patients?
What two markers will be elevated in labs that may help with Dx?
T2 helper cells increased
____ at the tendons and ligaments insertion sometimes identical to ____ can be seen at the plantar fascia and achilles... (25-50%)
What are the most common target sites of ReA
Small foot joints
Note: Hands affected rarely
What are a few of the GENERAL radiographic features seen in ReA?
- Linear fluffy periostitis/enthesitis
- Soft tissue thickening at the insertions of tendons and ligaments
- Pre-achilles or retrocalcaneal bursitis
T/F: Overall bone density is not maintained
False, overall bones density is maintained
What type of osteoporosis can be observed?
Hyperemia-related Juxta-articular osteoporosis
T/F: Spinal changes in ReA are seen in 40-60% early onset and 5-10% chronic cases
False, 5-10% Early, 40-60% Chronic
Is There sacroiliitis noted and if so, is it bilateral or asymmetrical?
Sacroiliitis is noted
There is bilateral sacroiliitis, but it is ASYMMETRICAL
In the T/L spine, what type of syndesmophytes are seen?
Non-marginal aka paravertebral ossifications
What imaging modality can be used for early diagnosis and what does it show?
MRI - T2 specifically & STIR
shows: tenosynovitis, enthesitis, soft tissue inflammation
Are there oral lesions in ReA?
What is the typical treatment for ReA?
Systemic steroid and NSAID
Can one distinguish the difference between ReA and PsA on a radiograph of the T/L region?
No, the non-marginal osteophytes will look the same
Note: to distinguish you must look at specific deformities, joints involved, and initial cause
What are the target sites of ReA?
- MTP's and 1st Ips
What is the prognosis for ReA?
Mostly it is thought to be self-limiting in 3-12 months
Note: cases with high HLA-B-27 tend to recurr in 15-50%, Therapy = inflammation control
What disease is defined as immune mediated triad or oral aphthous ulcers, genial ulcers and uveitis?