Flashcards in Seronegative Spondyloarthropathies: AS and EA Deck (37)
All seronegative spondyloarthropathies will present with what?
T/F: AS and EA are virtually identical radiographically
What are some characteristics of AS (formerly known as: Von Bechterew disease, Marie-Strumpell disease)
- RF neg, ESR, CRP = +
- Affects SI and "root" joints (hips, shoulders)
- 3-9:1 M:F
- HLA-B-27 Ag (>92%)
- 15-40 y/o
What are the clinical signs of AS?
LBP > 3 months
Fatigue > 65%
LBP is worse supine, relieved with activity
Limited chest expansion (1" and less)
What is the age of onset?
< 40 y/o
What are the extra-articular manifestations of AS?
Pulmonary Fibrosis (upper lobes)
What is a key radiographic feature of AS that can be seen in an AP pelvis x-ray?
What are 3 other things aside from symmetrical sacroiliitis that one would see on an x-ray?
2. Subchondral sclerosis of iliac side
3. Leads to ankylosis (ghost joints, star sign)
What are the "root joints" dr. korvatko likes for AS?
Hip and shoulder
What is the key pathophysiological process for AS?
CD4 and CD8 T-cell activation --> inflammatory cytokines --> Enthesitis --> initial osseous erosion --> Fibrosis and ossification
T/F: AS begins with the joints of the chest and progresses inferiorly until it reaches the SI joint.
FALSE: it begins with the SI joint progresses to lumbrosacral region gradually and ascends all the way to the cervical region and then will start to affect the costovertebral joints of the chest
What are the two major signs we talked about in class that have to do with AS.
Romanus lesion and shiny corner
Defined as Osteitis and enthesitis @ annular fiber attachments
Reactive zone of sclerosis
What is an important thing in AS that radiographically sets it apart from other types of bone diseases?
If looking at an AP spine x-ray of AS, what will one see when looking at the vertebral column?
What is Bamboo sign commonly accompanied by in relation to the SP?
What is another sign that can be clearly identified on an x-ray that would help with Dx of AS?
Squaring of the vertebral body
In AS, a sign called trolley track sign is present, what is this a representation of structurally?
Ossification of posterior ligaments and facet capsules
What is the 2nd site to the hip in AS?
Shoulder (GHJ) - erosion and enthesitis at greater humeral tuberosity, insertion of the rotator cuff muscles and shoulder ligaments
Where would instability develop in a patient with AS in the cervical region?
Note: MANIP IS STRONGLY CONTRAINDICATED
What test is performed to evaluate loss of flexion in the lumbar spine?
Schober test (norm is an increase of 5cm)
There is a certain discovertebral abnormality in AS known as _____ that may progress to re-fracturing phenomenon through end-plate.
What are 4 spinal complications for AS?
Dural ectasia (widening of dura)
There is a certain type of fracture that can occur with AS, it has been mentioned before in the DJD lecture as well...
What is the treatment for AS?
TNF-a antagonists have been used
Exercise and physiotherapy to maintain mobility and prevent ankylosis progression
What are some etiologies for enteropathic arthritis?
Post shigella, salmonella, yersenia arthritis
T/F: EnA is radiographically very different from AS
FALSE EnA is radiographically almost identical to AS
Is EnA less severe that AS or vice versa?
T/F: The Sacroiliitis that is present in EnA is different than that of AS
FALSE the sacroiliitis is identical to AS
What is another feature of EnA?
Hypertrophic osteoarthropathy (HOA)
What are the clinical presentations of EnA?
Morning pain and stiffness (especially after periods of inactivity)
Enthesitis in LE (foot, heel)
Skin: myoderma gangrenosum and erythema nodosum
If there was a periosteal reaction from EnA along the shaft and metastasis of the femur, what would the Dx be?
(Slide: 54 for picture, got a feeling on this one, in the nugs)
On a radiograph if you are looking for EnA, what would lead you to this Dx?
SI fusion and ankylosis
Colonic spasm, narrowing and lause of haustra in UC
(Note: got a feeling for this on lab exam, slide 56)
What markers would be elevated in EnA?
HLA-B-27, ESR, CRP
What would CMP and CBC be helpful for in Dx?
anemia of chronic disease
IDA - malabsorption of iron