Seronegative Spondyloarthropathies: AS and EA Flashcards Preview

Tri 5 - Arthridities > Seronegative Spondyloarthropathies: AS and EA > Flashcards

Flashcards in Seronegative Spondyloarthropathies: AS and EA Deck (37)
1

All seronegative spondyloarthropathies will present with what?

Negative RF
Sacroiliitis
HLA-B-27
Uvetis

2

T/F: AS and EA are virtually identical radiographically

True

3

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

4

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)
Peripheral enthesitis

5

What is the age of onset?

< 40 y/o

6

What are the extra-articular manifestations of AS?

Anterior Uveitis
Pulmonary Fibrosis (upper lobes)
Aortitis

7

What is a key radiographic feature of AS that can be seen in an AP pelvis x-ray?

Symmetrical sacroiliitis

8

What are 3 other things aside from symmetrical sacroiliitis that one would see on an x-ray?

1. Pseudo-widening
2. Subchondral sclerosis of iliac side
3. Leads to ankylosis (ghost joints, star sign)

9

What are the "root joints" dr. korvatko likes for AS?

Hip and shoulder

10

What is the key pathophysiological process for AS?

CD4 and CD8 T-cell activation --> inflammatory cytokines --> Enthesitis --> initial osseous erosion --> Fibrosis and ossification

11

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

12

What are the two major signs we talked about in class that have to do with AS.

Romanus lesion and shiny corner

13

Defined as Osteitis and enthesitis @ annular fiber attachments

Romanus lesion

14

Reactive zone of sclerosis

Shiny corner

15

What is an important thing in AS that radiographically sets it apart from other types of bone diseases?

Marginal syndesmophytes

16

If looking at an AP spine x-ray of AS, what will one see when looking at the vertebral column?

Bamboo spine

17

What is Bamboo sign commonly accompanied by in relation to the SP?

Dagger sign

18

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

19

In AS, a sign called trolley track sign is present, what is this a representation of structurally?

Ossification of posterior ligaments and facet capsules

20

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

21

Where would instability develop in a patient with AS in the cervical region?

C1-C2
Note: MANIP IS STRONGLY CONTRAINDICATED

22

What test is performed to evaluate loss of flexion in the lumbar spine?

Schober test (norm is an increase of 5cm)

23

There is a certain discovertebral abnormality in AS known as _____ that may progress to re-fracturing phenomenon through end-plate.

Anderson lesion

24

What are 4 spinal complications for AS?

Ankylosis
Fractures
Canal Stenosis
Dural ectasia (widening of dura)

25

There is a certain type of fracture that can occur with AS, it has been mentioned before in the DJD lecture as well...

Chalk-stick fracture

26

What is the treatment for AS?

NSAID, sulfasalazine
TNF-a antagonists have been used
Exercise and physiotherapy to maintain mobility and prevent ankylosis progression

27

What are some etiologies for enteropathic arthritis?

IBD
Ulcerative colitis
Crohn's disease
Post shigella, salmonella, yersenia arthritis
WHipple's disease
GI by-pass

28

T/F: EnA is radiographically very different from AS

FALSE EnA is radiographically almost identical to AS

29

Is EnA less severe that AS or vice versa?

Less severe

30

T/F: The Sacroiliitis that is present in EnA is different than that of AS

FALSE the sacroiliitis is identical to AS

31

What is another feature of EnA?

Hypertrophic osteoarthropathy (HOA)

32

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
Uveitis

33

If there was a periosteal reaction from EnA along the shaft and metastasis of the femur, what would the Dx be?

Hypertrophic osteoarthropathy
(Slide: 54 for picture, got a feeling on this one, in the nugs)

34

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)

35

What markers would be elevated in EnA?

HLA-B-27, ESR, CRP

36

What would CMP and CBC be helpful for in Dx?

anemia of chronic disease
IDA - malabsorption of iron
B12 deficiency

37

What would be treatment for this disease?

Treat the primary disease (Crohns, IBD, etc)
Immune modulatory drugs (TNF-a inhibitors)