Rheum E1 -Seronegative

What is the most common spondyloarthropathy?

Ankylosing spondylitis

When does the onset of ankylosing spondylitis usually occur?

Late teens to 20s

What is the most common spondyloarthropathy?

Ankylosing spondylitis

When does the onset of ankylosing spondylitis usually occur?

Late teens to 20s

What is the hallmark of ankylosing spondylitis?

Sacroilitis

What is common in ankylosing spondylitis?

Enthesopathy

How does Ankylosing spondylitis present?

back pain characteristically worse in AM and better with exercise

What are extra-articular symptoms of Ankylosing spondylitis?

Uveitis, skin rash (psoriatic & Reiter's), IBD, aortitis, apical pulmonary scarring

What is the target antigenic site of ankylosing spondylitis?

Enthesis

What antigen marker is present in Ankylosing spondylitis?

HLA-B27

True or False: You should rely on a positive HLA-B27 for diagnosis of Ankylosing spondylitis

False

Ankylosing spondylitis is mainly based on classic lower back pain symptoms for > ____ months

3

What lab values will be elevated in Ankylosing spondylitis?

ESR or CRP

iPAIN criteria for Ankylosing spondylitis:

Insidious onset

Pain at night or early AM

Age at onset < 45 y/o

Improvement with exercise

No improvement with rest

What is the new dx criteria for AS and is designed to catch the disease earlier?

iPAIN

What are the 2 stage of AS affecting the axial skeleton?

non-radiographic & radiographic

How does AS affect the axial skeleton?

mainly at SI joint w/ upward migration (LS>thoracic>cervical)

How does AS affect the peripheral skeleton?

asymmetric, oligoarticular pattern of extremeties or enthesopathy

What would you seen on a spinal XR of late Ankylosing spondylitis?

Bamboo spine -ascending spinal fusion

What would you see on an oblique XR of AS?

sclerosis of SI joints, syndesmophytes, spinal fusion (bamboo spine)

What does Ankylosing spondylitis do to the hips?

Sacroilitis

What are syndesmophytes?

bony overgrowths w/in ant. intervertebral ligaments

What is the 1st line tx for early/mild Ankylosing spondylitis?

NSAIDs (Indocin), low dose steroids, sulfasalazine, MTX

True or False: MTX is NOT effective in the axial region

True

What is a SE of sulfasalazine?

Reversible azoospermia

What NSAID is best for Ankylosing spondylitis?

Indocin

What is the tx for moderate-severe Ankylosing spondylitis?

TNF-alpha inhibitors

What is the first line and best treatment for axial Ankylosing spondylitis?

TNF-alpha inhibitors

Does psoriasis or arthritis come first in 85% of psoriatic arthritis cases?

Psoriasis

Psoriatic arthritis generally presents w/ what symptoms?

(1 or more)

generalized fatigue, tenderness/pain/edema over tendons, swollen fingers/toes, stiffness, throbbing joints, dec ROM, nail changes, conjunctivitis

What is Dactylitis?

Sausage digits -seen is Psoriatic arthritis

What nail changes are seen in psoriatic arthritis?

Pitting & ridging

Patients can present with psoriatic arthritis (before/after) HIV is diagnosed

Before -HIV worsens

What is Arthritis mutilans?

erosive and destructive psoriatic arthritis at the hands and feet

What are characteristics of RA-like polyarthritis?

no RF nor nodules

What would Psoriatic arthritis in the hands look like?

"Pencil in cup" deformity

What can occur at the distal phalanx causing a "pencil in cup" deformity seen on hand XRs of patients with psoriatic arthritis?

Bone erosions & Periostitis

What test should you ALWAYS order in males with new onset psoriatic arthritis?

HIV test

True or False: Oral steroids should NOT be used for treatment of psoriatic arthritis

True

What meds are becoming the 1st line tx for psoriatic arthritis?

Biologics: TNF-alpha inhibitors, IL-17A, and IL-12/23

What meds are used to tx Psoriatic Arthritis?

NSAIDs, CMARDs (classic MTX)

What med should be avoided when tx axial disease?

csDMARDs (MTX)

What med should be avoided when tx a pt w/ IBD?

IL-17 inhibitors

What did Reactive arthritis used to be called?

Reiter's syndrome

What is Reactive arthritis?

autoimmune condition that develops in response to a GI or GU infection

What GU infection can especially lead to reactive arthritis?

Chlamydia trachomatis

What is the triad of Reactive arthritis?

Conjunctivitis, Urethritis, Oligoarthritis

What lesions of the skin are associated with reactive arthritis?

Keratoderma blenorrhagicum

Reactive arthritis has a STRONG association w/ what disease?

HIV

What lesions of the mucous membrane involvement of Reactive arthritis?

Balantitis

What should you always check for in a MSM with reactive arthritis?

HIV

What is the tx for Reactive arthritis?

Tx underlying infection, NSAIDs, corticosteroids (prednisone), PT, immunosuppressive therapy

How does arthritis d/t Parvo present?

rash, small polyarticular joint swelling, symmetrical, pain; self-limiting (2-4 weeks)

How is a diagnosis of Parvovirus B19 infection made?

(+) IgM parvovirus titers

What is bowel related arthritis?

Enteropathic arthritis

What is Enteropathic arthritis caused by?

IBD, bacteria, parasites, other: bypass, celiac, whipple

What do enteropathic arthropathies have a strong genetic association with?

HLA-B27

What meds can be used in treatment of enteropathic arthropathies?

Biologics: TNF-alpha inhibitors & IL-23

*peripheral sx: administer corticosteroids

What is the tx of Enteropathic arthropathies?

Tx IBD

You should check a pts HIV status before initiating which drugs for Enteropathic arthropathies?

MTX and azathrioprine

What is the MC chronic inflammatory disease of the axial skeleton?

Ankylosing spondylitis

What part of the spine is MC affected in ankylosing spondylitis?

Lumbar

What is the non-pharmacologic treatment for AS?

PT/ROM exercise, Fx prevention

What is the most widely used treatment for enteropathic arthropathy?

Sulfasalazine

You need to be cautious administering what meds to patients with IBD related Enteropathic arthropathies, as this could exacerbate GI symptoms?

NSAIDs