Sammy MT2 Reveiw

Psoriasis comes from

T cells attacking skin cells —> hypertrophy of skin

Psoriasis is often seen with silver ___ and pitted ___

Silver scales and pitted nails

Rash for psoriasis is worst at ___ surfaces

Extensor

What % of psoriasis pts will get arthritis

42

Percent up to ___% with prominent nail changes

80

Psoriasis is believed to be a ____ condition

Autoimmune

What age do we see psoriatic arthritis MC in

20-50 years

Psoriatic arthritis love the ____, ____, and ____

Hands, spine and feet

Where specifically does psoriatic target in the hands and feet

PIPs and DIPs, sometimes MCPs (MTPs)

Whole finger swollen digits is known as

Sausage digit (DIP and PIP)

Focal swollen finger is known as

Spindle digit (DIP or PIP)

ESR is elevated for psoriatic arthritis T/F

True

Up to ___% of psoriatic arthritis patients are HLA B27 positive

60

Which joint in hand is most commonly affected for psoriatic arthritis

DIPS

We will see a symmetric distribution in the SI joint for psoriatic arthritis T/F

False

Do we see hyperemia for psoriatic arthritis

No

What don't we see on xray if we don't have hyperemia

Juxta articular osteoporosis

7 hallmark radiographic findings for psoriatic arthritis

1. Asymmetrical distribution

2. Prominent ST swelling (sausage and spindle digit)

3. Normal bone mineralization (no osteoporosis)

4. Bony erosions

5. Fluffy periostitis (mouse ears)

6. Narrowed or widened joint space

7. Distal tuft resorption

Distal tuft resorption is also known as

Acroosteolysis

Widened SI joint space comes after narrowed SI joint space T/F

False

Why do we see widened SI joint space first then narrowed

Widened is seen first from erosions, then narrowed from fibrosis

What 2 radiographic findings do we see in the spine for psoriatic arthritis

1. Asymmetric sacroilitis

2. Non-marginal/paravertebral syndesmophytes

*rule out Atlantoaxial intability

What % of psoriatic arthritis pts do we see atlantoaxial instability

45%

What radiographic findings do we see for hands and feet for psoriatic arthritis (4)

1. Mouse ear sign

2. Pencil in cup deformity

3. Ray sign

4. Acro-oseolysis

Mouse ear sign is what

Marginal erosions that trigger a periosteum reaction (Fluffy periostitis)

Can we see lanois' deformity in the feet for psoriatic arthritis, what other arhtopathy has this deformity

Yes, rheumatoid arthritis

Asymmetrical sacroilitis is more prominent on sacrum or ilium

Ilium

Nonmarginal syndesmophyte goes from vertebral ___ to vertebral ___

Body to body

Marginal syndesmophyte goes from vertebral ____ to vertebral ____

Endplate to endplates

What view do we see nonmarginal syndesmophytes on

AP lumbar only

Pencil in cup deformity AKA (2)

Motar and pestle

Mushroom and stem

Pencil in cup deformity definition

Contour change to proximal and distal articular joint margins via marginal erosions

Ray sign def

Fusion/involvement of MCP, PIP and DIP in one digit

What is the end game of psoriatic arthritis

Ankylosis

If left untreated, what can pencil in cup deformity change to

Ray sign (fully ankylosed)

Distal tuft resorption is also known as

Acroosteolysis

After ankylosis, what do we see on xray for psoriatic arthritis (hint: Wolff's law)

Osteoporosis

Reactive arthritis aka

Reiter's syndrome

Classic triad of reactive arthritis and what is the quote that goes with it

- conjunctivitis

- urethritis

- arthritis

(can't see, can't pee, can't dance with me)

Why is it named reactive arthritis

Due to its association with infection

What infections is reactive arthritis associated with (2)

Enteric and sexually transmitted

What is the most common sexually transmitted disease associated with reactive arthritis

Chlamydia

Reactive arthritis most common in what population

Males 18-40 years old (sexually active age)

Common complaint for reactive arthritis (2)

1. Asymmetrical painful joint effusion

2. Heel pain/inflammation

What do we see on xray for reactive arthritis (2)

1. Synovitis followed by fibrous proliferation and periostitis

2. Erosions and periostitis at enthesopathy (enthesitis)

What is the name sign specific to reactive arthritis

Lovers heel

What is lovers heel

Erosions at Achilles insertion

Where do we see enthesophyte formation for reactive arthrtitis

Plantar enthesophyte at calcaneus

Where else in the foot do we see erosions for reactive arthritis

MTP and IP

Spine and SI joint involvement for reactive arthritis (3)

Asymmetrical sacroilitis

Nonmarginal syndesmophytes

Rule out atlanto-axial intability

SLE stands for

Systemic lupus erythematosus

SLE is a _____ disorder

CT

SLE involves multiple organ systems, especially the ___

Kidneys

When we see SLE involve the kidneys, we can assume that it is ___

Progressing (bad)

Lupus is latin for

Wolf

What rash do we see for SLE

Butterfly rash

Butterfly rash describes the...

Malar erythema

What major -itis do we see for SLE

Vasculitis

Lupus demographic

20-40 years old females

What are the common complaints we see for SLE (6)

Malaise, fever, anorexia, weight loss, weight gain, polyarthalgia

Arthritis occurs in up to ___% of patients

90

In SLE, we see joint ____ with ____ joint spaces

Hypermobility, normal

Reversible deformity in SLE is due to

Ligament laxity

Steroid treatments may lead to... (3)

Avascular necrosis, osteonecrosis and osteoporosis

SLE also presents with soft tissue ___

Atrophy

Labs for SLE (3)

Elevated ESR

Anti-nuclear antibody test, anti-dsDNA

Proteinuria with kidney involvement

Positive ANA tests is only seen in lupus T/F

False, just because you have positive ANA test doesn't mean you have lupus

Positive Anti-dsDNA test is only seen in lupus T/F

True

What does it mean to have reversible deformities in SLE

Deformities go away once pressed onto a flat surface

Marked contractures and subluxations in SLE are in a ____ and ____ pattern

Bilateral and symmetric

___ osteophytes also common in SLE

Hooked

Do we see erosions and ST calcifications in SLE?

No

AVN of femoral head is called

Chandler's necrosis

Aka for Scleroderma (2)

Progressive systemic sclerosis

CREST syndrome

Scleroderma def

CT inflammatory disorder (excessive collagen —> rigidity)

What other body systems are involved with scleroderma (6)

Skin

Lungs

GI

Heart

Kidneys

Muscular system

Scleroderma is ___ cause

Unknown

Scleroderma demographic

30-50 years old, females more common

In scleroderma, we see ___ ___ swelling of extremities

Puffy painful

3 stages of progressive skin disorder in scleroderma

1. Edema

2. Induration (sclerosis, hardening)

3. Atrophy (use it or lose it)

CREST stands for

Calcinosis, Raynaud's, esophageal dysmotility, Scleroderma, Telangiectasia

Do you need all 5 CREST letters to diagnose scleroderma

No, only 2-3

Top 3 most important letters in CREST

CRE

Most common letter in CREST

Raynaud's

Most detrimental letter in CREST

Esophageal abnormality

What can esophageal abnormality lead to and why

Barrett's esophagus

-fibrosis leads to shortening —> gastroesophageal sphincter hardens —> acid reflux —> metaplasia —> barret's

What % of scleroderma patients get Barrett's esophagus

40%

Telangiecstasia means

Spider veins

-skin of face, palms, mucous membranes

Raynaud's come from

Systemic nervous system dysfunction

Raynaud's is precipitated by ___ or ____

Cold or emotional upset

Initial ____ is followed by ____ with severe pain and swelling (raynaud's)

vasoconstriction, vasodilation

Radiographic findings for scleroderma (3)

1. ST calcification (subcutaneous)

2. Distal tuft resorption

3. Normal joints, possible marginal erosion formation

ST calcification leads to distal tuft resorption and marginal erosions why?

Tight skin is pulling on the joints —> erosions

Subcutaneous means

Close to surface

Ankylosing spondylitis is part of the sero___ group

Negative

Bilateral sacroiliitis comes from

Synovial proliferation (pannus) —> reactive sclerosis —> joint interval narrowed + marginal erosions

What side of SI joint is affected first (ilium or sacrum)

Ilium due to sacrum having more cartilage (protection)

Aka for AS (2)

Bechterew

Marie Strumpell

AS distinctively involves the ___ skeleton

Axial

Average age of onset for AS is

15-35 years old