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SMALLER ARTHROPATHIES (REACTIVE ARTHROPATHY (SIGNS (enthesitis - e.g. heel…
SMALLER ARTHROPATHIES
REACTIVE ARTHROPATHY
can't see, can't pee, can't climb a tree
UAU
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SIGNS
enthesitis - e.g. heel pain
skin: erythema nodosum, mouth ulcers
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PSORIATIC ARTHROPATHY
SIGNS
- nail lesions
- asymetric oligoarthritis
- symmetric (difficult to differentiate from RA)
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PA vs RA
- lack of juxta-periarticular OP
- mainly DIP
- spine involvement
- skin/nail changes
- enthesopathy
- ankylosis
- asymmetry
- arthritis mutilans
arthritis mutilans
bone resorption :arrow_right: collapse of soft tissue
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MANAGEMENT
- NSAIDs
- DMARDs (MTX)
- steroid injections
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ANKYLOSING SPONDYLITIS
SIGNS
- bamboo spine :arrow_right: collapse of vertebral end plate :arrow_right: self-limiting
- squaring of the vertebrae
- syndesmophytes - VERTICAL
note: osteophytes are horizontal :!!:
ossification of outer fibres of annulus fibrosus
sacroilitis - pain may radiate down the legs dactylitis
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O/E:
- reduced lateral flexion
- schober's test: reduced forward flexion (distance should increase by more than 5 cm)
- anterior uveitis
- IBD
DIAGNOSIS
- low back pain/ stiffness for > 6 months improving with exercise and relieved by rest
- limitation of lumbar spine movement
- limitation of chest expansion
- grade 2 bilateral sacroilitis or grade 3/4 unilateral
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evidence of poor prognosis
- early hip involvement
- ESR>30
- poor response to NSAIDs
- dactylitis
- onset <16yo
MANAGEMENT
exercise
- NSAIDs and COX2 inhibitors
- DMARDs - if peripheral joint involvement
- anti-TNF in specific cases
ENTERIC ARTHROPATHY
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SIGNS
- knees and ankles
- sacroilitis can be present months before colitis or ileitis
- uveitis
- erythema nodosum, pyoderma gangrenosum
- aphthous stomatits
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