Psoriatic arthritis affects 30% of patients with psoriasis In 60% psoriasis precedes the arthritis In 15% the sx occur simultaneously In 25% the arthritis appears first Typical presentations Often intermittent Sx ‘A 45 y/o female presents to her GP with [slideserve.com]

[…] in 95% of AS patients but only 6% of normal population A seronegative arthritis which usually presents as an inflammatory, peripheral mono- or oligo- arthritis (wrists or knees) Rarely presents with polyarthritis or spinal disease A rare destructive [brainscape.com]

Probable AS is present if 3 clinical criteria are present or if one of the radiologic criteria is present without any signs or symptoms satisfying the clinical criteria. From van der Linden S, et al. [hss.edu]

[…] alternating between right and left gluteal areas - past or present enthesopathy - past or present spontaneous pain or tenderness at site of insertion of Achilles tendon or plantar fascia sacroilitis - bilateral grade 2-4 or unilateral grade 3-4 using [enotes.tripod.com]

• Weight Loss

  Bowel- loose stools, weight loss ie. [medicaleducationleeds.com]

  loss > 4.5 kg (10 pounds), unexplained profound weight loss and even cachexia occurs in some patients 32% fever > 101 degrees F (38.3 degrees C) 12% uveitis 6% aortitis < 1% amyloidosis Physical Exam: HEENT: 40% conjunctivitis (usually mild and transient [enotes.tripod.com]

  Clinical presentation The presentation is non-specific with fever, pain and weight loss. [radiopaedia.org]

  Symptoms: “abdominal, back and/or flank pain, oliguria and uremia, constipation, claudication and edema of lower limbs and testicular disorders” (453); “Constitutional symptoms and signs such as fever, fatigue, weight loss, anorexia and elevation of ESR [healthyresearcherblog.wordpress.com]

• Asymptomatic

  It is concluded that aortic root changes suggestive of inflammation or fibrosis, or both, occur in asymptomatic patients with ankylosing spondylitis and are detectable on two dimensional echocardiography. [ncbi.nlm.nih.gov]

  Asymptomatic sacroiliitis. Among asymptomatic HLA-B27-positive relatives of probands with AS and among random asymptomatic persons who are HLA-B27-positive, 20 % may be found to have radiographic sacroiliitis. [hss.edu]

  The initial infection can often be asymptomatic. Relationship between psoriatic skin disease and arthritis The activity of the two is unrelated and one may flare without the other. Enteropathic arthropathy is more closely related. [brainscape.com]

  occasionally heel pain, red eyes, low grade fever; rarely high fever, weight loss, severe malaise, fatigue History of Present Illness (HPI): typically acute onset 1-4 weeks after venereal infection or gastroenteritis, venereal infection frequently asymptomatic [enotes.tripod.com]

  AS duration was the only feature related to the valvular disease. “ Conduction abnormalities may range from an asymptomatic course, for first grade atrioventricular blocks or presence of an adequate escape rhythm, to complete heart block causing Stokes-Adam [healthyresearcherblog.wordpress.com]

• Constitutional Symptom

  symptoms; aortitis; cardiac conduction abnormalities; and anterior uveitis. [msdmanuals.com]

  Symptoms: “abdominal, back and/or flank pain, oliguria and uremia, constipation, claudication and edema of lower limbs and testicular disorders” (453); “Constitutional symptoms and signs such as fever, fatigue, weight loss, anorexia and elevation of ESR [healthyresearcherblog.wordpress.com]

  symptoms AV block Characteristics of AS back pain Insidious onset before 40yrs for longer than 3months Associated with early morning stiffness and improves with exercise May have nocturnal pain Degenerative versus ankylosing spinal changes Degenerative [brainscape.com]

  Constitutional symptoms  Fatigue  Malaise  Fever  Weight loss  Cardiac conduction defects  Aortic insufficiency  Central or peripheral nervous system lesions  Pleuropulmonary infiltrates. 89. [slideshare.net]

  Non-articular manifestations - Mucocutaneous: Keratoderma blennorhagica, circinate balantitis, stomatitis, and nail changes - Aortitis - Amyloidosis - Uveitis - Constitutional symptoms Term Diagnosis of Reactive Arthritis Definition - Lab findings: Anemia [flashcardmachine.com]

• Congestive Heart Failure

  Aortic valve regurgitation and aortitis occurs in small numbers of patients and occasionally may progress to congestive heart failure. Pulmonary involvement. [hss.edu]

• Pallor

  Ruptured, Ovarian Enlargement, Ovarian Infection, Ovarian Mass, Ovarian Neoplasm, Overdose, Overweight, Oxygen Saturation Abnormal, Oxygen Saturation Decreased, Pacemaker Complication, Pain, Pain Exacerbated, Pain In Extremity, Pain In Jaw, Pain of Skin, Pallor [bonkersinstitute.org]

• Regurgitation

  Inflammatory lesions evolving to fibrosis are primarily localized in the aortic root causing regurgitation, but this process can extend into the left atrium (subaortic bump) involving the mitral valve and the heart conduction system. [moh-it.pure.elsevier.com]

  Dilatation usually does not occur without aortic regurgitation. [ncbi.nlm.nih.gov]

  Aortitis is usually recognized in conjunction with aortic regurgitation, but can be diagnosed in isolation as aortic root thickening and subaortic fibrous ridging. [karger.com]

  Keywords Aortic Valve Ankylose Spondylitis Aortic Regurgitation Heart Block Plantar Fasciitis These keywords were added by machine and not by the authors. [link.springer.com]

• Constipation

  Symptoms: “abdominal, back and/or flank pain, oliguria and uremia, constipation, claudication and edema of lower limbs and testicular disorders” (453); “Constitutional symptoms and signs such as fever, fatigue, weight loss, anorexia and elevation of ESR [healthyresearcherblog.wordpress.com]

  Defect, Congenital Foot Malformation, Congenital Hydrocephalus, Congenital Jaw Malformation, Congenital Nose Malformation, Congenital Ventricular Septal Defect, Conjunctival Haemorrhage, Conjunctival Hyperaemia, Conjunctivitis, Consciousness Fluctuating, Constipation [bonkersinstitute.org]

• Loss of Appetite

  […] of appetite weight loss eye inflammation Signs and diagnostic testing Physical examination and characteristic symptoms are indicative of limited spine motion or chest expansion. [arthritisconsult.com]

• Heart Disease

  AS raises the risk for many types of heart disease, including heart attack, chest pain, valve disease, heart failure, and stroke. You're not powerless if you have AS. Claiming control of your heart disease risk factors can protect you. [everydayhealth.com]

  myocardial, congenital, and thoracic/aortic heart disease. [books.google.it]

  disease was more common in patients with FULL TEXT [annals.org]

• Hypertension

  Geriatric Disorders Chapter 5: Palliative Care & Pain Management Chapter 6: Dermatologic Disorders Chapter 7: Disorders of the Eyes & Lids Chapter 8: Ear, Nose, & Throat Disorders Chapter 9: Pulmonary Disorders Chapter 10: Heart Disease Chapter 11: Systemic Hypertension [accessmedicine.mhmedical.com]

  Hypertensive Cardiomyopathy, Hypertensive Crisis, Hypertensive Heart Disease, Hyperthermia, Hyperthyroidism, Hypertonia, Hypertonic Bladder, Hypertriglyceridaemia, Hypertrophic Cardiomyopathy, Hypertrophy Breast, Hyperventilation, Hypervigilance, Hypoacusis [bonkersinstitute.org]

  Ocular Hypertension.- Pigment Dispersion Syndrome.- Eale's Disease.- Stromal Dystrophy.- Fuchs' Endothelial Dystrophy.- Keratoconus.- Cogan's Syndrome.- Scleritis.- Toxoplasmic Retinochorioditis.- Retinitis Centralis Serosa (Central Serous Retinopathy [booktopia.com.au]

  Aortitis can result in aortic insufficiency, or the inability of the aorta to carry sufficient amounts of blood to the body, and hypertension (high blood pressure). [spondylitis.org]

• Vascular Disease

  Another study, published in the Annals of Internal Medicine in September 2015, found that people with AS are more likely to die from vascular diseases than are people who don't have this form of arthritis. [everydayhealth.com]

  Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren’s syndrome and relapsing polychondritis. [whatdotheyknow.com]

• Heart Murmur

  IBD Urethral dc, sexual hx CP, SOB, dry cough, palps, ankle swelling PMH (psoriasis, IBD, heart murmur, lung fibrosis, kidney problems), Fx (psoriasis, IBD, joints/back problems), Dx (including treatments tried), Sx IMPACT on life/work EXAMINE (3 mins [medicaleducationleeds.com]

• Diastolic Murmur

  In fact, a diastolic murmur can be audible for several years before dyspnea develops.” (p. 452) “Transesophageal echocardiography is a better imaging technique to visualize the internal structures of the heart.” [healthyresearcherblog.wordpress.com]

• Skin Disease

  Relationship between psoriatic skin disease and arthritis The activity of the two is unrelated and one may flare without the other. Enteropathic arthropathy is more closely related. [brainscape.com]

  Anti-TNFs are genetically engineered to suppress inflammation-causing proteins called tumor necrosis factor-alpha, and are used to treat ankylosing spondylitis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. [everydayhealth.com]

  Occasionally psoriatic arthritis may occur in the absence of skin disease, or there may only be an insignificant rash which may not be noticed. [patient.info]

  disease predates in 60% but arthritis predates skin disease in 20% - HLA-Cw6 is associated with skin disease with NO arthritis or nail disease - Transient and migrating swelling and redness Term Definition - Determine patterns of peripheral arthritis [flashcardmachine.com]

• Skin Rash

  Juvenile onset On examination Psoriatic nail changes Dactylitis(sausage shaped digits) are characteristic of psoriatic arthritis Psoriatic skin rash- remember to check the scalp Differential Diagnosis Rheumatoid arthritis (RA). [slideserve.com]

  Rash 23% keratoderma blennorrhagica papulosquamous rash most commonly on soles or palms; also occurs on toes, scrotum, penis, trunk, scalp; can occur anywhere starts as waxy papules that resemble mollusk shells or pustules lesions then coalesce and [enotes.tripod.com]

  Rubella: Arthritis in 30% --> Maculopapular rash on trunk - Joint symptoms can preceed the rash and mimic RA - 15% of patients develop arthritis 2 weeks after vaccination 5. [flashcardmachine.com]

• Skin Plaque

  The association with nail dystrophy is stronger than with skin plaques. 38 39 Asymmetrical inflammatory oligoarthritis (40%). [slideplayer.com]

• Morning Stiffness

  stiffness, Fatigue (lack of sleep due to pain at night) Ankylosis --> Increasing stiffness and reduced ROM and increasingly abnormal posture How to quantify spinal involvement in AS Measure the occiput to wall distance (increases as posture changes) [brainscape.com]

  Morning stiffness is characteristic. Inflammatory back pain : Often improves with moderate physical activity. Unlike mechanical back pain, patients often experience stiffness and pain which awaken them in the early morning hours. [patient.info]

  Morning stiffness and pain Pauciarticular (60%) JIA refers to cases where ≤4 joints are affected. [slideserve.com]

  Low back pain for 3 months improved with exercise not relieved by rest with morning stiffness 3. Reduced chest expansion 4. Definite radiological sacroilitis Criteria 4 plus any of 1, 2, or 3. 42. [slideshare.net]

• Fracture

  fractures is difficult due to osteopenia and deformity, and it is important to specifically search for disc space widening and discontinuity of the ossified paraspinal ligaments also known as " chalk stick " or "carrot stick fractures" 19 Andersson lesion [radiopaedia.org]

  Body Trauma, Formication, Fracture, Fracture Nonunion, Fractured Sacrum, Fragile X Syndrome, Frequent Bowel Movements, Frustration, Full Blood Count Decreased, Fungal Infection, Fungal Rash, Fungal Sepsis, Fungal Skin Infection, Fungus Sputum Test Positive [bonkersinstitute.org]

  Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

  […] lobe pulmonary fibrosis (1%) with upward retraction of hila Resembles tuberculosis Cardiovascular Aortitis (5%) of ascending aorta ± aortic valve insufficiency Prognosis: 20% progress to significant disability Occasionally death from cervical spine fracture [learningradiology.com]

  Patients that develop an increase in the amount of motion in the neck or back should be treated cautiously and should be considered to have developed a spinal fracture. X-rays are often obtained to determine if a fracture has occurred. [emedicinehealth.com]

• Osteoporosis

  Osteoporosis : bisphosphonates are often used to treat osteoporosis and reduce the risk of fracture in AS [ 17 ]. [patient.info]

  Anti-resorptive agents, such as alendronate or risedronate, in doses used for primary osteoporosis, may be indicated if osteoporosis is present or if fracture risk is high. Surgery. [hss.edu]

  Long-term hazards include osteoporosis, compression of the spine, gastrointestinal hemorrhage, and reduction in immune response to infection, especially tuberculosis. [emedicine.medscape.com]

  Peripheral joint involvement Hip is most frequently involved Concentric joint narrowing Few erosions Protrusio acetabuli Temporomandibular joint Joint space narrowing Erosions Osteophytosis Hand (30%) Target area MCP, PIP, DIP Exuberant osseous proliferation Osteoporosis [learningradiology.com]

  Osteoporosis in early ankylosing spondylitis: a primary pathological event?. Lancet, 2 (1989), pp. 1483-1485 [53.] S.H. Ralston, G.D. Urquhart, M. Brzeski, R.D. Sturrock. [reumatologiaclinica.org]

• Seizure

  Aseptic Necrosis Bone, Asocial Behaviour, Aspartate Aminotransferase Abnormal, Aspartate Aminotransferase Increased, Asphyxia, Aspiration, Asterixis, Asthenia, Asthenopia, Asthma, Asthmatic Crisis, Astigmatism, Ataxia, Atelectasis, Atherosclerosis, Atonic Seizures [bonkersinstitute.org]

• Uremia

  Symptoms: “abdominal, back and/or flank pain, oliguria and uremia, constipation, claudication and edema of lower limbs and testicular disorders” (453); “Constitutional symptoms and signs such as fever, fatigue, weight loss, anorexia and elevation of ESR [healthyresearcherblog.wordpress.com]

  Uremia.- Essential Mixed Cryoglobulinemia.- Benign Hematuria.- Chronic Prostatitis.- Pustular Bacterid of Andrews.- 15 Cardiovascular Diseases.- Rheumatic Fever.- Rheumatic Heart Disease.- Rheumatic Fever and Rheumatic Heart Disease.- Ischemic Heart [booktopia.com.au]

• Oliguria

  Symptoms: “abdominal, back and/or flank pain, oliguria and uremia, constipation, claudication and edema of lower limbs and testicular disorders” (453); “Constitutional symptoms and signs such as fever, fatigue, weight loss, anorexia and elevation of ESR [healthyresearcherblog.wordpress.com]

  Oedema, Oedema Mouth, Oedema Peripheral, Oesophageal Achalasia, Oesophageal Atresia, Oesophageal Carcinoma, Oesophageal Disorder, Oesophageal Perforation, Oesophageal Spasm, Oesophageal Ulcer, Oesophageal Ulcer Haemorrhage, Off Label Use, Oligodipsia, Oliguria [bonkersinstitute.org]

The above X-ray shows the characteristic appearance of the “bamboo spine” that is observed in ankylosing spondylitis ( source ) CLINICAL WORKUP: OTHER HLA Typing: Most all patients who have this condition are HLA-B27 positive. [stepwards.com]

• X-Ray Abnormal

  After a three-month course of exercise and at least two anti-inflammatory medications, one needs to demonstrate symptoms of active disease, decreased spinal mobility, x-ray abnormalities at the sacroiliac joints and an elevated ESR and/or CRP. [austin.org.au]

  […] bones of feet, occasionally "pencil-in-cup" deformities of small joints in feet or hands 16% x-ray changes at calcaneus (calcaneal spurs or bony erosions due to enthesopathy) 17% sacroiliitis on x-ray (unilateral early) 7% spondylitis (spinal arthritis [enotes.tripod.com]

  Skin Reaction, Skin Test Positive, Skin Tightness, Skin Ulcer, Skin Warm, Skull Fracture, Skull Fractured Base, Skull Malformation, Skull X-Ray Abnormal, Sleep Apnoea Syndrome, Sleep Attacks, Sleep Disorder, Sleep Disorder Due To General Medical Condition [bonkersinstitute.org]

• Cytopenia

  80%) --> Non-erosive, 2+ peripheral joints - Serositis --> Pleural or cardiac (44%) - Renal disorder --> Proteinuria or cellular casts - Neurological disorder --> Convulsions or psychosis without other cause - Hematological disorder --> Haemolysis and cytopenia [flashcardmachine.com]

Its treatment employs endoscopic and/or surgical procedures and administration of corticosteroids, even in association with immunosuppressive agents. [moh-it.pure.elsevier.com]

Leflunomide is recommended for the treatment of active peripheral psoriatic arthritis. [ 9 ] Sulfasalazine may be considered as an alternative in the treatment of peripheral psoriatic arthritis. [ 9 ] Methotrexate may be considered in the treatment of [patient.info]

Is there effective treatment for AS? The most important treatments for AS are daily exercise and anti-inflammatory medications (e.g. Indocid, Naprosyn, Voltaren, Neurofen, Feldene). [austin.org.au]

Treatment of the arthritis of these other spondyloarthropathies is similar to the treatment of reactive arthritis . [merckmanuals.com]

Pathogenesis, symptoms and signs, diagnosis, and treatment differ by etiology. However, the general principle for treatment is to treat the underlying disorder. Resources In This Article [msdmanuals.com]

Both aortitis (with conduction system alterations) and periaortitis should be kept in mind by the physicians because they can significantly influence the prognosis of ankylosing spondylitis patients and they can need a rapid treatment. [moh-it.pure.elsevier.com]

What is the prognosis? Enteropathic Arthritis Arthritis that accompanies inflammatory bowel disease. [slideserve.com]

Whether you are attempting to choose a course of therapy, ascertain the optimal timing for intervention, arrive at a prognosis, or determine the possible need for periodic diagnostic evaluation, this is an essential resource you'll consult time and time [books.google.it]

Prognosis The prognosis for many patients with AS will be complete spinal ankylosis, while others will experience intermittent flares between bouts of clinical remission. [hopkinsarthritis.org]

Pathogenesis, symptoms and signs, diagnosis, and treatment differ by etiology. However, the general principle for treatment is to treat the underlying disorder. Resources In This Article [msdmanuals.com]

Etiology The precise etiology of AS remains mostly unknown, though heritability is frequently cited as a significant contributor. Major histocompatibility alleles, particularly HLA-B27, may account for up to one-third of the genetic effect. [hopkinsarthritis.org]

General Considerations Chronic inflammatory disease of unknown etiology primarily affecting spine Most common spondyloarthropathy Age-young adults 15-35 years Mostly male M:F = 4:1 Mostly Caucasian Caucasians to Blacks = 3:1 Clinical findings Insidious [learningradiology.com]

Pathology Etiology infectious syphilitic aortitis tuberculous aortitis pyogenic aortitis: especially Salmonella infection aortitis due to HIV infected (mycotic) aortic aneurysm non-infectious giant cell arteritis Takayasu arteritis other rheumatologic [radiopaedia.org]

Etiology  Not completely understood  Auto-immune  HLA-B27 : seen in 90 % patients  Autosomal inheritance with 70 % penetration in males  some family history 34. [slideshare.net]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

Epidemiology of spondyloarthritis in North America. Am J Med Sci 2011;341(4):284-6. Dillon CF, Hirsch R. The United States National Health and Nutrition Examination Surveyand the epidemiology of ankylosing spondylitis. [hopkinsarthritis.org]

[ 3, 4 ] The diverse clinical manifestations of this condition have impaired meaningful research on epidemiology. [patient.info]

MCP joint destruction with bone resorption and finger shortening (Opera-glass hands) -- this eventually leads to paw like hands with subluxation and loss of function Arthritis effecting up to four joints in the first 6months of the disease classically Epidemiology [brainscape.com]

Focuses on aspects of pathophysiological processes, clinical presentations, screening tests, prognostic implications and novel therapeutic approaches. [books.google.it]

These patients are at high risk of anesthesia related mortality from the pathophysiology of the cardiac lesion, exacerbated by the cardiovascular changes of pregnancy and complicated by the hemodynamic aberrations caused by anesthesia. [unboundmedicine.com]

Clinical and genetic similarities suggest that they also share similar causes or pathophysiologies. Rheumatoid factor (RF) is usually negative in the spondyloarthropathies (hence, why they are called seronegative spondyloarthropathies). [merckmanuals.com]

The pathophysiology probably involves immune-mediated inflammation. [msdmanuals.com]

Ankylosing spondylitis Psoriatic arthritis Reactive arthritis (Reiters) Enteropathicarthritis (associated with IBD) HLA-B27 Ankylosing spondylitis Ankylosing Spondylitis primarily involves the axial skeleton (egsacroiliitis & spondylitis) Prevalence- 0.15% Pathophysiology [slideserve.com]

Can You Prevent AS? Currently, no method of preventing ankylosing spondylitis exists. However, a good stretching and exercise program can delay the normal disease progression. [emedicinehealth.com]

When it comes to ankylosing spondylitis and heart disease, it’s all about prevention, Dr. Steinbaum said. [everydayhealth.com]

Management of aortitis includes controlling the inflammation with medications, treating complications, and preventing its recurrence. [spondylitis.org]

If you pay attention to your posture, exercise regularly and avoid the stoop associated with the condition, you can prevent this from becoming too serious. [arthritisconsult.com]

PATIENT MANAGEMENT: PROPHYLACTIC MEASURES COULD THIS HAVE BEEN PREVENTED? ARCHIVE OF STANDARDIZED EXAM QUESTIONS This archive compiles standardized exam questions that relate to this topic. Page Updated: 02.19.2017 [stepwards.com]