Espondiloartrites 2013
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Transcript of Espondiloartrites 2013
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Disciplina Reumatologia2012
Luiza Fuoco
Espondiloartrites
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Conceito das Espondiloartrites
Epidemiológico
Genético
Ambiental
Achados clínicos e radiográficos
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Espondiloartrites• Epidemiológico
– Mais comum em homens– <40 anos
• Genético– HLA-B27+ em 90% dos casos de EA
• Pior prognóstico axial• Maior risco de manifestações extra-articulares
– Uveíte– Balanite circinada
– Caucasianos– Concordância em gêmeos monozigóticos: 50-70%
• Ambiental– Infecções– Estresse mecânico
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Espondiloartrites
• Achados clínicos– Uveite anterior
– Fator reumatoide negativo/ PAIs elevadas
– Sacroileíte
– Entesite
– Oligoartrite > MMII
• Achados radiológicos– Neoformação óssea
– Anquilose
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Espondilite Anquilosante• Esqueleto axial: dor e rigidez matinal
– Sacro-ilíacas: Lombalgia crônica caráter inflamatório– Cervical: sexo feminino– Coluna torácica
• Posterior• Costoesternais• Esternoclaviculares
• Artrite – Quadril: pior prognóstico, EA juvenil– Periférica: 30%, MMII, EA juvenil
• Manifestações extra-articulares: entesite, uveíte, aortite, fibrose pulmonar ápice• Homens 3x, <40 anos• HLA-B27 aumenta o risco em 10x
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Artrite Reativa
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Artrite Reativa: Envolvimento Ocular
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Artrite Reativa: Balanite Circinada
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Artrite Psoriatica• Onicodistrofia
– Muito relacionada a artrite
• Classificação:– Mutilante– Oligoarticular: + comum– Poliartricular: + sexo feminino– Axial: 5%– Periférica e axial: 20-50%– HLA-B27 + SI bilateral– Dactilite
• Psoríase + Atrite + HIV
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Critérios de Caspar
Categoria Pontos
Psoríase atual ou HF+ 2 se atual; 1 se HP ou HF
Onicodistrofia 1
FR negativo 1
Dactilite atual ou HF 1
Neoformação óssea justa articular ao RX 1
Diagnóstico APs: >3 pontosEspecificidade: 98,7%Sensibilidade: 91,4%
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Dactilite
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Artrite Enteropática
• Doença inflamatória intestinal:– Doença de Crohn– Retocolite Ulcerativa• H=M• 10-30 anos• Diarreia crônica• Sangramento retal• Dor abdominal
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Artrite Enteropática• Artrite periférica
– Tipo I: • <5 articulações• Assimétrico• MMII• Duração <10 semanas• Reativação DII
– Tipo II:• >5 articulações• Grandes e pequenas articulações• Pode ser erosiva e persistente• Independe da atividade de DII• Associado a uveíte
• Envolvimento Axial– Espondilite: + comum na DC– Evolução independente do DII– HLA-B27+
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Artrite Enteropática• Entesite
• Oculares:– Uveite e episclerite
• Pele: – Pioderma gangrenoso– Eritema nodoso: artrite periférica e uveite– Psoriase– Ulcera oral
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Teste de Schober
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Teste Gaenslen
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Manobra Patrick e Fabere
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Coluna em Bambu
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Espondiloartrites: tratamento
• Atividade física regular• AINE continuo • SSZ uveíte• Anti-TNF alfa– Etanercepte: sem evidencia para DII– Adalimumabe– Infliximabe