V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf ·...
Transcript of V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf ·...
![Page 1: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/1.jpg)
SPONDILARTROPATIILE
V M Pompilian
Medicina Interna Colentina
![Page 2: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/2.jpg)
CRITERII INCADRARE
- Moll(=si caractere generale)
- Amor
- ESSG
- Criteriile de la Berlin
- Criteriile ASAS
![Page 3: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/3.jpg)
CRITERII JMH MOLL
Absenta FR
Absenta noduli reumatoizi
Artrite periferice-caract:oligoartrita asim pred art mari,m inf +- dactilita
Afect POSIBILA art SI,col vert
Afect frecv tegum,mucoase
Suprapunere manif clinice
Frecvente entesopatii
Agregare familiala
![Page 4: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/4.jpg)
CRITERII B AMOR
CLINICE
1)dureri nocturne L/D si/sau redoare matinala………………………………..1p
2)oligoartrita asim……………………..2p
3)dureri fesiere cu topogr imprecisa/in bascula………………………………….1/2p
4)dactilita………………………………..2p
5)talalgii sau alta entesopatie…………2p
6)irita……………………………………..2p
7)uretrita negonococica/cervicita la < 1 luna de la debut artrita……………………………1p
8)diaree………………………………….1p
9)anteced/prezenta psoriazis/balanita..1p
![Page 5: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/5.jpg)
CRIT AMOR
RADIOLOGICE:
10)sacroileita gr >=2 daca e bilaterala sau grad >=3 daca e unilaterala…………….3p
GENETICE:
11)B 27 si/sau AHC:SA,sd Reiter,psoriazis,uveita,enterocolopatii cr…3p
TERAPUTICE:
12)ameliorare in 48h a durerilor sub AINS si/sau recurenta in 48h dureri dupa stop AINS…2p
SPA-DACA TOTAL>=6p
![Page 6: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/6.jpg)
CRITERII ESSG
Durere spinala de tip inflamator
sau
Sinovita:asim/predom m inf
si
Oricare din urmatoarele:
-ahc
-psoriazis
-boli inflam intest
-dureri fesiere alternante
-entesopatii
sens 77%,specif 89%
+sacroileitasens 86%,specif 87%
![Page 7: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/7.jpg)
Criterii noi
Berlin : -asemanatoare cu crit Amor
- exprimate prin coeficienti de probabilitate
- tin cont si de : B27, RMN sacroiliac
ASAS –crit pt forma axiala:
-SI-ita RX/ RMN + 1 trasatura SPA
Sau
-B27 + 2 trasaturi SPA
![Page 8: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/8.jpg)
Trasaturi SPA f axiala (ASAS)
Lombalgie inflamatoare
Artrită periferică
Entezită calcaneeană
Uveită
Dactilită
Psoriazis
Boală inflamatoare intestinală
Răspuns bun la antiinflamatoare nesteroidiene
Antecedente familiale de spondilartrită
Fenotip HLA-B27
Proteină C-reactivă pozitivă
![Page 9: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/9.jpg)
CRIT SPA F PERIFERICA
(ASAS)
Artrita sau entesita sau dactilita PLUS:
>= 1 trasatura SPA:
uveita/psoriazis/IBD/infectie
premergatoare/B27+/sacroiliita RX sau RMN
>=2 trasaturi SPA: artrita/entesita/dactilita/low
back pain ever/ahc SPA
![Page 10: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/10.jpg)
MEMBRII FAMILIEI SPA
Spondilita ankilozanta(SA)
Artritele reactive+sd Reiter
Artrita psoriazica
Spondilitele enteropatice
Sd Behcet(afectarea artic din~)
Sd SAPHO
Uveite anterioare B27+
Subseturi artrita cronica juvenile:JAS,SEA
SPA nediferentiate
![Page 11: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/11.jpg)
SPONDILITA ANKILOZANTA
Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.
Sinonime:Bechterew,Pierre Marie,Strumpell
Istoric:veche (crocodili,mumii)
Epidemiol-total SPA=1% pop gen
-preval II preval B27(Europa 5-8%;non albi preval<,amerindieni:Haida,Pima 50%)
-Predom masc:B/F oldies10/1,actual 3/1
-tineri:debut decada 3
![Page 12: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/12.jpg)
SA ETIOPATOGENIE
Trasaturi de raspuns imun innnascut
Citokine: TNF alpha,IL 17-IL 23
interrelatie B27/germeni
B27-mec:indirect/DIRECT
-exp:soarecele transgenic pt B27
-mec legat de fctia de prezentare a peptidelor antigenice catre CD8 pe care o are B27.
-ipoteze: peptid antigenic/misfolding/homodimeri
-subtipuri- probabil cca 100:asociate:01,02,04 ,05,07;protector 03(pop de culoare)
![Page 13: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/13.jpg)
SA ETIOPATOGENIE
Microbi:klebsiella pneumoniae(Ebringer):
-argumente:K in mf,Ac anti K,densit bact > in
reg valvei ileocecale.
-mec:mimetism molec;plasmidamodif struct
B27
![Page 14: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/14.jpg)
ANATOMIE PATOLOGICA
Artic:-entesita+sinovita
-productie os+liza os
Viscerale:ochi(iridociclita);pulm(fibroza
LS);cord(insuf ao,BAV);rinichi(amiloid,nefrop
IgA)
![Page 15: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/15.jpg)
TABLOU CLINIC SA
Dougados-4 sindroame:
-pelvirahidian
-articular periferic
-entesopatic
-extraarticular
![Page 16: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/16.jpg)
CLINIC SA
Pelvirahidian:rahialgii;dureri fesiere;dureri toracice
Artic perif:oligo(<5),asim,m inf art mari
Entesopatii:tend achil,patelara,talalgii post,dureri torace inspir,etc
Extraartic:-manif generale(febra,st gen alterata,inapetenta);
-manif de organ:ochi,pulmon,cord,rinichi
![Page 17: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/17.jpg)
Durerea lombara de tip inflamator
(low back pain)
Amelior. de efort; creste la repaus
Redoare matinala
Debut insidios
Pacient < 40 ani
Durata > 3 luni
![Page 18: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/18.jpg)
EX FIZIC IN SA
Art SI:pres directa dureroasa;manevre:dec
dorsal,lateral,ventral
Col L:stergere lordoza;contract musc;
-teste:Schober,degete-sol
Torace:acc cifoza;perim toracic;var test
Schober (pt flexie laterala)
Cervical:occiput-perete;menton-stern
![Page 19: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/19.jpg)
PARACLINIC SA
Probe biologice:RFA;FR -;IgA crescut;cresteri CK,fosf alc…
HLA B27
Imagistica:RX,RMN,CT,scintigrafie
-RX:bazin+incid oblice pt SI;col T-L;calcaneu profil
*SI:st 0:normale;st I:asp “suspect”,fara anomalii specifice;st II:stergere contur,pseudolargire;st III:condensare /ambe versante,dimin spatiu art;st IV:ankiloza
*col DL:sindesmof,squaring,shining corners(Romanus),calcif lig
*calcaneu:pinteni,periostita
![Page 20: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/20.jpg)
![Page 21: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/21.jpg)
![Page 22: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/22.jpg)
![Page 23: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/23.jpg)
![Page 24: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/24.jpg)
![Page 25: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/25.jpg)
![Page 26: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/26.jpg)
IMAGISTICA SA
CT,RMN:detalii suplim;std precoce
Scinti: - nespecificitate
+ scintigr cantitativa-index SI
afect perif:simetrica sau nu
precoce
mai ieftina decat RMN,CT
![Page 27: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/27.jpg)
PROBLEME DG
Lipsa sacroileitei
Debut tardiv(>50 ani)
Debut precoce:multe entesite,multe afect perif
Femei:boala mai blanda-ma cea axiala
![Page 28: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/28.jpg)
CRITERII DIAGNOSTIC
Motto:”spondilita ankilozanta=sacroileita simptomatica” Andrei Calin
Criteriile NY modificate -1984:
1)dureri L> 3L,amelior de exercitiu si neameliorate de repaus
2)scad mobilit col L in plan sagit si frontal
3)scad expansiune torace
4)sacroileita bilat gr >=2
5)sacroileita unilat gr >=3
Dg + daca crit 4 sau 5 + orice criteriu clinic
![Page 29: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/29.jpg)
DG DIF
Alte SPA
Durerea lombara comuna(spondiloza,discopatii);b Scheuermann;morb Pott;spondilodiscite infectioase*;TM coloana vert;mielom
*spond.disc infect:BK//staf,shigella,salmonella,brucella
Dg dif al sacroileitei:
-rar :PAR
-infect:idem spond.disc
-f rar-metabolic:guta
-artroza SI,b Forrestier
-osteita condensanta ilion
-LES (in special cu antiRo +)
![Page 30: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/30.jpg)
TRATAMENT
AINS:oricare…
Corticoizi sistemic: doar timp limitat;de rezerva
Trat fond:salazopirin
AntiTNF alpha
Alti agenti:talidomida;bisfosfonati(pamidronat)
BFT:proceduri,igiena posturala
Ortopedico-chirurgical:blocaje vert;osteotomii vert;proteze sold
![Page 32: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/32.jpg)
ARTRITE REACTIVE&SD
REITER
Def:1)artropatii inflam,sterile asociate cu focar infectios la distanta de articulatie
2)episod de artrita durata >1 L,asoc cu uretrita/enterita(ACR)
Istoric:1916:Reiter,Fiessenger si Leroy-triada(artrita,uretrita,conjunctivita)
1973 Aho conceptul de artrita reactiva
Relatia cu artrita septica:lq steril vs nesteril;daca se pot cultiva germeni sau nu
*antigeni bact in lq sinov exista si in artritele reactive!
![Page 33: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/33.jpg)
ETIOPATOGENIE
B27(rol<SA:60-85%);germeni(altii decat la
SA) –uropatogeni:chlamydia
trach,mycoplasma-ureaplasma
-enteropatogeni:shigella,salmonella
yersinia,campylobacter,cl.difficile
-guest star:Borellia
![Page 34: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/34.jpg)
CLINIC
Artrite periferice:-tip aditiv,fix\
-fen inflam loc intense(“artic rosie”)-dg dif:guta,sarcoidoza,a psoriazica,a.septica,RAA)
Afect axiala:-SI ita unilat/bilat asimetrica
-sindesmofite nonmarginale,grosiere,distrib intamplator (~artrita psoriazica)
![Page 35: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/35.jpg)
CLINIC-A.REACTIVE
Entesite:-caract dactilita;talalgii sn “lover’s heels”
Manif cutaneo mucoase:conjunctivita/uretrita*/balanita/keratoderma blen.
*coexist uretrita-artrita-3sit:
-u.gonococica+artr.septica
-u.negonococica+artr.reactiva
-u.aseptica+artr.reactiva enteropatica
![Page 36: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/36.jpg)
A.REACTIVE
Paraclinic:det Ac anti germeni/B27/scintigr/RX bazin,calcai
Dg dif:-”artic rosie”(v m sus)
-celelalte SPA
-RAA!
Tratament:AINS/corticoizi +medicatie de fond:SSZ/MTX/Hidroxiclq
*HIV-numai SSZ+HQ+AINS
*cure antibiotic? Chlamydia 3 luni doxi/lymeciclina;enteropatogeni quinolona
Tendinta largire spectru a.reactive:SA-Klebsiella,a.psor-staf,strepto,SAPHO-Corynebacterii,sp. Enteropatice-flora enterica,etc
![Page 37: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/37.jpg)
![Page 38: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/38.jpg)
ARTRITA PSORIAZICA
Def:artrop.inflam asociata cu psoriazis
Etiopatog:
-genetic:agreg fam/B27 corel cm slaba(46-
78%)/B38,B39-ma artrite asimetrice/DR4-ma
artrita simetrica distala
-mediu:germeni(retrovirusi,staf,strepto)/traum(fen
Koebner)
![Page 39: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/39.jpg)
A.PSORIAZICA
Clinic-tipuri afectare:
-oligoartrita asim:asoc dactilita
-poliartrita sim:+/- FR
-afect IFD:corel-psor unghial
-artrita mutilanta:corel-psor extensiv
-afect spinala
Afect cutanata:precede/concom/succede afect artic
Afect unghieinail pitting
RX:IFD-pencil∪afect axiala~a.reactiva
![Page 40: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/40.jpg)
A PSOR-TRATAMENT
AINS-oricare poate acc lez
cutan(benoxaprofen inhiba si COX si LOX)
Corticoizi-tendinta:puseu la scaderea dozei
Trat fond:MTX/SSZ
altele:retinoizi,PUVA,AZA,CFA,ciclosporina
Nu:Au,HQ
Trat biologic:anti TNF alfa
![Page 41: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/41.jpg)
ARTRITE ENTEROPATICE
Def:boli inflam artic asoc cu boli intestinale-f
diferite:RUH+ b.Crohn,bypass intest,enteropatia
glutenica,b Whipple,colita colagena,limfocitara,b
Poncet
Patogenie:prolif microb+permeab intestreactie
imunaartrita
IBD:artrita perif II activ bolii dig;artrita axiala II B27
B Poncet=artrita amicrobiana asoc cu TBC extrapulm
la adultul tanar
![Page 42: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/42.jpg)
ALTE SPA
Uveitele acute ant B27+/caract gen:acute,recurente,anterioare,negranulomatoase,progn in general bun-exc b Behcet
*clinic:painful red eye
SPA nediferentiate:boli cu trasaturi SPA dar neincadrabile intr-o forma definita(debuturi/f fruste/overlap)
Altele:SAPHO,JAS+SEA,afect artic din sd Behcet,b Lyme
![Page 43: V M Pompilian Medicina Interna Colentinabaicus.ro/Reumatologie/SPONDILARTROPATIILE.pdf · 2016-10-22 · Definitie:b inflam,afect schelet axial+- afect perif,in stransa corel cu HLAB27.](https://reader033.fdocuments.net/reader033/viewer/2022041808/5e55fe1e1ab42558972d2fae/html5/thumbnails/43.jpg)