Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0...
Transcript of Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0...
![Page 1: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/1.jpg)
Spondiloartriti sieronegativeSpondiloartriti sieronegative
![Page 2: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/2.jpg)
Spondiloartriti sieronegativeSpondiloartriti sieronegativeGruppo di malattie infiammatorie eterogenee (con caratteristiche simili, ma non identiche, all’artrite reumatoide) caratterizzate da:
• Entesite• Interessamento ad impronta flogistica delle
articolazioni dell’asse scheletrico (sacro-iliache e colonna vertebrale)
• Oligoartrite delle articolazioni periferiche• Negatività per F.R.
![Page 3: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/3.jpg)
Spondiloartriti:Spondiloartriti:caratteristiche comuni - 1caratteristiche comuni - 1
FamiliaritàFamiliarità Assenza di fattore reumatoideAssenza di fattore reumatoide Presenza nel 90% dei casi dell’HLA- B27Presenza nel 90% dei casi dell’HLA- B27 Presenza di sacroileite o spondilitePresenza di sacroileite o spondilite Artrite perifericaArtrite periferica Poliartrite simmetrica cronica ad impronta Poliartrite simmetrica cronica ad impronta
erosiva (erosiva (±± associazione di enteropatie) associazione di enteropatie) Interessamento tardivo del rachide cervicaleInteressamento tardivo del rachide cervicale
![Page 4: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/4.jpg)
Spondiloartriti:Spondiloartriti:caratteristiche comuni - 2caratteristiche comuni - 2
• Assenza di noduli reumatoidiAssenza di noduli reumatoidi• Patologia incentrata sulle entesi più che Patologia incentrata sulle entesi più che
sulla membrana sinovialesulla membrana sinoviale• Evoluzione anchilosanteEvoluzione anchilosante• Segno radiologici di erosioni articolari Segno radiologici di erosioni articolari
simmetriche e di fenomeni appositivi osseisimmetriche e di fenomeni appositivi ossei
![Page 5: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/5.jpg)
Spondiloartriti:Spondiloartriti:Inquadramento NosograficoInquadramento Nosografico
• Spondilite AnchilosanteSpondilite Anchilosante• Artrite ReattivaArtrite Reattiva• Artrite PsoriasicaArtrite Psoriasica• Artrite EnteropaticaArtrite Enteropatica• Spondiloartrite IndifferenziataSpondiloartrite Indifferenziata
![Page 6: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/6.jpg)
![Page 7: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/7.jpg)
Features Ankylosing spondylitisReactive arthritis (including Reiter's syndrome) Psoriatic arthritis
IBD-associated spondyloarthropathy
Prevalence 0.1% to 0.2% 0.1% 0.2% to 0.4% Rare
Age at onset Late teens to early adulthood
Late teens to early adulthood 35 to 45 years Any age
Male to female rate 3:1 5:1 1:1 1:1
HLA-B27 90% to 95% 80% 40% 30%
Sacroiliitis
Frequency 100% 40% to 60% 40% 20%
Distribution Symmetric Asymmetric Asymmetric Symmetric
Syndesmophytes Delicate, marginal Bulky, nonmarginal Bulky, nonmarginal Delicate, marginal
Peripheral arthritis
Frequency Ocassional Common Common Common
Distribution Asymmetric, lower limbs Asymmetric, lower limbs Asymmetric, any joint Asymmetric, lower limbs
Enthesitis Common Very common Very common Occasional
Dactylitis Uncommon Common Common Uncommon
Skin lesions None Circinate balanitis, keratoderma blennorrhagicum
Psoriasis Erythema nodosum, pyoderma gangrenosum
Nail changes None Onycholysis Pitting, onycholysis Clubbing
Ocular conditions Acute anterior uveitis Acute anterior uveitis, conjunctivitis Chronic uveitis Chronic uveitis
Oral conditions Ulcers Ulcers Ulcers Ulcers
Cardiac conditions Aortic regurgitation, conduction defects
Aortic regurgitation, conduction defects
Aortic regurgitation, conduction defects
Aortic regurgitation
Pulmonary features Upper lobe fibrosis None None None
Gastrointestinal conditions
None Diarrhea None Crohn's disease, ulcerative colitis
Renal conditions Amyloidosis, IgA nephropathy
Amyloidosis Amyloidosis Nephrolithiasis
Genitourinary conditions
Prostatitis Urethritis, cervicitis None None
![Page 8: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/8.jpg)
Spondilite anchilosanteSpondilite anchilosante
![Page 9: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/9.jpg)
Spondilite anchilosante: Spondilite anchilosante: patogenesipatogenesi
Associazione all’antigene HLA-B27Associazione all’antigene HLA-B27Familiarità di primo gradoFamiliarità di primo gradoAssociazione con infezioni del tratto Associazione con infezioni del tratto
gastrointestinale e genitourinario da gastrointestinale e genitourinario da gram negativi (in particolare Klebsiella gram negativi (in particolare Klebsiella Pneumoniae)Pneumoniae)
![Page 10: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/10.jpg)
Spondilite anchilosante: Spondilite anchilosante: anatomia patologicaanatomia patologica
Iperplasia villosa della sinovia con citoproliferazione ed infiltrati linfocitari
Interessamento dei tendini e legamenti sul punto d’inserzione dell’osso e delle articolazioni fibro-cartilaginee
Erosioni e sclerosi dell’osso subcondrale con fibrosi ed anchilosi
Infiammazione e proliferazione ossea reattiva ed ossificazione encondrale nella articolazioni colpite
![Page 11: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/11.jpg)
Sintomi e segniSintomi e segni Dolore riferito al rachide lombare e glutei, irradiato alla
coscia posteriormente (sciatica mozza alterna) Talalgia ribelle Dolore toracico intenso con interessamento delle
articolazioni costo-vertebrali, sterno-costali, manubrio-sternali e sternoclaveari
Andamento a poussees con progressione ascendente al tratto toracico e cervicale
Coinvolgimento dei cingoli nel 35% dei casi Positività del test occipite-muro e del test di Schober Uveite, insufficienza aortica e fibrosi polmonare apicale Aumento della PCR e positività dell’antigene HLA-B27
![Page 12: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/12.jpg)
Spondilite anchilosante: diagnosi clinica
Riduzione della mobilità del rachide lombare per la flessione, inclinazione laterale ed estensione
Anamnesi positiva per dolore localizzato al rachide lombare o al passaggio dorso-lombare
Riduzione espansibilità toracica a meno di 2,5 cm misurata al IV spazio intercostale
![Page 13: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/13.jpg)
ANKYLOSING SPONDYLlTISESSENTIALS OF DIAGNOSIS
• Inflammatory back pain in young adults.Inflammatory back pain in young adults.• Radiographic demonstration of sacroiliitis.Radiographic demonstration of sacroiliitis.• Reductions in spinal mobility, particularly lumbar Reductions in spinal mobility, particularly lumbar
flexion.flexion.• Association with anterior uveitis.Association with anterior uveitis.• Increased relative risk conferred by inheritance of Increased relative risk conferred by inheritance of
HLA-B27.HLA-B27.• Positive family history.Positive family history.
![Page 14: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/14.jpg)
![Page 15: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/15.jpg)
![Page 16: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/16.jpg)
![Page 17: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/17.jpg)
![Page 18: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/18.jpg)
![Page 19: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/19.jpg)
![Page 20: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/20.jpg)
Spondilite anchilosante: diagnosi differenziale
Malattia di PagetOsteite condensante dell’ileoMalattia di ScheuemannIperparatiroidismoIperostosi idiopatica diffusa FibromialgiaDiscopatie degenertive
![Page 21: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/21.jpg)
Spondilite anchilosante: radiologiaErosioni subcondraliSclerosi reattivaPseudoallargamento della rima articolareFenomeni erosivi ed appositivi nelle entesiOssificazione del legamento longitudinale
anteriore (squaring vertebrale), delle articolazioni interapofisarie (aspetto a rotaia di tram) e dei legamenti interspinosi (aspetto a cremagliera)
Aspetto in toto del rachide “a canna di bambù”
![Page 22: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/22.jpg)
Criteri proposti per la diagnosiEsordio insidioso di lombalgia da più di tre mesi, rigidità
mattutina, esordio prima dei 45 anniDolore toracico ricorrente e rigidità di eziologia non nota,
prima dei 45 anni, con positività di HLA-B27Uveite anteriore acuta, talalgia ricorrente, oligoartrite fissa
sieronegativa prima dei 45 anni con familiarità per spondilite anchilosante
Ridotta mobilità del rachide lombareDiminuzione dell’espansione toracica (escluse cause
scheletriche congenite, cardiache e pneumopatie)Sacroileite bilaterale dimostrata radiologicamente di grado
II, III, IV (escluse patologie infettive e neurologiche)
![Page 23: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/23.jpg)
![Page 24: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/24.jpg)
![Page 25: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/25.jpg)
Joint space narrowing and bony sclerosis around the sacroiliac joints
RADIOGRAPH OF THE PELVIS IN A PATIENT WITH ASRADIOGRAPH OF THE PELVIS IN A PATIENT WITH ASAND BILATERAL SACROILIITISAND BILATERAL SACROILIITIS
![Page 26: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/26.jpg)
Inflammation at the site of insertion of the annulus fibrosus has resulted in osteitis of the anterior vertebral margins, also called "shining corners".
Radiograph of the lumbar spine in a patient with ASRadiograph of the lumbar spine in a patient with AS
![Page 27: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/27.jpg)
Ossification of the annulus fibrosus in the lumbar spine has resulted in the formation of
marginal syndesmophytes in a gradually ascending pattern ("bamboo spine").
Radiograph of the lumbar spine in a patient with ASRadiograph of the lumbar spine in a patient with AS
![Page 28: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/28.jpg)
![Page 29: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/29.jpg)
![Page 30: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/30.jpg)
![Page 31: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/31.jpg)
![Page 32: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/32.jpg)
![Page 33: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/33.jpg)
![Page 34: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/34.jpg)
![Page 35: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/35.jpg)
![Page 36: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/36.jpg)
![Page 37: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/37.jpg)
Artropatia psoriasica
![Page 38: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/38.jpg)
Artropatia psoriasica
È un’artropatia infiammatoria associata a psoriasi cutanea e\o ungueale ad eziologia
sconosciuta.
![Page 39: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/39.jpg)
Artropatia psoriasica: patogenesi
Presenza del HLA B13, B16, CW6, B38 e B39Agenti infettiviMicro e macrotraumatismi a carico delle strutture
articolari periarticolariFibrosi perivasale e capsulare con fenomeni di
necrosi a livello del tessuto subsinoviale
![Page 40: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/40.jpg)
Artropatia psoriasica: clinicaMANIFESTAZIONI EXTRA-ARTICOLARI:
Psoriasi (dermopatia caratterizzata da placche eritemato-desquamanti a margini netti)
Psoriasi volgarePsoriasi guttataPsoriasi di von ZumbuschPsoriasi pustolosa localizzataEritrodermia psoriasicaEpiscleriteUveite anterioreValvulopatia aortica
![Page 41: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/41.jpg)
Artropatia psoriasica: clinicaMANIFESTAZIONI ARTICOLARI:
1) Malattia spondilitica (oltre il 30% dei soggetti presenta un interessamento dello scheletro assiale)
2) Oligo-poliartrite acrale (rappresenta il 60% dei casi ed interessa le articolazioni interfalangee distali e prossimali delle mani e le metatarso-falangee ed interfalangee dei piedi)
3) Poliartrite (interessamento generalizzato delle articolazioni nel 30% dei pazienti)
![Page 42: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/42.jpg)
Artropatia psoriasica: diagnosi e clinica
Psoriasi a carico delle unghie Ispessimento e periostosi lineare a carico delle piccole
articolazioni di mani e piedi radiologicamente evidenti Monolateralità della localizzazione Associazione di fenomeni erosivi ed osteoproduttivi
con riduzione della rima articolare interfalangea (immagini di “minus + plus”)
Aumento degli indici sierologici di flogosi ed anemia ipocromica
![Page 43: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/43.jpg)
![Page 44: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/44.jpg)
![Page 45: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/45.jpg)
![Page 46: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/46.jpg)
![Page 47: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/47.jpg)
![Page 48: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/48.jpg)
![Page 49: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/49.jpg)
![Page 50: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/50.jpg)
![Page 51: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/51.jpg)
![Page 52: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/52.jpg)
![Page 53: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/53.jpg)
![Page 54: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/54.jpg)
Severe destructive arthritis with a pencil-in-cup deformity.The deformity occurs when the distal head of a bone becomes pointed and the
adjacent joint surface becomes cup-like because of erosions.
Radiograph of the hands in a patient with arthritis mutilansRadiograph of the hands in a patient with arthritis mutilans
![Page 55: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/55.jpg)
![Page 56: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/56.jpg)
![Page 57: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/57.jpg)
Artriti reattive e Sindrome di Reiter
![Page 58: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/58.jpg)
Artriti reattive
Sono processi flogistici articolari asettici che seguono un’infezione in qualunque parte
dell’organismo
![Page 59: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/59.jpg)
Artriti reattive: eziopatogenesi Familiarità (presenza dell’antigene HLA B-27
nell’80% dei casi)Associazione ad infezioni: - del tratto gastrointestinale (da Shigelle,
Salmonelle, Campylobacter e parassiti) - del tratto urogenitale (da Gonococchi,
Clamydie ed Ureoplasmi) - delle alte vie respiratorie (faringite da
Streptococco β-emolitico di gruppo A)
![Page 60: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/60.jpg)
Artriti reattive: diagnosi Insorgenza a 1-2 settimane dall’evento infettivo acuto
primarioQuadro di mono-oligoartrite acuta, migrante e talvolta
febbrileMaggiore coinvolgimento di: ginocchia, caviglie ed
avampiedi in ordine decrescente di frequenzaCoinvolgimento degli arti superiori nel 50% circa dei
casiLombalgie al risveglio
![Page 61: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/61.jpg)
Artriti reattive: diagnosi Possibile interessamento delle entesi e delle guaine
tendineeUveite e balanite nel 10% dei casiNegatività del F.R.Stretta associazione con HLA –B27 Indici sierologici di flogosi aumentati, talvolta
leucocitosiDeterminazione del titolo anticorpaleNel 10% dei casi, evidenza radiologica di sacroileite
![Page 62: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/62.jpg)
Sindrome di Reiter
• Uretrite• Congiuntivite• artrite reattiva conseguente ad una infezione intestinale
![Page 63: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/63.jpg)
Sindrome di Reiter: eziopatogenesi Familiarità (presenza dell’antigene HLA B-27
nell’80% dei casi)Associazione ad infezioni: - del tratto gastrointestinale (da Shigelle,
Salmonelle, Campylobacter e parassiti) - del tratto urogenitale (da Gonococchi, Clamydie
ed Ureoplasmi) - delle alte vie respiratorie (faringite da
Streptococco β-emolitico di gruppo A)
![Page 64: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/64.jpg)
Sindrome di Reiter: diagnosiUveite bilaterale, non severaLesioni cutanee (cheratoderma, ovvero placche
ipercheratosiche molto estese a livello delle regioni plantare, dell’alluce, del palmo delle mani, del glande)
Lesioni mucose (ulcerazioni orali e balanite)Uretrite e cervicite ad eziologia non gonococcicaArtrite a decorso cronico, spesso poliarticolare che
colpisce le grosse articolazioni e gli arti inferiori
![Page 65: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/65.jpg)
Sindrome di Reiter: diagnosi Insorgenza acuta e spesso febbrile con tumefazioni
articolari locali Indici sierologici di flogosi aumentati e moderata anemia
normo-ipocromicaPresenza dell’antigene HLA B-27 nell’80% dei pazientiRiduzione della rima articolare ed erosioni a carico delle
articolazioni metatarso-falangee visibili radiologicamente
Speroni calcaneali all’inserzione della fascia plantareSacroileite asimmetricaSpondilite
![Page 66: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/66.jpg)
![Page 67: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/67.jpg)
![Page 68: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/68.jpg)
![Page 69: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/69.jpg)
![Page 70: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/70.jpg)
![Page 71: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/71.jpg)
![Page 72: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/72.jpg)
![Page 73: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/73.jpg)
![Page 74: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/74.jpg)
![Page 75: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/75.jpg)
![Page 76: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/76.jpg)
![Page 77: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/77.jpg)
Artropatia enteropatica
![Page 78: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/78.jpg)
Artropatia enteropatica
Si osservano nel corso di malattie intestinali croniche quali la rettocolite
ulcerosa ed il morbo di Crohn. Si associa anche alla celiachia e al morbo di
Whipple.
![Page 79: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/79.jpg)
Artropatia enteropatica: clinica
Artrite periferica dipendente dalla malattia associata ad iniziale interessamento monoarticolare e caviglie in particolare
Spondiloartrite e sacroileite indipendenti dal decorso della malattia associata, spesso indistinguibile dalla spondilite anchilosante per la frequente positività dell’antigene HLA-B27
Indici di flogosi aumentati, reuma test negativoNell’associazione col morbo di Whipple è rara la
presenza di sacroileite e\o spondilite
![Page 80: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/80.jpg)
Morbo di Whipple
![Page 81: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/81.jpg)
Morbo di Whipple: definizione
È un’artrite enteropatica metabolica, non legata alla presenza dell’HLA B27.
E’ una lipodistrofia intestinale che causa malassorbimento e si accompagna ad artrite
![Page 82: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/82.jpg)
Morbo di Whipple: clinicaPredilige il sesso maschile. Si presenta con diarrea, malassorbimento e steatorrea. Si hanno poi episodi di artralgie o di artrite senza
alterazioni permanenti delle articolazioni. Talvolta è presente una sacroileite. Altri sintomi complementari quali febbre e la
linfoadenopatia generalizzata possono essere presenti, così come iperpigmentazione cutanea, deperimento organico e ipotensione.
È stata occasionalmente riportata un’amiloidosi reattiva sistemica
![Page 83: Spondiloartriti sieronegative - ....:::::Chaos Scorpion 2.0 :::::....chaosscorpion.altervista.org/Medicina/Reumatologia/02... · PPT file · Web viewSpondiloartriti sieronegative](https://reader036.fdocument.pub/reader036/viewer/2022081419/5c66240109d3f20f218bd73e/html5/thumbnails/83.jpg)
Morbo di Whipple: diagnosi
Si effettua mediante biopsia del digiuno che mostra i villi con aspetto a “clava”, infiltrati da
macrofagi contenenti granuli PAS positivi