espondilite anquilosante e artrite psoriásica
TRANSCRIPT
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Espondilite Anquilosante
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E.Anquilosante
lombalgia crônica homens < 40 anos
piora c/ repouso, melhora c/exercício
Sacroileíte, artrite periférica : quadril e joelhos
pode ter ex. laboratoriais normais
Brancos : 80-95% HLA B27 +
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Sacroileíte
compressão direta
compressão antero-posterior (Ericksen)
extensão do quadril (Gaenslen)
Faber (Patrick)
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Russel, LeClercg, Arth Rheum, 1981
lombalgia
doença discal lombar
sacroileíte
espondilite anquilosante
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Lombalgia
compressão direta : 41 compressão sacral : 6 compressão L3-S1 : 24 Gaensler : 15 Ericksen : 9 compressão lateral : 6
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Sacroileíte clínica : 11 pacientes
compressão direta : 4 compressão sacral : 0 compressão L3-S1 : 2 Gaensler : 3 Ericksen : 3 compressão lateral : 3
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57 pacientes
Não foram suficientes para diferenciar sacroileíte da espondilite anquilosante de outras causas de lombalgia crônica
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Sacroileíte - Radiologia
I : borramento das margens alargamento articular
II : irregularidade margens osteoporose e/ou esclerose subcondral
III: erosões, cistos subcondrais
IV: obliteração espaço
anquilose óssea
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Cintilografia óssea
Controverso sensibilidade alta (jovens, magros) especificidade baixa questionamento relação SI/sacro
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Tomografia
confirma o diagnóstico
atividade atual?
não mostra cartilagem
não mostra edema ósseo
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RM
I Baixa intensidade sinal T1 Alta intensidade sinal T2 edema ósseo = inflamação
II Baixa intensidade sinal em todas as sequências tecido fribrosado = esclerose
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Tratamento
AINH
SulfasalazinaMetotrexate
Anti-TNF - etanercept
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Artrite psoriásica
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Artrite psoriásica
Artrite - em 4-10% dos doentes c/psoríase
Pode preceder lesão pele/unha em 30%
Entesite - calcaneo
Dactilite - dedo em “salsicha”
Em jovens com doença agressiva - HIV
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Formas clínicas
Oligoartrite assimétrica - 50% Poliartrite simétrica (AR) - 30% Espondiloartropatia - 30% Artrite distal (IFDs) - 10% Artrite mutilante - rara
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