Lyme and spondyloarthropathy Flashcards
stage 1 of lyme disease
early localized- days after bite
- erythema migrans rash at tick bite site
stage 2 of lyme disease
early disseminated- weeks
- flu-like illness, cardiac and neurologic
- secondary lesion occur after hematogenous dissemination
stage 3 of lyme disease
months to years- Lyme arthritis
- encephalopathy or neuropathy
lyme arthritis:
- pattern
- joint:
- spectrum
- pattern- intermittent and recurrent attacks of swelling and pain
- joint- monoarticular or oligoarticular, large joint especially the knee
- spectrum- short episodes of mild joint paint to intermittent attacks over years
Lyme titer are highly positive for ___
IgG
lyme arthritis resolution?
spontaneous resolution within a few weeks followed by recurrence of the knee swelling within the next year
B burgdorferi avoids immune detection in
__________ for months
synovium
Arthritis occurs when ______ activate against the bacteria that has persisted “quietly” in the joint
T-cells
___________ indicates presence of B burgdorferi in the synovial fluid of untreated Lyme arthritis patients
PCR (polymerase chain reaction)
Post Treatment Lyme arthritis:
high frequency of HLA-DRB1*0401 and related alleles
spondyloarthropathies is RF
negative- seronegative
spondyloarthropathies has increased incidence of HLA ____
B27
spondyloarthropathies is an inflammation of the
sacroiliac joint and spine
Ankylosing spondylitis :
- occurs more often in men or women?
- HLA-B27?
- mean age
- pain description
- x-rays
- enthesitis common?
- extraarticular features
- occurs more often in men
- HLA-B27 incidence close to 95%
- mean age of onset is in 3rd decade
- pain description- inflammatory pain- AM stiffness and improves with activity
- x-rays- calcification of interspinous ligaments and fusion of facet joints
- enthesitis common in contrast to RA—> sausage digits
- extraarticular features- uveitis, aortitis
If one has AS the chance of being B27 positive varies from 50% to over 90% depending on the population studied
yepppppp
cytokine activated in AS
IL-17—> trigger an inflammatory response at spine, joints and entheses
is there a breach of intestinal mucosal barrier occurs in AS pt.?
yep, The gut microbiome encounters an abundance of lymphoid cells that reside in the bowel wall
closest of spondyloarthropathies to RA in chronicity and pattern of joint distribution but still distinct
Psoriatic arthritis
Psoriatic arthritis:
- pattern
- RF and anti-CCP?
- enthesitis
- predominance
- affect SI joint?
- pattern is more often asymmetric and oligoarticular
- RF and anti-CCP is negative
- enthesitis can be prominent
- predominance is not really there females=males
- affect SI joint not really
HLA-B27 association with psoriatic arthritis
much lower association than AS
Likely caused by antigens from initial infecting agent (or in the case of chlamydia the organism itself) that have traveled to the joint or enthesis
reactive arthritis
in reactive arthritis where is chlamydia DNA is found in
synovium
inflammatory bowel disease associated arthritis
not associated with B27. peripheral arthritis associated with active bowel inflammation
