Lyme and spondyloarthropathy

Question 1

stage 1 of lyme disease

Answer 1

early localized- days after bite

• erythema migrans rash at tick bite site

Question 2

stage 2 of lyme disease

Answer 2

early disseminated- weeks

• flu-like illness, cardiac and neurologic
• secondary lesion occur after hematogenous dissemination

Question 3

stage 3 of lyme disease

Answer 3

months to years- Lyme arthritis

• encephalopathy or neuropathy

Question 4

lyme arthritis:

1. pattern
2. joint:
3. spectrum

Answer 4

1. pattern- intermittent and recurrent attacks of swelling and pain
2. joint- monoarticular or oligoarticular, large joint especially the knee
3. spectrum- short episodes of mild joint paint to intermittent attacks over years

Question 5

Lyme titer are highly positive for ___

Answer 5

IgG

Question 6

lyme arthritis resolution?

Answer 6

spontaneous resolution within a few weeks followed by recurrence of the knee swelling within the next year

Question 7

B burgdorferi avoids immune detection in

__________ for months

Answer 7

synovium

Question 8

Arthritis occurs when ______ activate against the bacteria that has persisted “quietly” in the joint

Answer 8

T-cells

Question 9

___________ indicates presence of B burgdorferi in the synovial fluid of untreated Lyme arthritis patients

Answer 9

PCR (polymerase chain reaction)

Question 10

Post Treatment Lyme arthritis:

Answer 10

high frequency of HLA-DRB1*0401 and related alleles

Question 11

spondyloarthropathies is RF

Answer 11

negative- seronegative

Question 12

spondyloarthropathies has increased incidence of HLA ____

Answer 12

B27

Question 13

spondyloarthropathies is an inflammation of the

Answer 13

sacroiliac joint and spine

Question 14

Ankylosing spondylitis :

1. occurs more often in men or women?
2. HLA-B27?
3. mean age
4. pain description
5. x-rays
6. enthesitis common?
7. extraarticular features

Answer 14

1. occurs more often in men
2. HLA-B27 incidence close to 95%
3. mean age of onset is in 3rd decade
4. pain description- inflammatory pain- AM stiffness and improves with activity
5. x-rays- calcification of interspinous ligaments and fusion of facet joints
6. enthesitis common in contrast to RA—> sausage digits
7. extraarticular features- uveitis, aortitis

Question 15

If one has AS the chance of being B27 positive varies from 50% to over 90% depending on the population studied

Answer 15

yepppppp

Question 16

cytokine activated in AS

Answer 16

IL-17—> trigger an inflammatory response at spine, joints and entheses

Question 17

is there a breach of intestinal mucosal barrier occurs in AS pt.?

Answer 17

yep, The gut microbiome encounters an abundance of lymphoid cells that reside in the bowel wall

Question 18

closest of spondyloarthropathies to RA in chronicity and pattern of joint distribution but still distinct

Answer 18

Psoriatic arthritis

Question 19

Psoriatic arthritis:

1. pattern
2. RF and anti-CCP?
3. enthesitis
4. predominance
5. affect SI joint?

Answer 19

1. pattern is more often asymmetric and oligoarticular
2. RF and anti-CCP is negative
3. enthesitis can be prominent
4. predominance is not really there females=males
5. affect SI joint not really

Question 20

HLA-B27 association with psoriatic arthritis

Answer 20

much lower association than AS

Question 21

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

Answer 21

reactive arthritis

Question 22

in reactive arthritis where is chlamydia DNA is found in

Answer 22

synovium

Question 23

inflammatory bowel disease associated arthritis

Answer 23

not associated with B27. peripheral arthritis associated with active bowel inflammation