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Cardio > MSK 6 Inflammatory Arthropathies > Flashcards

MSK 6 Inflammatory Arthropathies Flashcards

1
Q

Inflammatory arthropathies:

Common Types →

A 
➢	Rheumatoid Arthritis (RA)
➢	Spondyloarthropathies
➢	Systemic lupus erthematosus (SLE)
➢	Crystal-related arthropathies
➢	Polymyalgia rheumatic
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2
Q

Rheumatoid Arthritis:Cause

A

T cell driven (autoimmune) disease

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3
Q

Rheumatoid Arthritis: Early signs

A

Joint stiffness (15 mins lasting)
Joint tenderness
Cant close fist
Loss of grip strength

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4
Q

Rheumatoid Arthritis:Longer signs

A

Multiple joints involved
Evidence of deformities in joints
Poor skin/ulceration
Severe limitation of movement

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5
Q

Rheumatoid Arthritis:Pathogenesis

A

Mass of tissue forms → Pannaus containing macrophage setc. (pro-inflammatory cells)
Mass of tissue (Pannaus) secrete enzymes that erodes cartilage and bone

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6
Q

Rheumatoid Arthritis:Serum

A

Seropositive

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7
Q

Spondyloarthropathies: General definition

A

Group of rheumatic diseases regarded as a variant of RA but distinct from it

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8
Q

Spondyloarthropathies:Main features

A
  1. A family of inflammatory joint diseases characterised by involvement of synovium and enthuse (tendon insertion sites)
  2. Leads to spinal and oligarticular peripheral arthritis in genetically predisposed (HLA B27) individuals
  3. Spine effected (high frequency)
  4. Multiple joints effects
  5. Bowel inflammation
  6. Eye inflammation
  7. Cytotoxic T cell inflammation (initiation) recognising antigen bound to HLA B27)
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9
Q

Spondyloarthropathies: Common types of spondylarthropathies

A
  1. Ankolysing spondylitis
  2. Reactive arthritis
  3. Psoriatic arthrisis
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10
Q

Spondyloarthropathies: Key features

A

Enteses →tendon insertion sites.

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11
Q

Ankolysing spondylitis: Definition

A

Ankolysing (fusion) spondylitls (arthritis of vertebrae) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine.

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12
Q

Ankolysing spondylitis: Characteristic features

A

Severe back pain
Early morning stiffness of effected joints
Dorsal pysphosis
Flatten lumbar lorodis
Flattened knee
Prominent abdominal folds
Severe limitation in movement in all planes

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13
Q

Ankolysing spondylitis: Common joints effect

A

Spine
Shoulder
Hip joint
Sacroliliac joints

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14
Q

Ankolysing spondylitis: Tendon insertion sites eroded

A

Pelvis ASIS etc.

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15
Q

Ankolysing spondylitis: Serology

A

Most markers of systemic markers elevated (CRP) (ESR).

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16
Q

Ankolysing spondylitis: Gross anatomy of spine

A

Formation of bony bridges uniting vertebraes

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17
Q

Ankolysing spondylitis: Epi

A

The male to female ratio: 5:1

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18
Q

Ankolysing spondylitis: Defining feature

A

Involves high frequency of inflammation at the enthese

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19
Q

Ankolysing spondylitis: 90% of the patients

A

Are HLA B27 positive compared to 6% of the unaffected individuals. Unique structure of HLA B27 suggest that CD8+ T-cells or natural killer cells are involved in pathogenesis

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20
Q

Ankolysing spondylitis: Serum

A

Seronegative – no rheumatoid factors in the blood

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21
Q

Ankolysing spondylitis: Prevalence

A

0.5-1.0% in Caucasians

22
Q

Ankolysing spondylitis: Mechanism of AS

A

HLA-B27 carry specific amino acids can bing to appropriate antigen that triggers AS

23
Q

Reactive arthritis: (Rieter’s syndrome) Definition

A

Initial arthritis can be described as antibodies and T-lymphocytes reacting with the bacterial antigens

24
Q

Reactive arthritis: (Rieter’s syndrome)Confirmation

A

Test synovial fluid and stain for bacteria associated with reactive arthritis

25
Q

Reactive arthritis: (Rieter’s syndrome)Treatment

A

Antibiotics?

26
Q

Reactive arthritis: (Rieter’s syndrome)Joint inflammation

A 
Occurs in 1-4% of the patients following enteric infection with:
1.	Salmonella
2.	Shigella
3.	Camplyolbacter
Yersinia
27
Q

Reactive arthritis: (Rieter’s syndrome) Pathogenesis

A

Bacterial component and T-cell eactive to these antigens can be found within the synovial membrane and synovial fluid

28
Q

Reactive arthritis: (Rieter’s syndrome) Epi

A

Male: female equal

29
Q

Reactive arthritis: (Rieter’s syndrome) Features

A

Skin lesions (keratoderma blenorrhagicum/pustulosis palmoplantaris)

30
Q

Reactive arthritis: (Rieter’s syndrome) 60-70% of patients

A

Are positive for HLA B27

31
Q

Psoriatic arthritis: Definition

A

Is an inflammatory skin disorder characterised by epidermal hyper-proliferation and abnormal keratinisation (skin)

32
Q

Psoriatic arthritis: Features

A

Typically effects small joints of hand
But Can also effect elbow and knee
Mirrored image

33
Q

Psoriatic arthritis:Joint involvement

A

Wrist
Phalanges
Shoulder
Metatarsals

34
Q

Psoriatic arthritis: Koebner phenononmen

A

Factors trigger (heat, tropical medicine, clothes) psoriasis to flare

35
Q

Psoriatic arthritis:Immune involvement

A

Eviden of involvement and production od pro-inflammatory cytokines (Il-1, TNF)

36
Q

Psoriatic arthritis:Epi

A

5-8% develop arthritis and the prevalence in Caucasians is between 0.2 and 0.1%

37
Q

Psoriatic arthritis:Treatment and explanation

A

Though to be a TH1 mediated disease because of the beneficial effects of cyclosporine (immunesuppressant) A and other anti-CD4 treatmetns

38
Q

Psoriatic arthritis:Antigen involved

A

Unknown but antigens derived from the keratinocytes or group A streptococci are possible candidates.

39
Q

Systemic Lupus erythematousus: Definition

A

An inflammatory multi-system disease associated with complement C4 deficiency

40
Q

Systemic Lupus erythematousus:Clinical features

A

Inflamamtion in various organ systems including skin and mucus membrane, joints, kidneys, brain,serous membranes, lung, heart, GI tract.

41
Q

Systemic Lupus erythematousus: Affect

A

Primarily women

42
Q

Systemic Lupus erythematousus: Common manifestation

A
  1. Arthritis but not erosive or destructive of bone
  2. Butterfly redness – from sunlight
  3. Any part of body exposed to sunlight
  4. Vasculitis
    → Small vessels effected = Necrosis around nails and skin of fingertips
  5. Acute arthritis may affect any joint but the small joints of the hands, wrist and knees are involved
  6. Soft tissue swelling and joint effusions present
43
Q

Systemic Lupus erythematousus: Pathological processes in SLE

A
  1. Inherited complement deficiencies
  2. Histocompatibility antigens – freqeuncy of HLA-A1, B* and DR3 is 3x greater in SLE than controls
  3. Sex hormones – SLE is 6-10x higher in females
  4. Polyclonal B-cell activation and multiple autoantibody production
44
Q

Systemic Lupus erythematousus: Recognisable feature

A
  1. Most cases are symmetric but asymmetric polyarthritis is also seen
45
Q

Crystal-related arthropathies: Epi

A

More common in men

40-60yrs

46
Q

Crystal-related arthropathies: Characterised

A

Acute attacks of arthritis

47
Q

Crystal-related arthropathies:Pathology

A

Urate crystals in synovial fluid from patients with gout

48
Q

Crystal-related arthropathies:Two types

A

Gout → Urate crystals

Pseudo Gout → different crystals calcium pyrophosphate dehydrate (CPD)

49
Q

Crystal-related arthropathies: Two genes associated with Gout

A

ABCG2

SLC2A9

50
Q

Crystal-related arthropathies: Long-term mechanisms and presentation

A

Tophi – accumulations of crystals
Crystals become coated with proteins in synovial fluid e.g. MSU crystal can become coated with IgU
Apolipoprotein coats the crystals and inhibits the recognition by pro-inflammatory cells

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