Path 2.5 Flashcards
spondyloarthropathies and characteristics
inflamm d/o around entheses w/ unknown etiology; commonly RF neg, HLA-B27, fhx, radiographic SI-itis
spondyloarthropathies commonly affect?
entheses, spinal joints (SI, spondylitis), peripheral joints, extraarticular manifestations
HLA-B27 fxn
HLA-B allele of MHC I –> present ag to CD8
arthritogenic peptide hypothesis
B27 binds and presents arthritogenic peptides to CD8 –> cross recognize self peptides or other peptides bound to B27 –> can recognize bacterially non/infected cells
which self peptides can activate CD8?
Type IV collagen (in fibrocartilage, component of entheses), vasoactive intestinal peptide receptor (VIP1R)
enthesitis vs cartilaginous joint arthritis vs synovial joint arthritis involves?
involves annulus fibrosus of intervertebral disc, achilles tendon, plantar fascia vs involves intervertebral joint => spondylitis vs involves SI joint, intervertebral apophyseal joint, costovertebral joint, peripheral joints (hips, shoulders, knees)
SI joint characteristics (3)
true diarthrodial/synovial joint; hyaline cartilage + fibrocartilage, discontinuous posterior capsule; articular surfaces w/ ridges –> min movement and better stability
SI-itis
lesion in subchondral bone, fibrin on surface cartilage –> inflamm and granulation –> cartilage metaplasia –> dec joint space –> bone metaplasia of articular cartilage and fusion –> SI joint disappears
oss of annulus fibrosus vs nucleus pulposus
lymphocytic infiltration of enthesis –> granulation tissue –> oss (fibroblasts –> osteoblasts) –> syndesmophytes form and create bony ridges vs inflamm and granulation tissue erodes lateral syndesmophytes –> oss –> fusion and immobilization of vert
pathology: involving vert synovial joints vs peripheral entheses vs peripheral synovial joints
apophyseal joints, costovertebral joints vs Achilles tendon, plantar fascia, costosternal jxns, manubriosternal joint, pubis symphysis vs hip, shoulder, knee
bamboo spine
rigid spine: ant/post longitudinal ligaments, apophyseal joints, annulus fibrosus = ossified
ankylosing spondylitis clinical pres
dull inflamm pain in SI joint and spine, morning stiffness >30min, improvement w/ moderate physical activity (not rest); stooped forward-flexed position –> neck and hip flexion deformity, thoracic kyphosis, lost nml lumbar lordosis; peripher enthesitis, dactylitis
how to test spine stiffness: flesche test vs schober test
cervical ROM, stand against wall, measure inin to wall vs lumbar ROM, mark midpoint/5cm below/10cm above L5 erect, touch toes; if distance inc by <5cm –> lumbar flexion restriction
extraskel manifestations of ankylosing spondylitis
acute anterior uveitis (inflamm eye’s midlayer); aoritis of ascending aorta an aortic valve regurg; restricitve lung dz, emphysema; idiopathic IBD, ulcers of ileal and colonic mucsoa –> asx
labs of anklyosing spondylitis
high ESR, CRP, ALP (active oss); mild leukocytosis, anemia; RF neg; pos HLA typing
