Path 2.5

Question 1

spondyloarthropathies and characteristics

Answer 1

inflamm d/o around entheses w/ unknown etiology; commonly RF neg, HLA-B27, fhx, radiographic SI-itis

Question 2

spondyloarthropathies commonly affect?

Answer 2

entheses, spinal joints (SI, spondylitis), peripheral joints, extraarticular manifestations

Question 3

HLA-B27 fxn

Answer 3

HLA-B allele of MHC I –> present ag to CD8

Question 4

arthritogenic peptide hypothesis

Answer 4

B27 binds and presents arthritogenic peptides to CD8 –> cross recognize self peptides or other peptides bound to B27 –> can recognize bacterially non/infected cells

Question 5

which self peptides can activate CD8?

Answer 5

Type IV collagen (in fibrocartilage, component of entheses), vasoactive intestinal peptide receptor (VIP1R)

Question 6

enthesitis vs cartilaginous joint arthritis vs synovial joint arthritis involves?

Answer 6

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)

Question 7

SI joint characteristics (3)

Answer 7

true diarthrodial/synovial joint; hyaline cartilage + fibrocartilage, discontinuous posterior capsule; articular surfaces w/ ridges –> min movement and better stability

Question 8

SI-itis

Answer 8

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

Question 9

oss of annulus fibrosus vs nucleus pulposus

Answer 9

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

Question 10

pathology: involving vert synovial joints vs peripheral entheses vs peripheral synovial joints

Answer 10

apophyseal joints, costovertebral joints vs Achilles tendon, plantar fascia, costosternal jxns, manubriosternal joint, pubis symphysis vs hip, shoulder, knee

Question 11

bamboo spine

Answer 11

rigid spine: ant/post longitudinal ligaments, apophyseal joints, annulus fibrosus = ossified

Question 12

ankylosing spondylitis clinical pres

Answer 12

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

Question 13

how to test spine stiffness: flesche test vs schober test

Answer 13

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

Question 14

extraskel manifestations of ankylosing spondylitis

Answer 14

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

Question 15

labs of anklyosing spondylitis

Answer 15

high ESR, CRP, ALP (active oss); mild leukocytosis, anemia; RF neg; pos HLA typing

Question 16

anklyosing spondylitis imging of which joints?

Answer 16

radiographic changes of SI (required for AS dx), discovertebral, apophyseal, costovertebral, costotransverse joints

Question 17

ankylosing spondylitis complications

Answer 17

osteopenia, cervical fx; amyloidosis (accum serum amyloid A –> chronic inflmm –> deposits in organs –> heart/renal failure), proteinuria, peripheral edema

Question 18

tx for ankylosing spondylitis

Answer 18

none specifically. NSAIDs, DMARDs, PT

Question 19

Reactive arthritis/Reiter syndrome

Answer 19

autoimmune dz from GI or GU infxn cause by Salmonella, Shigella, Yersinia, Camplyobacter, Chlamydia

Question 20

sxs of Reactive arthritis/Reiter syndrome

Answer 20

abd pain, diarrhea; pelvic pain, dysuria; arthritis, enthesitis, dactylitis, back pain, SI-itis, asymmetric oligoarthritis

Question 21

extraarticular sxs of Reactive arthritis/Reiter syndrome

Answer 21

conjunctivitis; keratoderma blenoorhagica, hyperkeratotic skin lesions

Question 22

labs vs img for Reactive arthritis/Reiter syndrome

Answer 22

high acute phase proteins, neu in synovial fluid; HLA B27 pos vs SI-itis an syndesmophytes

Question 23

enteropathic arthropathies. examples?

Answer 23

spondylitis + SI-itis + IBD. Crohn’s and ulcerative colitis

Question 24

2 joint manifestations in pts w/ IBD

Answer 24

SI-itis w/ or w/o spondylitis; peripheral arthritis of lg and sm joints. both assoc w/ HLA B27

Question 25

pathogenesis of enteropathic arthropathies

Answer 25

unclear.
Theory 1: molec mimicry: immunity against gut ag cross reacting w/ nml host protein
Theory 2: HLA B27 gut immunocompetent cells migrate to synovium via adhesion molec –> inflamm arthritis