Rheum 4 - Seronegative Spondyloarthropathies

Question 1

Spondyloarthropathies include what

Answer 1

Anklyosing spondylitis
Psoriatic arthrtis
Reactive arthritis (after infection)
Enteropathic arthritis (IBS)
Juvenile ankylosing spondylitis

Question 2

HLA

Answer 2

Human leukocyte antigens
Major histocompatability complex
On chromosome 6
Primary genes that determine immuno response patterns
Encode human leukocyte antigens
REgion encodes for neumerous genes associated with a variety of autoimmune diseases

Question 3

HLA B27 disease associations

Answer 3

Ankylosing spondylitis = more than 90% association
Reactive = 85%
Reiters = 80%
IBD = 50%

Question 4

Ankylosing spondylitis is what

Answer 4

Chronic inflammatory disease of the SI joints and spine

Characteristic extra spinal features - enthesitis, synovitis, inflmmatory eye disease

Question 5

Ankylosing spondylitis - epidemiology

Answer 5

0.5 - 1% US caucasians

6% Haida native americans

Question 6

Ankylosing spondylitis - description

Answer 6

Primarily an axillary arhtropathy 
Presents with inflammatory back pain
Spinal discomfort and stiffness gradually ascend the spine and may lead to loss of motion and spinal fusion
Avg age onset is 26
M:F = 5:1

Question 7

Ankylosing spondylitis - characteristcs of back pain

Answer 7

Onset = before age 40, is insidious with common night pain

Duration of greater than 3 months

Inflammatory back pain - presetn greater than 3 months, associated with mronign stiffness, improves with exercise

Question 8

Ankylosing spondylitis - nonvertebral symptoms

Answer 8

Asymmetric peripheral arthritis
Sausage digits
Enthesopathy - plantar fasciitis = ex
Aortic valvular disease
Cardiac conduction abnormalities
Apical pulmonary fibrosis
Iritis (red eye, sens to light)
Costochondritis

Question 9

Psoriatic arthritis - what is it

Answer 9

Heterogenous disease presenting with features of spondyloarthropathies, RA or both

Question 10

Psoriatic arthritis - prevalence

Answer 10

Psoriasis = 2%
PA = 0.1%
In patients with psoriasis is 5-7% (other lecture says 5-20%)

Question 11

Psoriatic arthritis - onset

Answer 11

Psoriasis is 5-15 years, peak around teens or 20s and then also in 50s or 60s
PA = 30-55 years

Male:Female is 1:1

Question 12

Psoriatic arthritis - patterns

Answer 12

Oligoarticular asymmetric arthritis - 4 joints or fewer and is often larger joints
Polyarticular symmetric arthritis - similar to RA
Spondylitis
DIP arthritis
Arthritis mutilans = very destructive

Question 13

Psoriatic arthritis - clinical characteristics

Answer 13

Negative RF and anti CCP antibodies
Asymmetric pattern of joitn invovlement
Sausage digits 
Nail pitting or onysholysis
Inflammatory arthritis of DIP 
Enthesopathy 
No rheumatoid nodules

Question 14

Reactive arthritis - what is it

Answer 14

Reiters syndrome
Form of peripheral arthritis with one or more extra articular menifestation that occurs after urogenital or GI infection
Urogenital = chlamydia
GI = salmonella, shigella, campylobacter

Question 15

Reactive arthritis - keratoderma

Answer 15

Waxy papules - usually on palms or soles of hands and/or feet

Question 16

Reactive arthritis - prognosis

Answer 16

Typically self limiting disease - may only require NSAID tx
Can last for a range of time - may have chronic or relapsing course
HLA - B27 positive indivduals may have worse prognosis

Question 17

Enteropathic arthritis is what

Answer 17

Arthropathy associated with IBD

• Crohns, ulcerative colitis
• 10-20% develop peripheral arthritis (may reflect underlying bowel inflammation)
• 10% with spondylitis

Whipples disease = rare, multisystem disease related to gut infection with tropheryma whippelii

Question 18

Treatment

Answer 18

Simialr to RA
NSAIDs
DMARDs
Biologics