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Blood and Lymph Unit 3 > Rheumatology: Axial Arthropathies > Flashcards

Rheumatology: Axial Arthropathies Flashcards

1
Q

What are the group of diseases known as axial arthropathies characterized by?

A
  1. Axial arthritis
  2. Peripheral arthritis
  3. Enthesitis
  4. Mucocutaneous lesions
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2
Q

The pathogenesis of axial arthropathies is unknown, but it is strongly associated with what?

A

HLA-B27 and unknown infecious agent

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3
Q

What three demographics are found most often in ankylosing spondylitis?

A
  1. Men > Women
  2. Between 16-40 years
  3. Caucasians
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4
Q

All patients with ankylosing spondylitis have inflammatory back pain characterized by…

A
  1. Insidious onset of pain lasting > 3 months
  2. Prolonged morning stiffness ( > 30-60 minutes)
  3. Improvement of pain with exercise
  4. No neurological sequelae
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5
Q

What would you find on physical examination of a patient with ankylosing spondylitis?

A
  • SI joint tenderness
  • Global loss of spine range of motion
  • Late in disease course may find back deformities and reduced chest expansion
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6
Q

What percent of patients with AS also have peripheral arthritis?

A

25%- Hip and shoulder

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7
Q

What are synchondroses?

A

Areas of cartilaginous union with bone. This includes manubriosternal joint, costovertebral joints, and pubic ramis

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8
Q

Name some extraarticular manifestations of AS.

A
  1. Acute anterior uveitis- 25%
  2. Osteoporosis
  3. Microscopic colitis
  4. Pulmonary apical fibrosis
  5. Cardiovascular disease
  6. Cauda equina syndrome
  7. Amyloidosis
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9
Q

Which of the following tests would be positive or negative for a patient with AS:

  • ESR
  • ANA
  • RF
A

ESR- positive
ANA- negative
RF- negative

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10
Q

What percentage of sarcoiliitis is found in patients by age 45?

A

100%

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11
Q

What three deomgraphics are found most often in patients with reactive arthritis?

A
  1. Males> Females
  2. Onset occurs from childhood to age 40-50
  3. Caucasians
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12
Q

What precedes the onset of reactive arthritis?

A

History of infectious diarrhea or urethritis which precedes by 2-4 weeks

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13
Q

What microorganisms cause the diarrhea preceding reactive arthritis?

A

Shigella
Salmonella
Yersinia
Camphylobacter

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14
Q

What microorganism causes urethritis preceding reactive arthritis?

A

Chlamydia

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15
Q

What is the site of reactive arthritis?

A

Inflammatory peripheral arthritis, typically lower extremities

Inflammatory back pain symptoms

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16
Q

How does the peripheral arthritis associated with reactive arthritis present?

A

Asymmetric, oligoarticular, and predominately lower extremity arthritis (knee and ankles)

Dactylitis- Diffusely swollen toes due to tendon inflammation

17
Q

What percentage of reactive arthritis patients experience inflammatory back disease?

18
Q

What is enthesopathy and what percentage of patients with reactive arthritis have it?

A

Pathology of tendons

-Achilles tendinitis and/or plantar fasciitis in 20% of patients

19
Q

Name three extraarticular manifestations of reactive arthritis.

A
  1. Inflammatory eye disease- conjunctivitis (50%) and acute uveitis (20%)
  2. Mucocutaneous lesions (20%)
  3. Aortitis and cardiac conduction defects (rare)
20
Q

What are the results of the following tests of a patient with reactive arthritis?

  • ESR
  • ANA
  • RF
A

ESR- Positive
ANA- Negative
RF- Negative

21
Q

Describe colitic arthropathies.

A
  • Inflammatory peripheral arthritis occurs in 10-20%

- Axial arthritis involving sacroiliac joints and spine occurs in 5% of patients and resembles AS

22
Q

Describe psoriatic arthritis.

A
  • 10% of patients with psoriasis will develop peripheral and/or axial
  • Inflammatory peripheral arthritis predominantly involves upper extremities especially DIP, PIP, and MCP (asymmetric )
  • Axial arthritis in 5-10% of psoriatic arthritis pts.
23
Q

What is the strongest of all associations with anklyosing spondylosis?

A

Over 90% of Caucasians with AS are HLA-B27 positive

24
Q

What percentage of the general population have AS?

25
Q

What is the chance of developing AS for individuals that are HLA-B27 positive?

What if the patient is HLA-B27 positive and has a first-degree relative with AS?

A

1-2%

10-20%

26
Q

What is enthesis?

A

Inflammation of ligamentous, tendinous, and fibrous structures as they insert into bone.

27
Q

What are the inflammatory infiltrates involved in enthesis?

A

Macrophages
T cells
Cytokines

28
Q

What are the four possible theories of how HLA-B27 can predispose a person to developing AS?

A
  1. Arthitogenic peptide hypothesis
  2. Molecular Mimicry
  3. Free heavy chain hypothesis
  4. Unfolded protein hypothesis
29
Q

How is arthritis triggered in reactive arthritis?

A

Monocytes transport bacteria either alive or dead to the joints

30
Q

Which bacterium reaches the joint alive in reactive arthritis?

A

Chlamydia which causes urethral infections

31
Q

Which bacteria reach the joint dead in reactive arthritis?

A

Yersinia, salmonella, and shigella in monocytes

32
Q

What is the cytokine response seen in reactive arthritis?

A

High IL-4, IL-10

33
Q

Name some treatments for AS?

A 
Back exercises
Good posture 
Smoking cessation
NSAIDS- limit formation of new bone growth
Antibiotics 
Anti-TNF biologic

Blood and Lymph Unit 3 (12 decks)

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