Rheumatology: Spondyloarthropathies

Question 1

Ankylosing spondylitis affects?

Answer 1

males>females, 16-40yo, Caucasians

Question 2

What are the s/s of ankylosing spondylitis?

Answer 2

inflammatory back pain (insidious, prolonged morning stiffness, improvement with exercise, no neuro sequelae), SI joint tenderness, loss of ROM, deformities and reduced chest expansion

Question 3

Ankylosing spondylitis frequently affects _____, which are areas of cartilaginous union with bone.

Answer 3

the enthesis

Question 4

What labs and radiologic findings will be seen in ankylosing spondylitis?

Answer 4

elevated ESR, negative RF, negative ANA; sacroiliitis with bone erosion and sclerosis; radiographic spondylitis; inflammatory hip disease

Question 5

Reactive arthritis affects?

Answer 5

males>females, childhood to age 40-50, Caucasians

Question 6

What are the s/s of reactive arthritis?

Answer 6

infectious diarrhea or urethritis preceding peripheral arthritis (asymmetric, lower extremities); dactylitis; enthesopathy (Achilles tendonitis or plantar fasciitis); eye disease, mucocutaneous lesions, heart problems

Question 7

What labs and radiologic findings will be seen in reactive arthritis?

Answer 7

elevated ESR, negative RF, negative ANA; erosive changes of feet, ankles, and sometimes knees; SI joint and spine abnormalities; erosion and calcification of enthesis insertion

Question 8

What organisms cause the diarrhea in reactive arthritis?

Answer 8

shigella, salmonella, Yersinia, or campylobacter

Question 9

What organisms cause the urethritis?

Answer 9

chlamydia

Question 10

Name the extra-articular manifestations of ankylosing spondylitis.

Answer 10

1. acute anterior uvetis (25%) 2. osteoporosis (19-62%) 3. micro. colitis (22-69%), Crohn’s-like lesions (7%) 4. pulm. atypical fibrosis (2%) 5. CV disease (10%) 6. cauda equine syndrome 7. amyloidosis

Question 11

What is another name for complete spinal fusion that 10% of ankylosing spondylitis pts get?

Answer 11

bamboo spine

Question 12

What is the associated allele in ankylosing spondylitis?

Answer 12

HLA-B27

Question 13

What is the clinical hx for reactive arthritis pts?

Answer 13

infectious diarrhea or urethritis 2-4 weeks prior to arthritis beginning

Question 14

What extraarticular finding are assoc. with reactive arthritis?

Answer 14

inflammatory eye disease (conjunctivitis/acute anterior uveitis) mucocutaneous lesions (painless oral ulcers, balanitis, keratoderma blennorrhagicum) aortic/heart defects

Question 15

What are the colitic arthropathies?

Answer 15

inflam. peripheral arthritis in pts with IBS following activity of bowel disease OR axial arthritis in SI/spine resembling AS not following activity of bowel disease

Question 16

What is psoriatic arthritis?

Answer 16

psoriasis pts that get peripheral and/or axial arthritis, but skin disease does not correlate to arthritis severity. Mostly upper extremities esp DIPs, PIPs, and MCPs, asymmetric; dactylitis. Resembles reactive arthritis in spine.

Question 17

What is the primary and unique pathologic site in spondyloarthropathies?

Answer 17

the enthesis

Question 18

Name 5 theories as to why HLA-B27 can predispose a pt to develop AS.

Answer 18

1. arthritogenic peptide hypothesis (peptides bind to HLA-B27 and are presented to CD8+) 2. molecular mimicry 3. free heavy chain hypothesis (can form homodimers that can activate NK cells directly) 4. unfolded protein hypothesis (propensity to misfold, causing stress response and increased cytokines) 5. inflammation and calcification (aggregan in cartilage is released, causing inf)

Question 19

What is the treatment for the spondyloarthropathies?

Answer 19

back exercises and good posture smoking cessation NSAIDs (indomethacin, tolmetin) steroids sulfasalazine/methotrexate anti-TNF agents

Question 20

What is the treatment for reactive arthritis?

Answer 20

tetracycline, erythromycin, quinolone (bc of initial infections)