Rheumatology: Spondyloarthropathies

Question 1

What’s the genetic association with spondyloarthropathies?

Answer 1

HLA-B27

Question 2

Which joints are most affected?

Answer 2

SI joint
Spine
(psoriatic arthritis in 10% can have feet/ DIP problems)

Question 3

What do they call it when the fingers are all swollen and enlarged?

Answer 3

Sausage fingers

Question 4

How is this different from RA?

Answer 4

• Young males is more common (than female childbearing age)
• NO RHEUMATOID FACTOR
• Back problems, pain
• not symmetrical distribution

Question 5

What different conditions are classified as spondyloarthropathies?

Answer 5

• Ankylosing spondylitis (AS)
• reactive arthritis
• psoriatic arthritis
• the arthropathies associated with regional enteritis (Crohn’s disease) and ulcerative colitis

Question 6

Where in the joint is the inflammation? (Be specific)

Answer 6

The enthesis
Enthesitis is inflammation of ligamentous, tendinous, and fibrous structures as they insert into bone
(Achilles tendon, annulus fibrosis, plantar fascia, joint capsules)

Question 7

Who is the stereotypical patient of ankylosing spondylitis and reactive arthritis? (age. sex, race)

Answer 7

White male ages 16-40

**Younger than someone typically with OA

Question 8

What would the patient tell you about the conditions history of ankylosing spondylitis?

Answer 8

• Insidious onset of pain lasting > 3 months
• Prolonged morning stiffness (> 30-60 minutes)
• Improvement of pain with exercise

Question 9

What other manifestations could you see in ankylosing spondylitis, not in the joints?

Answer 9

• Uveitis
• aortitis (leading to aortic regurgitation)
• osteoporosis
• Microscopic colitis

Question 10

In reactive arthritis, what usually precedes the patients onset of arthritis?

Answer 10

infectious diarrhea or

urethritis due to chlamydia

Question 11

Describe the most common forms of arthritis in reactive arthritis?

Answer 11

• Asymmetric, oligoarticular, predominately lower extremity arthritis - knees and ankles most common.
• Dactylitis (20-50%) - diffusely swollen toes (sausage digit) due mainly to tendon inflammation.
• 25% also have axial back problems

Question 12

T/F: in reactive arthritis, hips are usually spared

Answer 12

True

which is very different from ankylosing spondylitis

Question 13

What are the theories of how HLA-B27 can predispose a person to develop AS? (our facilitator said they like to ask)

Answer 13

• Arthritogenic peptide hypothesis
• Molecular mimicry
• Free heavy chain hypothesis
• Unfolded protein hypothesis

Question 14

What’s another name for reactive arthritis?

Answer 14

Reiter syndrome

characterized by arthritis, urethritis, and conjuctivitis

Question 15

True/ False: Having HLA-B27 is indicative of getting the disease

Answer 15

False

About 6% of caucasians have gene, but much fewer have condition