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Inflammation block > Seronegative inflammatory arthritis > Flashcards

Seronegative inflammatory arthritis Flashcards

1
Q

List the different types on inflammatory arthritis

A
  • RA
  • Undifferentiated inflammatory arthritis
  • Spondyloarthritis
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2
Q

Outline the different types of spondyloarthritis

A 
Axial SpA:
-ankylosing spondylitis
-Non radiographic axial SpA
Peripheral SpA:
-psoriatic arthritis
-Enteropathic arthritis
-Reactive arthritis
-Juvenile onset SpA
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3
Q

What is enthesitis

A

-Inflammation of the entheses, the sites where tendons or ligaments insert into the bone

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4
Q

What is enteropathic arthritis

A

A form of chronic, inflammatory arthritis associated with the occurrence of an IBD eg Crohn’s or UC

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5
Q

Outline the characteristics of axial spondyloarthritis (AxSpA)

A

-Men 3:1
-Age 20-40
-HLA B27+ (~5% of patients)
Symptoms=
-chronic low back pain
-Buttock/hip/neck pain
-Improves with exercise
-Night pain
-Morning stiffness>30mins
-Peripheral arthritis
-Enthesitis
-Dactylitis
-Elevated CRP

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6
Q

How can you diagnose non radiographic axial SpA?

A
  • MRI changes

- PLUS clinical suspicion

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7
Q

What are the features of SpA fractures?

A

-Inflammatory back pain
-Arthritis
-enthesitis(heel)
-uveitis
-dactylitis
-psoriasis
Crohn’s/colitis
-good response to NSAIDs
-Family history of SpA
-HLA-B27
-elevated CRP

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8
Q

How can we manage SpA?

A
  • NSAIDs
  • Exercise(physio& hydrotherapy)
  • Biologics eg Adalimumab may be used
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9
Q

How does psoriatic arthirits affect the synovial joints?

A
  • Inflammed synovial membrane
  • Enthesitis
  • Pannus
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10
Q

What is a pannus and what does it consist of?

A
  • An abnormal layer of fibrovascular tissue or granulation tissue
  • Major cell types= T lymphocytes, macrophages
  • Minor cell types= Fibroblasts, Neutrophils, dendritic cells, mast cells
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11
Q

What are the clinical features of psoriatic arthritis?

A
  • Peripheral arthritis
  • Axial disease
  • Enthesitis
  • Dactylitis
  • Skin & nail disease
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12
Q

What are the 3 main types of psoriatic arthritis?

A
  1. ) Polyarticular:
    - Involvement of many small joints usually in hands& feet
    - Most common
    - Rarely get rapid joint damage (Arthritis mutilans)
  2. )Oligoarticular:
    - Affects a few large joints
    - eg knee,ankle,elbow
  3. ) Spondyloarthritis:
    - Involvement of the sacroiliac joints& spine
    - Sometimes with an oligoarticular peripheral arthritis
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13
Q

What joint inflammation may occur in PsA?

A
  • DIP synovitis
  • PIP synovitis
  • Dactylitis
  • Asymmetric oligoarthritis
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14
Q

Outline the use of PsA in joint arthroscopy

A

A type of keyhole surgery used to diagnose and treat joint problems.

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15
Q

Outline the use of ultrasound in PsA

A
  • We use peri doppler
  • Within the inflammed joint you get increased blood flow& angiogenesis. We can use this to see how active/inflammed the joint is at a particular point in time
  • Black stuff= fluid within the joint
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16
Q

Outline the challenges in PsA

A
  • Diversity in clinical manifestations of psoriatic diease
  • Musculoskeletal manifestations & abnormal blood results not so obvious and may be difficult to diagnose
  • Many patients with PsA remain undiagnosed
  • Delays in diagnosis can lead to progression of the disease
17
Q

Outline the management of PsA

A

-NSAIDs
-DMARDS eg methotrexate,sulphasalazine
-Treatment escalation: 3 tender & 3 swollen joints; failure of 2 DMARDs
USE (as means of escalation) Apremilast & biologics

18
Q

What are fumaric ester acids used for

A

-Used in the treatment of psoriasis

19
Q

Outline the characteristics of reactive arthritis

A

-Asymmetric oligo-arthritis
-1 to 4 weeks post infection:
gastrointestinal& urogenital affected
-Good pneumonic to remember = ‘cant see(conjunctivitis). can’t pee(urethritis). Can’t climb a tree(Arthritis)

20
Q

Which bacteria can affect the GI system and so lead to reactive arthriris

A
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
  • C diffiicile
21
Q

What bacteria can affect the urogenital system and so lead to reactive arthritis

A
  • Chlamydia trachomatis

- Chlamydia pneumoniae

22
Q

Describe the muscular manifestations of PsA

A
  • Peripheral arthritis- often knee joint
  • Enthesitis
  • Dactylitis
  • Axial( low back pain)

extra articular:

  • Ocular( conjunctivitis, anterior uveitis, episcleritis, keratitis)
  • GU(dysuria, pelvic pain etc)
  • GI(diarrhoea)
  • Oral lesions, skin lesions, nail changes
  • Sometimes concomitant infection ( stool cultures; urine & genital swab)
  • Elevated acute phase reactants
  • HLA B27+ (30-50%)
  • Radiological changes
23
Q

Describe the management and prognosis of reactive arthritis

A
  • Clinical diagnosis
  • Treat with NSAIDs, steroids. DMARDs

VARIABLE PROGNOSIS:

  • Typically lasts 3-5 months
  • Complete resolution within 6-12months
  • 15-20% experience more persistent chronic arthritis
  • Can differentiate into another form of SpA
24
Q

Outline enteropathic arthritis

A

UC & Crohn’s disease:

  • Estimated to occur in 6-46% of patients with IBD
  • Peripheral arthritis (relapsing remitting)
  • Axial involvement
  • Enthesitis & dactylitis
  • Manage with NSAIDs& glucocorticoids
25
Q

Outline the genetics of SpA

A
  • Strong MHC class 1 pathway association(eg HLA-B27 Region)
  • SNPs
  • 30-40% heritability in twin studies
  • IL-17A(one of the most important inflammatory cytokines in this condition) is secreted by many cells including TH17 and Tc17 cells
  • Clear role for the IL17/23 pathway-similar to spondyloarthritis& psoriasis
26
Q

List the key inflammatory cytokines in inflammatory arthritis

A

IL-17/23 = psoriasis, PsA, SpA
IL-6= RA &GCA
TNF-alpha: JIA/AID
IL-1: gout

27
Q

What are tissue resident memory T cells?

A
  • Memory T cells that remain persistent in tissues& organs in the absence of antigen stimulation
  • Respond rapidly to pathogen challenge
  • Shown to express markers including CD69 & CD103
28
Q

Outline the characteristics of reactive arthritis

A

-Asymmetric oligo-arthritis

1 to 4 weeks post infection:

  • GI (Salmonella, Shigella, Yersinia, Campylobacter, C difficile)
  • Urogenital (Chlamydia Trachomatis. Chlamydia pneumoniae)

-CAN’T SEE; CAN’T PEE; CAN’T CLIMB A TREE
Conjuncvitis
Urethritis
Arthritis

29
Q

How can we diagnose reactive arthritis

A

-Sometimes concomitant infection: take stool cultures, urine and genital swab
-Elevated acute phase reactants
HLA B27+ 30-50%
-Radiological change s

Inflammation block (27 decks)

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