Seronegative Spondyloarthritis B&B

Question 1

spondylo =

Answer 1

spine

Question 2

what are the 4 types of seronegative spondyloarthritis?

Answer 2

aka spine joint inflammation negative for rheumatoid factor

1. ankylosing spondylitis
2. psoriatic arthritis
3. inflammatory bowel disease
4. reactive arthritis

all autoimmune disorders mediated by T-cells, unknown trigger/cause

Question 3

all forms of seronegative spondyloarthritis are autoimmune disorders mediated by…

Answer 3

T cells

1. ankylosing spondylitis
2. psoriatic arthritis
3. inflammatory bowel disease
4. reactive arthritis

Question 4

how does the arthritis of seronegative spondyloarthritis differ from that caused by rheumatoid arthritis?

Answer 4

seronegative spondyloarthritis: asymmetric oligoarthritis, often lower extremities

rheumatoid arthritis: symmetric polyarthritis (5+ joints), often involves hands

Question 5

enthesitis

Answer 5

inflammation of ligament/tendon attachment to bone

Question 6

which HLA gene is very common in patients with spondyloarthritis disorders?

Answer 6

HLA B27

ex, 90% of patients with ankylosing spondylitis, 50% of psoriatic arthritis

Question 7

how does ankylosing spondylitis typically present?

Answer 7

classic form of seronegative spondylitis caused by new bone formation in spine —> stiffness, inflammatory back pain which improves with exercise but NOT rest, pain at night but better with awakening

more common in males 20-30yo, insidious onset

Question 8

what does a “bamboo spine” finding indicate?

Answer 8

aka fused vertebra seen on x-ray due to inflammation + syndesmophytes (bone protuberances)

finding of ankylosing spondylitis

Question 9

where does enthesitis classically occur?

Answer 9

aka inflammation of tendon insertions to bone - classically affects insertions of Achilles tendon to calcaneus —> heel pain

Question 10

what cardiac dysfunction is common in patients with ankylosing spondylitis?

Answer 10

classic form of seronegative spondylitis caused by new bone formation in spine

many patients have aortitis which leads to aortic regurgitation

Question 11

Pt is a 25yo M presenting with slow onset of inflammatory back pain, heel pain, and swollen fingers. The back pain is worst at night and improves with exercise. X-ray reveals bamboo spine. ESR and CRP are elevated, and the patient is HLA B27 positive. What is the diagnosis, and what type of mAb can be used to treat this patient?

Answer 11

ankylosing spondylitis: classic form of seronegative spondylitis caused by new bone formation in spine (many extra-spine effects), can treat with anti-TNF mAb (infliximab)

heel pain - enthesitis (tendon inflammation)
swollen fingers - dactylitis
ESR/CRP - acute phase inflammatory reactants
may also present with uveitis or aortitis (—> regurgitation), restrictive lung disease (decreased chest wall mobility)

Question 12

patient with psoriasis presenting with nail findings such as pitting, onycholysis (separation from nail bed), or hyperkeratosis =

Answer 12

patient also has psoriatic arthritis

nail findings in 46% of uncomplicated psoriasis but 90% of psoriatic arthritis

Question 13

how does psoriatic arthritis present? contrast this to rheumatoid arthritis

Answer 13

form of seronegative spondyloarthritis, presents with asymmmetric polyarthritis (5+ joints) that causes morning stiffness but improves with use (contrast to RA which is symmetric)

affects DIP joints (distal inter-phalangeal), dactylitis, heel pain (enthesitis)

Question 14

what are the 2 patterns of seronegative spondyloarthritis see with inflammatory bowel disease (Crohn’s or ulcerative colitis)?

Answer 14

Type 1: <5 large joints (knees, hips, shoulders), symptoms flare with GI disease

Type 2: >5 small joints of hands, independent of GI disease

Question 15

what makes reactive arthritis different from arthritis caused by spread of infection to joints?

Answer 15

reactive arthritis: autoimmune form of spondyloarthritis, occurs days-weeks after infection

usually resolves 6-12 months

Question 16

what type of pathogens trigger reactive arthritis?

Answer 16

reactive arthritis: autoimmune form of spondyloarthritis, occurs days-weeks after infection

GI bacteria - those that cause diarrhea (salmonella, shigella, yersinia, campylobacter, C. diff)

urogenital - chlamydia trachomatis

Question 17

Pt is a sexually active F presenting with asymmetric oligoarthritis affecting the lower extremities, enthesitis (heel pain), inflammatory low back pain, and conjunctivitis. Pt does not recall having a recent infection; however, blood test is positive for a pathogen. What pathogen is most likely, and what is the diagnosis?

Answer 17

reactive arthritis following chlamydia trachomatis infection (usually asymptomatic)

reactive arthritis - autoimmune, occurs days-weeks following infection

can also be triggered by diarrhea-causing GI bacteria