Seronegative Spondyloarthropathies Flashcards
What are Seronegative Spondyloarthropathies( Axial Arthropathies)?
lecture by Sterling West,MD,MACP
A cluster of interrelated chronic inflammatory diseases including: Ankylosing spondylitis Reactive arthritis Psoriatic arthritis Inflammatory bowel disease
What is the hallmark of Seronegative Spondyloarthropathies?
They inflame the enthesis (not ligament, tendon or bone –> the insertion site)
What are some features of seronegative spondyloarthropathies?
Sacroilliitis and spondylitis Negative rheumatoid factor Asymmetrical arthritis Enthesitis Extraarticular manifestations Familial and racial aggregation HLA-B27
Which race is most effected by seronegative spondyloarthropathies?
Caucasians
What are symptoms of ankylosing spondylitis?
Men > women 3:1 - often starts in teens Inflammatory back pain Age 3 months Morning (>60 min) and night time stiffness Improves with activity No neurologic symptoms
What exam items should be looked at in someone with ankylosing spondylitis?
Global loss of spinal range of motion Schobers maneuver 10 cm -15 cm normal Occiput to wall Chest expansion 4 cm Patrick test - Fabere maneuver
what clinical feature is in 100% of patients with ankylosing spondylitis?
Sacroiliitis
What are some treatments for ankylosing spondylitis?
P.T. exercise (aerobic, strength, flexibility) and smoking cessation.
Indocin best of the NSAIDS in these illnesses
Sulfasalazine and Methotrexate good for peripheral arthritis
Anti-TNF agents good for axial arthritis
What are poor prognostic signs for ankylosing spondylitis?
Hip disease or, Three of the following: Onset< age 16 Limitation of spine motion Oligoarthritis Sausage digit High ESR or CRP Poor efficacy of NSAIDs
What is Reactive Arthritis?
Formerly called Reiters disease Lower extremity joints – Asymmetrical Sacroiliitis is asymetrical Sausage digits Enthesitis Rash (keratoderma blennorragica, circinate balanitis, oral, nails)
What are the demographics of Reactive Arthritis?
M>F 5-10:1
Caucasians> other races
What is the symptom progression of reactive arthritis?
Starts with G.I. infection with Shigella , Salmonella,yersinia or Campylobacter OR G.U. infection with Chylamdia Followed by Urethritis Conjunctivitis Arthritis (enthesitis)
What is the treatment of reactive arthritis?
Treatment: PT, intraarticular steroids, NSAIDs, sulfasalazine, MTX, anti-TNF
Treat chlamydia-induced with doxycycline for 3 months. Antibiotics don’t work for diarrhea-induced organisms
What is the course of Reactive Arthritis?
Duration 3-5 months
Often chronic mild symptoms for 1 year
Chronic arthritis with disability in 15%
What are clinical features of PsA (Psoriatic arthritis)?
Arthritis, Dactylitis/sausage digits,Enthesitis,
Tenosynovitis, Sacroiliitis/spondylitis. Psoriasis, Nail pitting, Onycholysis, Conjunctivitis/iritis/uveitis, Aortitis- rare.
Which condition may be difficult to distinguish from RA?
Symmetric Polyarticular Arthritis
Not many diseases cause inflammation of the DIPs, what is this an indication of?
Psoriatic arthritis
What is Arthritis Mutilans?
Findings of telescoping digits and flail joints associated with extensive osteolysis and joint instability describe the condition.
How can you differentiate nail changes in dactylitis from a fungal infection?
dactylitis won’t affect all finger nails, a fungal infection usually will.
What are features of Enteropathic Arthritis?
10-40 % of ulcerative colitis and Crohns have peripheral inflammatory arthritis
Peripheral arthritis correlates in 60% with activity of bowel disease
Peripheral arthritis tends to be large joint and recurrent. Not severly destructive.
Sacroiliitis and spondylitis in 10-15%. Looks like AS. Associated with HLA-B27(50%). Does not correlate with bowel disease.
What is HLA-B27?
Class I MHC antigen on the surface of all cells
24 subtypes
Binds intracellular antigens in ER and presents them to CD8+ T cells
What happened when they experimented with putting HLA-B27 in rats?
Put human HLA-B27 gene in rat, and then the rat got a lot of the same symptoms of A.S.
But when they raised the rat in a sterile environment, without bacteria in food, the signs and symptoms do not appear.
So it is a combination of the gene and a bacterial catalyst.
