Seronegative Spondyloarthropathies Flashcards
Is rheumatoid factor positive in spondyloarthropathies?
NO
What gene are spondyloarthropathies assoicated with?
HLA-B27
What are characteristic musculoskeletal features of spondyloarthropathies?
axial skeleton involvement with sacroilitis and spondylitis
What are enthesitis?
inflammation at the sites where tendons and ligaments attach to bone
What is HLA-B27?
MHC class I molecule that binds antigenic peptides and presents them to CD8+ T cells
What does the presence of HLA-B27 lead to?
increased disease susceptibility and severity.
What cytokine is highly increased in Ankylosing Spondylitis?
TNF-alpha excess
When are symptoms bad in AS?
in the morning and they improve with exercise
How common is peripheral joint involvement in AS?
1/3 of patients (usually in lower limbs)
Why can a person with AS not touch their toes?
bony fusion of spine (leads to decrease of spinal flexibility)
What are hints that your patient has aortic insufficiency? (complication of AS)
low diastolic
increased systolic
What are some physical findings of AK?
Abnormal Schober’s test
Reduced chest expansion
Increased occiput to wall distance
What is codfishing of the spine?
inflammation at the margin of the vertebral bodies will eat away at the bones and “square them”
What are some extra-articular features of AK (eye)?
-Anterior Uveitis
ribs)
What are some extra-articular features of AK (heart)?
- Aortic regurgitation (heart block)
- MI
What are some extra-articular features of AK (lungs)?
-Pulmonary (apical lung fibrosis, thoracic cage restriction due to ankylosis of costovertebral joints of
What drugs are used to treat AK axial disease?
NSAIDs
TNF blockers
What drugs are used to treat AK peripheral disease?
NSAIDs
sulfasalazine
local corticosteroids
TNF blockers
What is Reiter’s Syndrome (reactive arthritis)?
Arthritis due to inflammation that arises after an infectious process
What is the classic triad of reactive arthritis?
- Arthritis
- Urethritis (burning with urination with either GI or GU pathogen!)
- Conjunctivitis
What disease is Reiter’s syndrome VERY COMMONLY associated with?
HIV/AIDS
What is keratoderma glennorrhagia?
psoriasis-like rash located on palms and soles of feet
Waht are lab tests used to diagnose Reiter’s syndrome?
- elevated ESR, CRP
- Unusual to have positive culture
- Get serology for potential pathogens
- Consider HIV
- Measure B27
How long do symptoms of Reiter’s syndrome last?
2-3 months
or 20-50% demonstrate a chronic course
What are some clinical patterns of psoriatic arthritis?
- DIP involvement
- Assymetric oligoarthritis (less than 5 small/large joints affected asymmetricly)
- Symmetric polyarthritis (mimics RA)
- Arthritis mutilans (very deforming)
- Spondyloarthropathy
What is a hand-finding in psoriatic arthritis?
- *NAIL PITTING IN PsA!
- LOOK OUT FOR this picture on exam along with DIP involvement
Telescopic digits are characteristic of what type of psoriatic arthritis?
arthritis mutilans
What is the characteristic x-ray finding in arthritis mutilans?
“pencil-in-a-cup” DIP involvement
What is enteropathic arthritis?
Inflammatory arthritis associated with Crohn’s disease, Ulcerative colitis, and Whipple’s disease
How does enteropathic arthritis occur?
gut wall is a leaky barrier to commensal and pathogenic microorganisms–there is a balance between inflammatory events and tolerance that, if altered, could lead to problems
What genetic predisposition do some enteropathic arthritis patients have?
HLA-B27
What are the two patterns of enteropathic arthritis?
- peripheral (parallels GI disease)
- axial (does not parallel GI disease)
What is Celiac Disease?
Immune reaction to partly digested wheat gluten by T lymphocytes in the gut of genetically HLA-DQ2 positive or HLA-DQ8 postiive individuals
How many Celiac Disease patients get joint symptoms?
25%
How does celiac disease alter bone?
osteomalacia due to vitamin D deficiency (from malabsorption due to vilous atrophy)
