Seronegative Spondyloarthropathies

Question 1

Association

Answer 1

Association with HLA B27 whcih encodes MHC 1 molecules

Question 2

All of them

Answer 2

Have inflammation of axial joints (particularly sacroiliac), asymmetric oligoarthritis involving lower exteemities, dactylitis of the digits and enthestuis

May also get uveitis

Question 3

AS general

Answer 3

Chronic inflamm with predominant in axial…particularly lumbar spine and sacroiliac joints

Question 4

Patho of AS

Answer 4

Immune mediated inflam process that results in CD4, CD8, and macros into affected joints

Characterized by new bone formation***

Question 5

Epi of AS

Answer 5

European ancestry
Most in male
HLA-B27 strongest association

Question 6

CM of AS

Answer 6

Sx begin in late adolescence or early adulthood and lamost alwyas befoe 40

Lumbar spine and sacroiliitis with characteristics of inflammatory

Dull and localized

Limitation of flexion, ext, and lateral flexion

Peripheral arthritis in about 1/2 of patients…asymmetric pain, stiffness, and joint swelling of ankeles, hips, and knees

Pain and stiffness in achilles, plantar fascia, and costochodnral

Uvietis in 25-40%

Question 7

Coms of AS

Answer 7

Hyperkyphosis of the spine…spinal cord compression

Chornic inflamm get osteopenia and bone loss so could have fractures/neuro sx

Question 8

Dx of AS

Answer 8

Chroninc inflammatory signs

Symmetric sacroiliitis - joint space narrowing, sclerosis, erosions, obilteration of joint with fusion of bones

As the dz progresses, syndesmophyres form and facet joints fuse to get bamboo spine appearance

Question 9

Management and prognosis of AS

Answer 9

First line is NSAIDs

Could tx with TNF-alpha inhibitors

Vairbale

Question 10

Reactive A pathogenesis

Answer 10

Following infection

GI/genitourinary infection

Salmonella, shigella, yersinia, campylobacter, or chlamydia

Immune mediated ynsovitiis from systemic inflamm response

Question 11

Epi of Reactive

Answer 11

Uncommon

Male to female is even unless chalmydia

Question 12

CM of reactive

Answer 12

1-3 weeks after infection

Acute asymmetric oligo of hips, knees, and ankles

Could have sacroiliac and lumbar spine involvement but mostly along with others

Enthesitis is common…pain and swelling of achilles and plantar fascia

Dactylitis - “suasage digit” common

Conjunctivitis and uveitis

Mucocutaneous lesions

Keratoderma blennorhagica appears as hyperkeratotic skin lessions on palsm and soles

Circinate balantis on the penis

Question 13

Dx and managmenet of reactive and prognosis

Answer 13

Confirm inflamm

Urine test for chalmydia

NSAIDs are cornerstones….Tx chlamydia urogential infection

Most have resolution within 6 mos

Question 14

Psoriatic patho and epi

Answer 14

Inflamm response is indistinguishable from RA with identical pattern of cytokine production

Synovial hyperplasia and diffuse infiltration of T, B, and macros

1-1 ratio

Question 15

CM and psoritac

Answer 15

Asymmetric olgi oof hips, knees, and ankles

25% get small joint poly like RA

50% get axial inbolbing sacoiliac and llumbar spine

Some get DIP swelling and erythema and onycholysus

Enthesist of achilles and plantar fascia

Nail pitting**

Question 16

Dx, mamangment and prog of psoriatic

Answer 16

Confirm inflammatoryu

10% will habve positive ACPA or RF

NSAIDs…if worse, then methotrexate and if faioled, TNF-alpha inhibitor

Variable progression similar to RA

Question 17

IBS arthritis patho, epi, clinical

Answer 17

Leukocytes traffic between intestinal tract and joints

Ratio is equal…more common in colon dz

Identical to AS (20%)

20% asymmetric oligoarthritis of hips, knees, and ankles

Dactylitis and enthesitis

Question 18

Dx and managment of IBS arth

Answer 18

Confirm inflamm

Radiolographic findingins similar to AS

Sulfasalaizine and TNF-alpha ingibitors

NSAIDs of limited use bc of GI SEs