Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medicine Phase 2a MSK and Rheumatology > Seronegative spondyloarthropathies > Flashcards

Seronegative spondyloarthropathies Flashcards

1
Q

Examples

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
(Enteropathic arthritis e.g. Crohns UC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ankylosing spondylitis

A

Inflammatory arthritis of the spine and ribcage (eventually leading to new bone formation and fusion of the joints - bamboo spine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

5 main traits of all seronegative spondyloarthropathies

A 
Predilection for axial inflammation
Asymmetrical peripheral arthritis
Absence of rheumatoid factor
Inflammation of the enthesis 
Strong association with HLA-B27
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology of ankylosing spondylitis

A

Syndesmophytes form following inflammation and ankylosis therefore occurs.
This leads to the fusion of the vertebrae.
The cause of the inflammation is not known, but thought to involve CD8 T cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical presentation of ankylosing spondylitis

A 
Typically starts in late teenage years/20s 
Increasing pain and prolonged morning stiffness in the lower back (*inflammatory back pain) and buttocks. 
Improves with exercise. 
Progressive loss of spinal movement. 
Characteristic abnormalities: 
-Loss of lumbar lordosis
-increased kyphosis
-Limitation of lumbar spine mobility
*ALSO:
Asymmetrical (large joint) arthritis
Skin Psoriasis
IBD
Inflammatory eye disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aetiology of ankylosing spondylitis

A

Unknown - strong genetic association

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Epidemiology of ankylosing spondylitis

A

Usually young males

More common and severe in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnostic tests of ankylosing spondylitis

A

X-ray - normal or shows erosion and sclerosis of the margins of the sacroiliac joints -> ankylosis
‘Bamboo spine’ from rehealing of enthesitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatments of ankylosing spondylitis

A

NSAIDs, TNF-alpha inhibitors (infliximab)

Surgery - can correct spinal deformities to repair damage (possible hip/shoulder replacement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of ankylosing spondylitis

A

Small chance of spinal fusion -> severe kyphosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Psoriatic arthrtis

A

Inflammatory arthritis associated with psoriasis (skin condition that causes red, flaky, crusty patches of skin covered with silvery scales)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical presentation of psoriasis arthritis

A

Ranges from mild synovitis to severe progressive erosive arthropathy, usually preceded by the rash.
Skin disease can be as minor as an occult rash.
Nail changes are characteristic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aetiology of psoriasis arthritis

A

Autoimmune mediated, with defined HLA associations (HLA-B27, -B17, -CW6, -DR4, -DR7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epidemiology of psoriasis arthritis

A

20% of patients with psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is psoriasis

A

skin condition that causes red, flaky, crusty patches of skin covered with silvery scales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic tests of psoriatic arthritis

A

X-ray - pencil in cup deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of psoriatic arthritis

A

Drugs: NSAIDs, DMARDs, TNF-alpha (infliximab)

Surgical - cant correct deformed joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications of psoriatic arthritis

A

Joint destruction

Psycho-social damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What kind of infection is followed by reactive arthritis usually

A

GI or GU infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Types of reactive arthritis

A

Post-enteric

Post-venereal

21
Q

Pathophysiology of reactive arthritis

A

Persistent bacterial antigen in the inflamed synovial of affected joints is thought to drive the inflammation

22
Q

Clinical presentation of reactive arthritis

A

*Arthritis typically 2 days to 2 weeks post infection (Acute onset)
Malaise, fatigue, fever
Low back pain common
Asymmetrical, oligo/monoarthritis (no more than 6 joints -> large joints)
*Conjunctivitis, Urethritis, Arthritis (enthesitis/ dactylitis/ sacroiliitis) - can’t see, can’t pee, can’t climb a tree - classical triad
*Psoriatic like skin lesions (keratoderma)

23
Q

Aetiology of Post-enteric reactive arthritis

A

Usually infection by Campylobacter, Salmonella and Shigella

24
Q

Aetiology of Post-veneral reactive arthritis

A

usually infection by Chlamydia, Trachomatis or HIV

25
Epidemiology of reactive arthritis
Typically affects young males
26
Diagnostic tests of reactive arthritis
Serum antibodies Diagnosis based on clinical features. (Once arthritis discovered cultures show negative) May test for Chlamydia infection (urine sample or genital swab) or test for the HLA-B27 gene Raised ESR/CRP Aspirate joint to exclude infection/crystals Urethral swab, stool culture
27
Treatment of reactive arthritis (similar to enteropathic arthritis)
``` Aspirate synovial effusions Physiotherapy NSAIDs Corticosteroids Antibiotics or causative organism ```
28
Complications of reactive arthritis
Minority may develop destructive enthesitis or spondylitis | High recurrence by new infection or stress
29
**What is HLA B27
Human Leucocyte Antigen B27 Class I surface antigen (all cells, except red blood cells) Patients are either HLA B27 +ve or -ve Encoded by Major Histocompatibility Complex (MHC) on chromosome 6 Antigen presenting cell
30
**Why is HLA B27 linked with disease (3 main theories)
Mis-folding theory HLA B27 heavy chain homodimer hypothesis "Molecular mimicry" (AI response against HLA B27 could be triggered)
31
What is meant by molecular mimicry with HLA B27 disease
Infection > Immune response > Infectious agent has peptides very similar to HLA B27 molecule > Auto-immune response triggered against HLA B27
32
What is the HLA B27 heavy chain homodimer hypothesis
Suggests that B27 heavy chains can form stable dimers, which tend to dimerize and accumulate in the endoplasmic reticulum. In turn, this initiates the proinflammatory ERUPR. In addition, these heavy chains and dimers can bind to other regulatory immune receptors such as the natural killer receptors (NKRs). This causes the expression and survival of more proinflammatory leukocytes and subsequent production of proinflammatory mediators.
33
What is the HLA B27 misfolding theory
Unfolded HLA-B27 proteins accumulate in the endoplasmic reticulum (ER). A proinflammatory stress response called the endoplasmic reticulum unfolded protein response (ERUPR) ensues. As a result, interleukin 23 (IL-23) is released, activating a proinflammatory response via interleukin-17+ T lymphocytes.
34
What would be worst prognosis scenario in ankylosing spondylitis
``` Male Smoker B27 +ve Syndesmophytes at presentation High CRP ```
35
Presentation of scaroiliitis (on X-RAY and other imaging)
X-ray: Sclerosis; Erosions; Loss of joint space; Fusion On general imaging: Active (acute) inflammation on MRI highly suggestive of sacroiliitis with SpA Definite radiographic sacroiliitis according to mod NY criteria
36
Classifaction criteria of Ankylosing/Axial spondylitis
At least 3 months of back pain and age onset <45 years: Saroiliitis on imaging plus at least 1 SpA (spondyloarthritis) feature HLA-B27 plus at least 2 other SpA features
37
SpA (spondyloarthritis) features
``` Inflammatory back pain Arthritis Enthesitis (heel) Uveitis (inflamed uvea in eye) Dactylitis (entire finger/digit inflamed) Psoriasis Crohns/colitis good response to NSAIDs SpA Family Hx HLA-B27 elevated CRP ```
38
What is enthesis and thus enthesitis
Enthesis is connective tissue between ligament/tendon and bone Inflammation of this
39
Treatment of spondyloarthritis
Originally long term NSAIDs (but side effects) Physio can be used in combination *TNFi* (NICE approved)
40
Side effects of NSAIDs
Gastric ulcer Vascular disease Renal damage
41
Management of psoriasis arthritis
(similar to RA) Early intervention with DMARDs -MTX, leflunomide, ciclosporin, sulfasalazine -DMARDs often help skin disease Anti TNF drugs (Etanercept, adalimumab, golimumab, certolizumab, infliximab) IL12/23 blockers (ustekinumab)
42
Example of DMARD
MTX (Methotrexate) | leflunomide
43
Example of anti TNF drug
Etanercept
44
Example IL12/23 blocker
Ustekinumab
45
Psoriatic like skin lesions in Reactive Arthritis
Keratoderma | Circinate Balanitis
46
Differential diagnosis of reactive arthritis
Hot swollen joint | exclude septic arthritis and gout
47
What is enteropathic arthritis
a chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD)
48
Clinical presentation and differential diagnosis of enteropathic arthritis
Asymmetric lower limb arthritis | 20% of patients with IBD show episodic peripheral synovitis
49
SpA features: what does SPINEACHE stand for
``` Sausage digit Psoriasis / Positive family Hx of SpA Inflammatory back pain NSAID good response Enthesitis (heel) Arthritis Crohn's/Colitis disease-elevated CRP HLA-B27 Eye (uveitis) ```

Medicine Phase 2a MSK and Rheumatology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions