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Derm Rheum > Seronegative spondyloarthropathies - Postlethwaite > Flashcards

Seronegative spondyloarthropathies - Postlethwaite Flashcards

1
Q

List group of disorders associated with Spondyloarthropathies

A

PAIR + 2

Psoriatic arthritis

Ankylosing spondylitis

Inflammatory bowel disease

Reactive arthritis (Reiter Syndrome)

Undifferentiated Spondyloarthropathies

Juvenile chronic arthritis and Juvenile-Onset Ankylosing Spondylitis

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2
Q

Spondyloarthropathies

Rheumatoid factor (+ or -) ?

A

negative ghostrider

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3
Q

Spondyloarthropathies

High Association with what gene?

A

HLA - B27

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4
Q

Spondyloarthropathies

More often in males or females?

A

Males

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5
Q

Spondyloarthropathies

Axial or appendicular skeleton involvement?

A

Axial skeletal involvement with sacroiliitis and spondylitis

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6
Q

Spondyloarthropathies large joint features

Poly or oligoarthritis?

Symmetric or asymmetric?

Upper or lower extremities?

A

Large joint asymmetric oligoarthritis predominantly in lower extremites

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7
Q

Spondyloarthropathies

Familial involvement?

A

Yes, Significantly

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8
Q

Spondyloarthropathies

Absence of what (that are commonly seen in RA)

A

Absence of subcutaneous nodules and other extra-artiular manifestations of RA

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9
Q

HLA-B27 is what MHC class?

A

MHC Class I, binds antigenic peptides and presents them to CD8+ T cells

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10
Q

HLA-B27 is found in over 90% of patients with what disorder?

General population frequency?

A

Ankylosing Spondylitis

8% of general population has HLA-B27. means that just b/c you have it, doesn’t mean you have disorder

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11
Q

HLA-B27 is found in 75% of which patients?

A

Pts with Reactive Arthritis (Reiter’s)

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12
Q

Frequency of HLA-B27 in Psoriatic Arthritis?

A

50%

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13
Q

Ankylosing Spondylitis Epidemiology

Age?

Gender preference? Ratio?

Etiology?

A

Age: Adolescence to 35

Gender: Male:Female 3:1

Etiology: Unknown

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14
Q

Ankylosing Spondylitis has what pathologic findings (3)?

A

Inflammatory cell infiltrates

Synovial inflammation similar to RA

TNF alpha excess

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15
Q

Clinical features of Ankylosing Spondylitis?

Rapid vs insiduous onset?

A

Insidous onset

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16
Q

Clinical features of Ankylosing Spondylitis?

Pt pain usually begins where in body?

Overtime where does pain go? What does this cause?

A

Pain usually begins in lower back, vertebral bodies eventually involved, causing fusion of the vertebrae “bamboo spine”

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17
Q

Bamboo spine refers to what pathology of which disorder?

A

Vertebral fusion, seen in Ankylosing spondylitis

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18
Q

What extra-articular manifestation are seen in Ankylosing spondylitis? Which is most common?

A

Eye: Anterior Uveitis (25-30%) = MOST COMMON

Cardiac: Aortitis (leading to aortic regurgitation), heart block, pericarditis, Increased risk for MI

Lungs: Apical lung fibrosis, thoracic cage restriction

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19
Q

If AS patient has peripheral joint involvement, what extra-articular symptoms are more common?

A

Aortic regurg and heart block 2x more common

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20
Q

Describe spine of Ankylosing Spondylitis patient?

A
  • Fusion of spine causes limited ROM in all directions
  • Loss of lumbar lordosis & development of thoracic and cervical kyphosis
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21
Q

Ankylosing Spondylitis Exam findings (3) ?

A
  1. Abnormal Schober’s test (< 3 cm)
  2. Reduced chest expansion (<2.5 cm) measured at 4th Intercostal space
  3. Increased occiput to wall distance
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22
Q

Spine probs in Ankylosing Spondylitis lead to what feature?

A

generalized osteopenia, increased risk for fractures

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23
Q

Drug of choice for AS? If pt cant take this type of drugs, next best drug of choice?

A

TNF blockers = BEST choice (Infliximab, adalimumab)

Indomethacin = next best if needed

24
Q

Cant see, Cant pee, Cant climb a tree. What am I talking about?

A

Reactive Arthritis (Reiter syndrome)

Triad of: Arthritis, Urethritis, and Conjunctivitis

Urethritis might not be present for long

25
Q

Reactive Arthritis Epidemiology.

Male or Female?

What gene is it most associated with?

More common in what subset of patients? Prognosis?

A

M/F ratio 5:1 (Goljian says 10:1)

75% pts have HLA-B27

ReA most common in HIV/AIDS (much more severe and resistant to therapy). Also a feature seen in Psoriatic Arthritis

26
Q

Reactive Arthritis usually caused by?

A

Arises after infectious process

27
Q

Urethritis in Reiter’s most commonly due to what bacterial infection?

A

Chlamydia trachomatis

28
Q

Arthritis in Reiter’s most commonly associated with what bacterial infections?

A

Shigella, Salmonella, Campylobacter, Yersinia

29
Q

Made you look. But seriously, what the hell is going on here?

A

Circinate balanitis. Feature of Reactive Arthritis. Rash on the distal shaft and glans penis that appears as vesicles, shallow ulcerations, or both

30
Q

What is this called? Which spondyloarthropathy is it most associated with?

A

Enthesitis, most commonly seen in Reactive Arthritis

31
Q

What is this? What disease is it associated with?

A

Keratoderma blennorrhagica, feature of Reactive arthritis

32
Q

What lab tests does Dr. P get on all reactive arthritis patients?

A

HIV test, HLA-B27.

Also check ESR, CRP, blood culture (usually +), Serology

33
Q

How long does reactive arthritis last? Will it ever recur?

A

Mean duration 2-3 months, Recurrence common, 20-50% demonstrate chronic course

34
Q

Actual name of sausage shaped DIP joints? Associated with what disorder?

A

Dactylitis. Primarly associated with Psoriatic arthritis. Also enteropathic (IBS), reactive, and AS

35
Q

What is going on here? What disease is it associated with?

A

Etensive nail pitting seen in Psoriatic Arthritis

36
Q

Psoriatic Arthritis Immunopathology compared to RA

Synovial cytokines that are greater?

Synovial cytokines that are less than RA?

A

More TNF-alpha, IL-1 beta, IL-2, IL-10, and IFN Gamma as compared to RA

Less IL-4, IL-5 as compared to RA

37
Q

Besides the cytokines mentioned in comparison to RA, what other synovial cytokine is present in psoriatic arthritis? Features of this cytokine?

A

IL-18. Member of IL-1 Superfamily

stimulates angiogenesis, upregulates chemokine expression on synovial fibroblasts, increases mononuclear cell recruitment

38
Q

How many types of Psoriatic Arthritis? Name them

A

5 Types

  1. Polyarticular pattern
  2. Oligoarticular pattern
  3. DIP involvement pattern
  4. Arthritis Mutilans
  5. Axial involvement
39
Q

Which type of PsA involves >4 joints? What disorder is it similar to?

A

Polyarticular pattern. Similar to RA

40
Q

Which type of PsA involves ≤ 4 joints? Symmetrical or Assymetrical involvement seen in this type?

A

Oligoarticular pattern. Assymetric involvement

41
Q

Which type of PsA involves only a specific joint? which joint is this?

A

DIP involvement pattern

42
Q

Which type of Psoriatic Arthritis is severe and destructive?

A

Arthritis Mutilans

43
Q

If PsA patient is B27+, what type of bone involvement is seen? Similar to what disease?

A

Axial involvement type (similar to sacroilitis and sponydlitis)

44
Q

What is being shown here? What disease?

A

“pencil in cup” deformity seen in Psoriatic Arthritis

45
Q

Another name for Enteropathic arthritis? Helps you to remember its association?

A

Inflammatory bowel disease associated arthritis

46
Q

Enteropathic arthritis is associated with what other disorders?

A

Crohn’s, Ulcerative colitis, Whipple’s (rare)

47
Q

Epidemiology. Enteropathic Arthritis gender association?

48
Q

Enteropathic arthritis types? Which is associated with HLA-B27?

A

Axial, Peripheral

  • axial associated with HLA-B27
49
Q

Which comes first, the GI disease or enteropathic arthritis?

A

GI disease usually comes first

50
Q

Axial vs Peripheral enteropathic arthritis.

Which is clinically and radiographically identical to idopathic Ankylosing spondylitis?

51
Q

Axial vs Peripheral Enteropathic Arthritis.

Which often parallels GI disease (meaning the arthritis worsens when GI disease worsens)

A

Peripheral

Axial does not parallel. Can do what it wants.

52
Q

Peripheral enteropathic arthritis is similar to what other form of spondyloarthropathy?

A

Reactive arthritis

  • oligoarticular, generally asymmetric; lower extremity joint involvement; Dactylitis and enthesitis; parallels GI inflammation
53
Q

Which arthritis is associated with IgA deficiency?

A

Arthritis of Celiac Disease

54
Q

In Arthritis of Celiac Disease, which comes first?

A

Arthritis can present prior to development of Celiac Diseaes. Can help distinguish this from enteropathic arthritis.

55
Q

In DISH (diffuse idiopathic skeletal hyperostosis), calcification and ossification is most common on which side of the spine?

56
Q

DISH is inflammatory or non-inflammatory?

A

non inflammatory

Derm Rheum (39 decks)

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