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MSK/Derm > SM 228: Spondylarthropathies > Flashcards

SM 228: Spondylarthropathies Flashcards

1
Q

What is Spondyloarthritis?

A

SpA is a group of related disorders with common clinical, biological, and genetic characteristics

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2
Q

What are the common elements in SpA’s?

A

Spondyloarthritis includes arthritis with: Genetic Markers - HLA B27 Spine involvment Asymmetric joint involvement Enthesitis Iritis Negative RF

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3
Q

What is the common genetic factor in SpA’s?

A

HLA B27

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4
Q

Are SpA’s generally symmetric or asymmetric?

A

SpA’s involve asymmetric joint damage

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5
Q

What is sacroiliitis?

A

Inflammation of the Sacroiliac joints, a common finding in SpA’s

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6
Q

Broadly speaking, how can SpA’s be classified?

A

Axial or Peripheral disease - where the disease affects the body

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7
Q

What is Reactive Arthritis?

A

An acute inflammatory arthritis following GI or GU infection

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8
Q

Which sex is more impacted by Reactive Arthritis, male or females?

A

Males are more effected by Reactive Arthritis

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9
Q

How does Reactive Arthritis present?

A

“Can’t see, can’t pee, can’t climb a tree” Conjuctivitis/Iritis Nongonoccal Urethritis Arthritis

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10
Q

How does Reactive Arhtritis effect the joints/articulations?

A

Additive, asymmetric mono or oligo arthritis involve large lower extremity joints Dactylitis = swollen digits Enthesitis Inflammatory lower back pain (Sarcoiliitis)

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11
Q

What is Enthesitis?

A

Heel pain at tendon insertion

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12
Q

Which joints does Reactive Arthritis tend to effect?

A

Large, lower extremity joints are effected more often by Reactive Arthritis

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13
Q

What is inflammatory enthesopathy?

A

Subchondral bone inflammation and resporption along with periosteal new bone formation

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14
Q

What are extra-articular features seen in Reactive Arthritis?

A

Skin: Keratoderma blennorrhagicum = keratotic conical lesions on lateral and palmoplantar aspects of hands and feet

Mucosal lesions: painless oral ulcers

Nails: thickened, opacified

Eyes: conjunctivitis, acute anterior uveitis

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15
Q

What does seronegative mean for rheumatic diseases?

A

Seronegative = negative for Rheumatoid Factor and ANA

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16
Q

What are the laboratory findings and synovial fluid culutre results of Reactive Arthritis?

A

Synovial fluid culture negative

Antigens from inciting organisms detected inside synovial cells as well as T-cells in fluid specific for those antigens

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17
Q

Do antibiotics treat Reactive Arthritis?

A

No, because it may be driven by antigens and molecular mimicry

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18
Q

Which SpA is associated with molecular mimicry?

A

Reactive Arthritis

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19
Q

Explain how molecular mimicry mediates Reactive Arthritis?

A

Hosts that carry HLA-B27 analogs may be susceptible to autoimmune responses against the HLA-B27 antigen

The HLA-B27 antigen may be introduced after an entiric or urogenital infection

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20
Q

How do GI and GU infections cause Reactive Arthritis?

A

In a patient who is HLA-B27+, GI and GU infections can introduce an antigenic form of HLA-B27 that leads to an immune respose against host HLA-B27 due to molecular mimicry

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21
Q

What is the clinical course of Reactive Arthritis?

A

Usually self-limited over 3-12 months

May relapse or develop into another chronic disease or SpA in 15% of patients each

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22
Q

How should Reactive Arthritis be treated (first line agents)?

A

NSAIDS

Physical Therapy

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23
Q

How should Reactive Arthritis be treated if NSAIDs fail?

A

Corticosteroids

DMARDS like Sulfasalazine

Biologics like Infliximab

24
Q

What are the roles of NSAIDS and antibiotics in treated Reactive Arthritis?

A

NSAIDS = anti-inflammatory

Antibiotics should not be used because Reactive Arthritis is driven by molecular mimicry against a specific antigen

25
What is Psoriatic Arthritis?
A seronegative inflammatory arthritis (like Reactive Arthritis) that is associated with Psoriasis
26
What is Psoriasis?
A hyperkeratotic and inflammatory skin condition that presents with a red, scaly rash on extensor surfaces
27
What is Dactylitis?
Inflammation of the fingers = sausage fingers
28
Which joints does Psoriatic Arthritis effect?
Psoriatic Arthritis effects the DIPs of fingers as well as the sacroiliac joints
29
Which disease does fingernail pitting suggest?
Psoriatic Arthritis, sicne the fingernails are made of Keratin
30
How does Psoriatic Arthitis present?
Peripheral articular disease - oligoarticular, asymmetric Dactylitis Enthesitis Typically at the sacroiliac joint
31
What are the extra-articular manifestations of Psoriatic Arthritis?
Psoriasis Nail dystrophy - pitting Conjunctivitis Subclinical IBD
32
What specific nail change is associated with Psoriatic Arthritis?
Pitting of the nails ![]()
33
How can Psoriatic Arthritis effect the nails?
Thickened nails Opacified nails Separation of nail from nailbed
34
Does Psoriatic Arthritis occur before or with Psoriasis?
Both
35
Does the severity of Psoriasis correlate with severity of joint disease in Psoriatic Arthritis?
No, but joint disease is more likley to be present with severe skin disease
36
How is Psoriatic Arthritis treated?
NSAIDS Corticosteroids DMARDs like Sulfasalazine and Methotrexate
37
What are the DMARDs for Psoriatic Arthritis?
Sulfasalazine and Methotrexate
38
Which TNFalpha inhibitor is a humanized Fab' fragment?
Certolizumab
39
Which TNFalpha inhibitoris a human recombinant fusion protein?
Etanercept
40
Which TNFalpha inhibitors are a human recombinant mAb?
Adalimumab and Golimumab
41
Which TNFalpha inhibitor is a chimeric mAb?
Infliximab
42
Which biologics can be used to treat Psoriatic Arthritis?
TNF inhibitors IL-12/23 inhibitors IL-17 inhibitors
43
What drug is an IL-12/23 inhibitor?
Ustekinumab
44
What drug is an IL-17 inhibitor?
Secukinumab
45
Are biologics like TNFalpha inhibitors used as a monotherapy in Psoriatic Arthritis?
Yes, unlike Reactive Arthritis, do not need to use them with Methotrexate
46
What is the ideal first-iine therapy for Psoriatic Arthritis?
Use a TNFalpha inhibitor, unclear which is best
47
What is Axial Spondylarthritis?
A chronic inflammatory disease of the sacroiliac joints and spines associated with several extra-articular mainfestations
48
How do patients with Axial Spondylarthritis present?
Often diagnosed in the 20's Inflammatory back pain and stiffness that worsens with rest and improves with activity "Bamboo Spine" Lower exremity oligoarthritis
49
What are the extra-auricular manifestations of Axial Spondlyoarthritis?
Eyes: conjuctivitis not related to joint activity Heart: Aortic insufficiency from dilation of aortic arch base Gut: IBD
50
What is the treatment for Axial Spondyloarthropathy, and what component is most important?
Physical therapy is most important Exercise NSAIDS Corticosteroids Sulfasalazine/Methotrexate TNF inhibitors and IL-17 inhibitors
51
What is IBD related Arthritis?
A type of arthritis that develops is people with Ulcerative Colitis or Crohn's diseae
52
How does the underlying GI disease effect treatment of IBD related Arthritis?
In patients with peripheral joint disease, treating the underlying GI disease can cure the joint disease In patients with axial joint disease, joint disease may persist despite treating the GI diseae
53
How does IBD related arthritis present?
Systemic symptoms and change in bowel habits Classic SpA symtptoms: Inflammatory back pain and stiffness Sacroiliitis Enthesitis Dactylitis
54
How should IBD related arthritis be treated?
NSAIDS - careful for GI flareups though Corticosteroid DMARD = Sulfasazaline Biologic monotherapy = TNFalpha inhibitors
55
Do SpA's effect men or women more?
Unlike most arthritis, SpA's effect men and women equally

MSK/Derm (46 decks)

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