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MSK/Derm > SM 228: Spondylarthropathies > Flashcards

SM 228: Spondylarthropathies Flashcards

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Dermatology Board Prep 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
Q

What is Psoriatic Arthritis?

A

A seronegative inflammatory arthritis (like Reactive Arthritis) that is associated with Psoriasis

26
Q

What is Psoriasis?

A

A hyperkeratotic and inflammatory skin condition that presents with a red, scaly rash on extensor surfaces

27
Q

What is Dactylitis?

A

Inflammation of the fingers = sausage fingers

28
Q

Which joints does Psoriatic Arthritis effect?

A

Psoriatic Arthritis effects the DIPs of fingers as well as the sacroiliac joints

29
Q

Which disease does fingernail pitting suggest?

A

Psoriatic Arthritis, sicne the fingernails are made of Keratin

30
Q

How does Psoriatic Arthitis present?

A

Peripheral articular disease - oligoarticular, asymmetric

Dactylitis

Enthesitis

Typically at the sacroiliac joint

31
Q

What are the extra-articular manifestations of Psoriatic Arthritis?

A

Psoriasis

Nail dystrophy - pitting

Conjunctivitis

Subclinical IBD

32
Q

What specific nail change is associated with Psoriatic Arthritis?

A

Pitting of the nails

33
Q

How can Psoriatic Arthritis effect the nails?

A

Thickened nails

Opacified nails

Separation of nail from nailbed

34
Q

Does Psoriatic Arthritis occur before or with Psoriasis?

A

Both

35
Q

Does the severity of Psoriasis correlate with severity of joint disease in Psoriatic Arthritis?

A

No, but joint disease is more likley to be present with severe skin disease

36
Q

How is Psoriatic Arthritis treated?

A

NSAIDS
Corticosteroids
DMARDs like Sulfasalazine and Methotrexate

37
Q

What are the DMARDs for Psoriatic Arthritis?

A

Sulfasalazine and Methotrexate

38
Q

Which TNFalpha inhibitor is a humanized Fab’ fragment?

A

Certolizumab

39
Q

Which TNFalpha inhibitoris a human recombinant fusion protein?

A

Etanercept

40
Q

Which TNFalpha inhibitors are a human recombinant mAb?

A

Adalimumab and Golimumab

41
Q

Which TNFalpha inhibitor is a chimeric mAb?

A

Infliximab

42
Q

Which biologics can be used to treat Psoriatic Arthritis?

A

TNF inhibitors

IL-12/23 inhibitors

IL-17 inhibitors

43
Q

What drug is an IL-12/23 inhibitor?

A

Ustekinumab

44
Q

What drug is an IL-17 inhibitor?

A

Secukinumab

45
Q

Are biologics like TNFalpha inhibitors used as a monotherapy in Psoriatic Arthritis?

A

Yes, unlike Reactive Arthritis, do not need to use them with Methotrexate

46
Q

What is the ideal first-iine therapy for Psoriatic Arthritis?

A

Use a TNFalpha inhibitor, unclear which is best

47
Q

What is Axial Spondylarthritis?

A

A chronic inflammatory disease of the sacroiliac joints and spines associated with several extra-articular mainfestations

48
Q

How do patients with Axial Spondylarthritis present?

A

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
Q

What are the extra-auricular manifestations of Axial Spondlyoarthritis?

A

Eyes: conjuctivitis not related to joint activity

Heart: Aortic insufficiency from dilation of aortic arch base

Gut: IBD

50
Q

What is the treatment for Axial Spondyloarthropathy, and what component is most important?

A

Physical therapy is most important

Exercise

NSAIDS

Corticosteroids

Sulfasalazine/Methotrexate

TNF inhibitors and IL-17 inhibitors

51
Q

What is IBD related Arthritis?

A

A type of arthritis that develops is people with Ulcerative Colitis or Crohn’s diseae

52
Q

How does the underlying GI disease effect treatment of IBD related Arthritis?

A

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
Q

How does IBD related arthritis present?

A

Systemic symptoms and change in bowel habits

Classic SpA symtptoms:

Inflammatory back pain and stiffness

Sacroiliitis

Enthesitis

Dactylitis

54
Q

How should IBD related arthritis be treated?

A

NSAIDS - careful for GI flareups though

Corticosteroid

DMARD = Sulfasazaline

Biologic monotherapy = TNFalpha inhibitors

55
Q

Do SpA’s effect men or women more?

A

Unlike most arthritis, SpA’s effect men and women equally

MSK/Derm (46 decks)

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