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MSK-Derm by Minnie > SM 228a - Spondyloarthropathies > Flashcards

SM 228a - Spondyloarthropathies Flashcards

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Dermatology Board Prep flashcards
1
Q

What genetic factor is associated wtih seronegative spondyloarthropathies?

A

HLA-B27

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2
Q

Which cytokines can be targeted using biologic therpay to treat psoriatic arthritis?

A

IL-23 (+/- IL-12)

IL-17

TNF

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3
Q

What percentage of psoriasis patients will develop psoriatic arthritis?

A

~25%

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4
Q

What pattern of articular disease defines seronegative spondyloarthropathies?

A

Inflammation

  • Spine involvement
  • Hands: PIP and DIP affected
    • MCP spared
  • Asymmetric joint involvement
  • Enthesitis
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5
Q

What is the typical treatment for patients with seronegative arthritis?

A
  • Anti-inflammatory agents (NSAIDs)
  • Physical therapy
  • If NSAIDs fail…
    • Corticosteroids
    • DMARDS
    • Biologics
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6
Q

What are the typical extra-articular manifestations of the seronegative spondyloarthropathies?

A

Enthesitis

Iritis

Skin (psoriatic), GI (IBD-related)

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7
Q

Which arthritis has both destructive and new-bone changes?

What pattern does this produce?

A

Psoriatic arthritis

“pencil in cup”

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8
Q

Describe the presentation of ankylosing spondylitis

A
  • Inflammatory back pain and stiffness
  • Sacroiliitis
  • Oligoarthritis
  • Enthesitis
  • Systemic symptoms
    • Fatigue, imparied sleep
  • Extra-articular disease
    • Uveitis, IBD, aortitis
  • Symptoms begin in 20’s, but diagnosis is often late
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9
Q

List some of the relevant spondyloarthropathies

A

Spondyloarthropathies = inflammatory, seronegative

  • Reactive arthritis
  • Psoriatic arthritis
  • Axial spondyloarthritis
  • Arthritis associated with IBD
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10
Q

Describe the clinical presentation of reactive arthritis

A
  • Acute inflammatory arthritis
  • Involves only a few joints
  • Follows GI or GU infection
  • Usually self-limited
    • May be recurrent or chronic
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11
Q

What is spondyloarthritis?

A

A specific group of inflammatory arthritides that share some common elements

  • Sero-Negative (negative for RF)
  • Spine involvement
  • Enthesitis
  • Genetic markers
  • Asymmetric joint involvement
  • Iritis
  • No female predominance
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12
Q

How can you distinguish between rheumatoid arthritis and reactive arthritis?

A
  • Rheumatoid Arthritis
    • More likely to be RF positive
    • MCP affected
      • DIP spared
    • Female predominance
  • Reactive arthritis
    • Asymmetric
    • DIP and PIP affected
    • No female predominance
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13
Q

Which picture shows osteoarthritis?

Which one shows inflammatory?

How do you know?

A
  • 1 = ostoarthritis
    • No hypercellularity
    • Cartilage erosion
    • New bone formation
      • No bone erosions
  • 2 = inflammatory arthritis
    • Hypercellularity in the synovium
    • Bone erosion
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14
Q

Describe the pathophysiology of reactive arthritis

A

Previous infection can trigger an inflammatory reaction

  • This is not an ongoing infection
  • Must treat the inflammation - treating the microbe doesn’t work
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15
Q

These nail changes are characteristic of which kind of arthritis?

A

Psoriatic arthritis

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16
Q

A “Pencil in cup” feature of a joint is pathopneumonic for which arthritis?

A

Psoriatic arthritis

Requires both erosion and new bone formation

(psoriatic arthritis is the only arthritis that has both destrictive and new bone changes)

17
Q

What infections can trigger reactive arthritis?

A
  • Enteric infections
    • Shigella, salmonella, yersinia, campylobacter, clostridium
  • Urogenital infection
    • Chlamydia

Causative agent may be asymptomatic!

May be a genetic predispostion (HLA-B27) in addition to previous infection

18
Q

Which spondyloarthritides are classically “axial?” Which are classically “peripheral”?

A
  • Axial
    • Axial spondyloarthritis (ankylosing spondylitis is a subset)
  • Peripheral
    • Psoriatic arthritis

IBD arthritis, reactive arthritis are more in the middle

19
Q

What is the significance of HLA-B27 in reactive arthritis?

A

Some HLA-B27 subtypes may have an amino acid sequence homology with some infectious agents

  • Yersinia enterocolitica
  • Salmonella typhimurium
  • Shigella flexneri
  • Klebsiella

Infection by these agents triggers the immune system ot attack its own HLA-B27

Rats with high levels of HLA-B27 developed reactive arthritis spontaneously

20
Q

What is inflammatory enthesopathy?

A

Subchondral bone inflammation and resorption at the insertion of tendons

Periosteal new bone formation (not just calcification of the tendon)

21
Q

Describe the clinical features of psoriasis arthritis

A
  • Cutaneous disease
    • Psoriatic plaques
    • Onycholysis and nail pitting
    • Skin disease usually (90%) precedes joint involvement
  • Inflammatory polyarthritis
    • Asymmetric or symmetric
      • DIP and PIP, MCP spared
        (MCP usually involved in RA)
    • Axial
  • Dactylitis
  • Enthesitis
  • RF negative

Psoriatic arthritis is a spondyloarthritis

22
Q

Describe the articular features of reactive arthritis

A
  • Additive
  • Asymmetric
  • Mono or oligo arthritis
  • More commonly affects large lower extremity joints
  • Dactylitis
  • Enthesitis
  • Inflammatory lower back pain
23
Q

Which feature is shown in this radiograph?

Which arthritis is it characteristic of?

A

Bamboo spine

Due to ossification of the outer layers of the annulus fibrosis

Note: no osteophytes, which are characteristic of osteoarthritis

MSK-Derm by Minnie (48 decks)

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