spondy, iritis Flashcards
ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-associated arthritis, arthritis associated with acne and other skin diseases, SAPHO syndrome, and undifferentiated spondyloarthritis
What are the American criteria for the diagnosis of spondylitis?
American criteria for the diagnosis of spondylitis requires backache for at least 3 months and/or the age of onset prior to age 45. The diagnosis is definite should HLA-B27 be positive, or sacroiliitis be demonstrated by x-ray.
What are the characteristics of inflammatory backache?
Inflammatory backache is defined as age of onset prior to age 40, incidious onset, improvement with exercise, no improvement with rest, pain at night which improves on arising. Other features suggestive of spondylitis include: arthritis diagnosed by a physician, heel enthesitis, acute uveitis, dactylitis, psoriasis diagnosed by a physician, inflammatory bowel disease, good response to NSAIDs, reactive arthritis, inflammatory bowel disease, elevated C-reactive protein, first or second-degree relative with a ankylosing spondylitis.
What is the indication to use intra-articular steroids in managing ankylosing spondylitis?
When non steroidal agents fail, and the situation does not warrent anti-TNF treatment.
What S100 type protein is involved in psoriatic inflammation?
S100 proteins are calcium binding proteins with 2 helix loop helix binding sites. Unlike calmodulin they are cell type specific. The S100A7 gene codes for psoriasin which is an inflammatory cytokine in autoimmune skin conditions including psoriasis. S-100 proteinIs are found in melanomas, schwamnomas, neurofibromas, histiocytomas, and clear cell sarcomas. They are markers of inflammatory disease and act as an antimicrobial.
What are the criteria for diagnosis of psoriatic arthritis?
A firm diagnosis of psoriatic arthritis can be made if at least three points are present according to the following CASPAR (ClASsificatio of Psoriatic ARthritis) point scheme.
Point Feature
2 Skin psoriasis,
1 history of psoriasis
1 family history of psoriasis and patient not affected
1 Nail lesions with onycholysis or pitting
1 Dactylitis present or past documented by rheumatologist1
1 Negative rheumatoid factor
1 Juxtaarticular bone formation on radiographs distinct from osteoarthritis.
Poor prognostic indicators include the presence of increasing number of actively inflamed joints, damage to large joints, polyarticular involvement with loss of function, low quality of life, failure of previous medication trials, elevated sedimentation rate (a 2% increase in risk for every mm above normal), presence of HLA-B27, -B39, or -DQw3, and positive anti CCP.
How common is idiopathic iritis and what clues indicate a known cause?
30% of iritis remains idiopathic.
Uveitis that is bilateral, posterior to the lens, insidious in onset and chronic in duration include psoriasis, inflammatory bowel disease, and JIA.
Unilateral forms that are brief in duration, and recurrent suggest Behcet’s syndrome, and sarcoidosis especially if resolution is incomplete. Complete resolution favors AS.
Idiopathic forms behave like localized sarcoidosis.
What idiopathic inflammatory diseases are associated with iritis?
40% of acute anterior uveitis is due to idiopathic inflammatory disease which include:
psoriatic arthritis, inflammatory bowel disease, HLA B 27, ankylosing spondylitis, Behcet’s syndrome, systemic lupus erythematosus, juvenile idiopathic arthritis, Kawasaki’s disease, reactive arthritis, relapsing polychondritis, sarcoidosis, Sjogren’s syndrome, Sweet syndrome, granulomatosus with polyangiitis.
Blau syndrome (periodic fever, autosomal dominant, non caseating granuloma), Vogt Koyanagi Harada syndrome (vitiligo, poliosis-patch white hair, HLA-D, DR4), interstitial nephritis, multiple sclerosis, vasculitis vitiligo.
Known causes include
drug or hypersensitivity reaction (rifabutin, moxifloxacin, biphosphonates I.V.).
What other eye diseases mimic iritis?
Diseases that mimic uveitis include giant retinal tears, ischemia, leukemia, lymphoma, ocular melanoma, pigmentary diversion syndrome, retinitis pigmentosa, retinoblastoma.
What sort of infections cause Iritis?
infections causing iritis include:
Bacterial:
Lyme disease, syphilis, tuberculosis, atypical mycobacteria, cat scratch disease, leprosy, propionibacteria, Rocky Mountain spotted fever, Whipple’s disease
viral: cytomegalovirus, Epstein-Barr, herpes simplex, herpes zoster, HIV-1, human T-cell leukemia, mumps, rubella, rubeola, vaccinia, West Nile virus
Fungal:
aspergillosis, and the diocese, Cryptococcus is, histoplasmosis, pneumocystis jirovecii, blastomycosis, sporotrichosis
Parasitic
toxocariasis, toxoplasmosis, acanthamoeba, cystercercosis
What uveitis syndromes are limited to the eye?
Uveitis syndromes limited to the eye include: acute retinal process, birdshot choroidopathy (HLA-A29), glaucomatocyclidic crisis, immune reconstitution uveitis, Leber’s neuroretinitis, pars planitis, sub retinal fibrosis, sympathetic ophthalmia, trauma.
How effective are Biologics in treating psoriatic uveitis?
It is series of 717 patients with ankylosing spondylitis TNF inhibitors (infliximab) reduced the incidence of anterior uveitis from 16 to 3%. Etanercept and adalimumab work about as well. Treatment results in reducing uveitis flares from 62 to 3 per hundred patient years. Ustekinumab is marginally more effective than etanercept (68 versus 58%) in treating psoriatic skin lesions.
What is the incidence of iritis in psoriasis and inflammatory bowel disease?
7% of patients with psoriasis may develop uveitis, 6% with inflammatory bowel disease of which 45% are HLA B 27 positive. Such uveitis is usually bilateral posterior to the lens, insidious and onset, chronically duration, and more common in females, similar to JIA. Uveitis in inflammatory bowel disease have arthritis in 75%
