Spondylarthropathies/LED

Question 1

Quelles pathologies sont comprises dans les spondylarthropathies ?

Answer 1

Arthrite psoriasique
Arthrite réactive
Arthrite 2° MII
Spondylite ankylosante

Ankylosing spondylitis: Spinal involvement is the defining feature.
Psoriatic arthritis: Psoriasis co-occurs with spinal and/or peripheral arthritis.
Inflammatory bowel disease–associated arthritis: Clinically apparent intestinal inflammation is present along with spinal and/or peripheral arthritis.
Reactive arthritis: Inflammatory synovitis (primarily peripheral) occurs following specific gastrointestinal or genitourinary infections.
Undifferentiated spondyloarthritis: Spondylitis occurs in the absence of diagnostic features (including radiographic changes) that would permit diagnosis of one of the other categories of disease.

Question 2

FdR génétique le plus important en spondylarthropathie ?

Answer 2

HLA-B27
However, only 5%-6% of those carrying HLA-B27 develop spondyloarthritis, and not all patients with spondyloarthritis are positive for HLA-B27. For these reasons, HLA-B27 should not be used as a screening test for these disorders, although its presence in a patient with a high pretest probability can support the diagnosis.

Question 3

T or F.

Continuous use of NSAIDs may help slow disease progression in ankylosing spondylitis.

Answer 3

True. Several studies suggest that, in contrast to most forms of arthritis. NSAIDs are recommended as first-line treatment in ankylosing spondylitis and remain important in management throughout the course of disease. Patients with ankylosing spondylitis are more likely to respond to NSAIDs and to do so more rapidly and completely than patients with chronic low back pain from other causes.

Question 4

S’il y a persistance des sx malgré AINS en spondylite ankylosante (atteinte axiale), quelle est la 2e ligne de traitement ?

Answer 4

Inhibiteurs de TNF-a

MTX n’a pas d’effet a/n axial et effet limité a/n périphérique.

Question 5

Quel est le DMARD le plus utilisé en arthrite psoriasique (léger, périphérique)?

Answer 5

MTX
Although benefit can be demonstrated in control of skin disease and joint pain, MTX has not been shown to reduce progression of joint damage. Sulfasalazine and leflunomide can also improve joint symptoms.

Question 6

Quel agent utiliser en arthrite psoriasique sévère ou axial (et ayant effet prouvé pour diminuer progression des dommages articulaires) ?

Answer 6

Inhibiteurs de TNF-a
The biologic agents ustekinumab (anti-IL-12/23 antibody) and secukinumab (anti-IL-17A antibody) have also been approved for treating both psoriasis and psoriatic arthritis, and can improve dactylitis and enthesitis.

Question 7

En quoi consiste le traitement de l’arthrite réactive ?

Answer 7

• Traitement de l’infection indiqué si cause identifiable; cependant, majorité se présente en post-infection, et donc ATB habituellement inefficace pour traiter arthrite.
• Majorité ont maladie auto-limitée —> AINS court terme améliore souvent sx ad résolution.
• Si soulagement incomplet —> injection glucocorticoïdes IA + corticos PO.
• Si sx > 3-6 mois: DMARDs (sulfasalazine, MTX, inhibiteur de TNF-a) pour contrôler sx et prévenir érosion.
  
  • Cesser traitement 3-6 mois après rémission de la maladie.

Question 8

Quels agents infectieux sont associés à l’arthrite réactive ? (7)

Answer 8

GU: Chlamydia Trachomatis, Ureaplasma urealyticum
GI: Shigella, E. Coli, Salmonella, Yersinia, Campylobacter

Question 9

Germe #1 en arthrite septique a/n articulation native ou prothétique (même germe) ?

Answer 9

S. Aureus

Question 10

Germe #1 en ostéomyélite et arthrite septique chez patient ayant anémie falciforme ?

Answer 10

Salmonella

Question 11

Quels sont les 2 sd communs de l’arthrite gonococcique ?

Answer 11

1. Triade polyarthralgies migratrices (sans arthrite purulente), lésions vésiculo-pustuleuses, ténosynovites.
2. Arthrite purulente sans lésions cutanées (nécessite ATB + long).

Question 12

Quelles sont les indications de débuter traitement hypouricémiant en goutte ? (6)

Answer 12

Arthropathie goutteuse (ex: érosions) [même si jamais de flare]
Goutte tophacée (même si jamais de flare)
> 2 attaques/an
1 épisode de goutte ET
- IRC st 3 et +
- Urolithiase
- Acide urique > 535

Question 13

Association anticorps (au ENA) et maladie
Anti-histone

Answer 13

Lupus médicamenteux

LED

Question 14

Association anticorps (au ENA) et maladie
Anti-RNP

Answer 14

MCTD (nécessaire pour dx)

LED

Question 15

Association anticorps (au ENA) et maladie
Anti-Ro (SSA)

Answer 15

Bloc cardiaque congénital, lupus cutané congénital

Sjögren

Question 16

Association anticorps (au ENA) et maladie
Anti-La (SSB)

Answer 16

Sjögren