Spondyloarthopathies

Question 1

Axial Arthropathies

Answer 1

Ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, colitic arthropathies

Question 2

Axial Arthropathy ? Genetic

Answer 2

HLA-B27 (= strongest disease assoc of any class I HLA)

Question 3

Do reactive/ psoriatic / colitic arthritis have HLA-B27 assoc?

Answer 3

Only w/ spondylitis

Question 4

Axial Arthropathy ? hallmarks

Answer 4

axial arthritis, peripheral arthritis, mucocutaneous lesions, enthesitis, HLA-B27

Question 5

Axial Arthropathy ? Pathology

Answer 5

enthesitis and synovitis, macs, CD4/8 T cells, cytokines (TNF-a, IL-17, TGF-b), no synovial pannus

Question 6

Axial Arthropathy ? Treatment

Answer 6

NSAIDs, steroid injections peripheral joints, sulfasalazine (peripheral), methotrexate (axial), anti-TNF agents

Question 7

AS ? S/S

Answer 7

Inflamm back pain (insidious >3 mo, prolonged morning stiffness, better w/ exercise, no neurologic)

Question 8

AS ? S/S, Phys Exam

Answer 8

SI joint tenderness, peripheral at hips/shoulders, spine lose ROM, synchondroses, (late) back deformities and reduced chest expansion

Question 9

AS ? S/S, extra-articular

Answer 9

Uveitis, Osteoporosis, colitis/Crohn’s, Pulmonary apical fibrosis, CV disease, (rare) cauda equina syndrome, (rare) amyloidosis

Question 10

AS ? Lab

Answer 10

Elev ESR, neg RF, neg ANA (i.e., seronegative)

Question 11

AS ? Radiographs

Answer 11

sacroiliitis w/ erosion and sclerosis, spondylitis w/ syndesmophytes, inflamm hip disease w/ fusion

Question 12

AS ? Incidence

Answer 12

M>F 7:3, onset 16-40 yo, caucasians more

Question 13

AS ? Pathophysiology

Answer 13

genetic (LA-B27, ERAP1, IL23R, IL-1R2, ANTXR2, gene deserts, RUNX3, IL12B, TNF assoc), environment (gut bacteria)

Question 14

AS ? HLA-B27 Theories

Answer 14

Arthritogenic peptide, Molecular Mimicry, Free heavy chain (homodimers ? NK cells), unfolded protein (ERAP-1, IL-23), inflamm-autoimmune-calcify (TNF-a, IL-17, TGF-b, BMP, WNT)

Question 15

AS ? Treatment

Answer 15

exercises and posture, no smoking (loss chest wall fxn)

Question 16

Reactive Arthritis ? S/S

Answer 16

Inflamm peripheral arthritis of esp LE, maybe axial also, Hx diarrhea (shigella, salmonella, yersinia, campylobacter) or urethritis (chlamydia)

Question 17

Reactive Arthritis ? S/S, Phys Exam

Answer 17

asymmetric, oligoarticular LE arthritis; dactylitis (sausage digit); enthesopathy; axial arthritis

Question 18

Reactive Arthritis ? S/S, extra-articular

Answer 18

inflamm eye (conjunctivitis, uveitis), mucocutaneous, rare (cardiac)

Question 19

Reactive Arthritis ? Lab

Answer 19

Elev ESR, neg RF, neg ANA (i.e., seronegative)

Question 20

Reactive Arthritis ? Radiographs

Answer 20

sacroiliitis asymmetric, spondylitis w/ large and non-marginal syndesmophytes (jug handle)

Question 21

Reactive Arthritis ? Incidence

Answer 21

M>F 5-10:1, onset childhood to 40-50 yo, caucasians more

Question 22

Reactive Arthritis ? HLA-B27 Theories

Answer 22

Arthritogenic peptide, Molecular Mimicry (Shigella/Chlam Ags resemble HLA-B27), Free heavy chain (homodimers ? NK cells), unfolded protein (ERAP-1, IL-23)

Question 23

Reactive Arthritis ? Pathophysiology

Answer 23

Immune response to bacterial Ags (hsp60) in joint, characterized by CD4/8 T cells, low Th-1 INF-g response, elev Th-2 IL-4/10 response (bacterial persistence)

Question 24

Reactive Arthritis ? Treatment

Answer 24

tetracycline, antibiotics (quinolone)

Question 25

Psoriatic Arthritis ? S/S

Answer 25

+/- peripheral arthritis of UE, esp DIP, PIP, MCP, asymmetric; +/- axial arthritis (like reactive arthritis)

Question 26

Psoriatic Arthritis ? Incidence

Answer 26

5-10% of psoriatic arthritis patients

Question 27

Colitic Arthritis ? S/S

Answer 27

axial arthritis of spine/SI joints (like AS)

Question 28

Colitic Arthritis ? Incidence

Answer 28

10-20% of IBD